Psychosis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]


Psychosis must be differentiated from, Apparitional experience, delusional disorder, monothematic delusions, Jerusalem syndrome,clinical lycanthropy,soteria, hallucinations in the sane.

Differential Diagnosis

According to the DSM, psychosis can be a symptom of mental illness, but it is not a mental illness in its own right. For example, people with schizophrenia often experience psychosis, but so can people with bipolar disorder (manic depression), unipolar depression, delirium, or drug withdrawal.[1][2] People diagnosed with these conditions can also have long periods without psychosis. Conversely, psychosis can occur in people who do not have chronic mental illness (e.g. due to an adverse drug reaction or extreme stress).[3]

Psychosis should be distinguished from insanity, which is a legal term denoting that a person is not criminally responsible for his or her actions.[4]

Psychosis should be distinguished from psychopathy, a personality disorder associated with violence, lack of empathy and socially manipulative behavior.[5] Despite both being colloquially abbreviated "psycho", psychosis bears little similarity to the core features of psychopathy, particularly with regard to violence, which rarely occurs in psychosis,[6][7] and distorted perception of reality, which rarely occurs in psychopathy.[8]

Psychosis should also be distinguished from delirium. A psychotic individual may be able to perform actions that require a high level of intellectual effort in clear consciousness, whereas a delirious individual will have impaired memory and cognitive function.

Psychosis should further be distinguished from neurosyphilis, which presents as hallucinations, delusions, auditory hallucinations, and flat or blunted affect and emotion, poverty of speech (alogia), anhedonia, and lack of motivation.[9]


  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth edition - Text Revision (Published by the American Psychiatric Association, 2000).
  2. Tsuang, Ming T. (2000). "Toward Reformulating the Diagnosis of Schizophrenia". American Journal of Psychiatry. 157 (7): 1041–1050. PMID 10873908. Retrieved 2006-08-19. Unknown parameter |month= ignored (help); Unknown parameter |coauthors= ignored (help)
  3. Jauch, D. A. (1988). "Reactive psychosis. I. Does the pre-DSM-III concept define a third psychosis?". Journal of Nervous and Mental Disease. 176 (2): 72–81. PMID 3276813. Unknown parameter |coauthors= ignored (help); Unknown parameter |month= ignored (help)
  4. Jacobson J.L. and A.M. Jacobson, eds. Psychiatric Secrets (Philadelphia: Hanley and Belfus, 2001)
  5. Hare, R. D. Psychopathy and Antisocial Personality Disorder: A Case of Diagnostic Confusion, Psychiatric Times, February 1996, XIII, Issue 2 Accessed June 26, 2006
  6. Milton, John (2001). "Aggressive incidents in first-episode psychosis". British Journal of Psychiatry. 178: 433–440. PMID 11331559. Retrieved 2006-10-21. Unknown parameter |month= ignored (help); Unknown parameter |coauthors= ignored (help)
  7. Foley, Sharon R. (January 1, 2005). "Incidence and clinical correlates of aggression and violence at presentation in patients with first episode psychosis". Schizophrenia Research. 72 (2–3): 161–168. doi:10.1016/j.schres.2004.03.010. PMID 15560961. Retrieved 2006-10-21. Unknown parameter |coauthors= ignored (help); Check date values in: |date= (help)
  8. Nestor, Paul G. (2002). "Psychosis, Psychopathy, and Homicide: A Preliminary Neuropsychological Inquiry". American Journal of Psychiatry. 159 (1): 138–140. PMID 11772704. Retrieved 2006-10-21. Unknown parameter |month= ignored (help); Unknown parameter |coauthors= ignored (help)
  9. Friedrich F, Geusau A, Greisenegger S, Ossege M, Aigner M (2009). "Manifest psychosis in neurosyphilis". Gen Hosp Psychiatry. 31 (4): 379–81. doi:10.1016/j.genhosppsych.2008.09.010. PMID 19555800.

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