Appendix B: Diagnosing Psychosis

Diagnosing Psychosis
SYNDROME	HISTORY	MENTAL STATUS	PHYSICAL FINDINGS
Delirium (Consult Chapter 3)	Acute onset (hours to days) Diagnosed medical illness Currently taking medications for medical illness Over age 40 and no previous psychiatric history	Stupor or lethargy Illusions Visual hallucinations Disorientation Memory impairment Sundowner's syndrome Impaired attention span Fluctuating symptoms	High blood pressure Sweating Rapid pulse Rapid breathing
Drug and alcohol Intoxication and withdrawal (Consult Chapters 4 and 5)	Acute onset (hours to days) Previous history of treatment for drugs or alcohol	Stupor and lethargy or agitation Visual hallucinations Tactile hallucinations Delusions	Alcohol odor on breath Needle tracks on arms Nasal septum erosion Ataxia Slurred speech Hyperreflexia Pupillary changes High blood pressure Sweating Rapid pulse Rapid breathing
Schizophrenia (Consult Chapter 6)	History of schizophrenia	Delusions Hallucinations (usually auditory) Disorganized, incoherent thinking Flat or inappropriate affect	Poor hygiene
Mania (Consult Chapter 6)	History of mania and depression	Elevated, expansive, or irritable mood Hyperactivity Flight of ideas Rapid, forceful speech Decreased need for sleep	Hoarse voice
Depression (Consult Chapter 9)	History of depression or mania Recent personal loss Sleep disturbance Loss of appetite Loss of sex drive	Somatic delusions Delusions of guilt Self-reproach Suicidal ideation Hopelessness	Weight toss Physical debilitation