This study was designed to determine if symptoms of delirium were mistaken for symptoms of depression in hospitalized patients referred for psychiatric consultation. Records were surveyed for all patients seen by a university hospital psychiatric consultation-liaison service for a 38-month period. Of 737 patients referred for depressive symptoms, 42 received a final diagnosis of delirium. Those patients with delirium tended to be older and were more likely to be male when compared with all patients referred for symptoms of depression. Given the grave prognostic implications of delayed or missed diagnosis, one needs to be aware that the presentation of delirium may be disguised as depression.