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Clinical manifestations, differential diagnosis, and initial management of psychosis in adults

Stephen Marder, MD
Michael Davis, MD, PhD
Section Editor
Murray B Stein, MD, MPH
Deputy Editor
Richard Hermann, MD


Psychosis is a condition of the mind broadly defined as a loss of contact with reality. It is estimated that 13 to 23 percent of people experience psychotic symptoms at some point in their lifetime, and 1 to 4 percent will meet criteria for a psychotic disorder [1,2].

Psychotic symptoms can increase patients’ risk for harming themselves or others or being unable to meet their basic needs. Most clinicians will encounter patients with psychosis and will thus benefit from knowing how to recognize psychotic symptoms and make appropriate initial evaluation and management decisions. Other clinicians, particularly mental health specialists, will conduct a more thorough patient assessment, consider the patient’s differential diagnosis, and determine the patient’s diagnosis to guide long-term treatment.

This topic will characterize different types of psychotic symptoms, provide guidance for formulating a differential diagnosis, and suggest initial evaluation and management practices. Issues related to antipsychotic medications, the treatment of specific disorders, and psychosocial interventions are discussed separately. (See "Second-generation antipsychotic medications: Pharmacology, administration, and side effects" and "First-generation antipsychotic medications: Pharmacology, administration, and comparative side effects" and "Schizophrenia in adults: Epidemiology and pathogenesis" and "Schizophrenia in adults: Clinical manifestations, course, assessment, and diagnosis" and "Pharmacotherapy for schizophrenia: Long-acting injectable antipsychotic drugs" and "Pharmacotherapy for schizophrenia: Acute and maintenance phase treatment" and "Psychosocial interventions for co-occurring schizophrenia and substance use disorder" and "Evaluation and management of treatment-resistant schizophrenia" and "Anxiety in schizophrenia" and "Depression in schizophrenia" and "Pharmacotherapy for schizophrenia: Side effect management" and "Brief psychotic disorder" and "Psychosocial interventions for schizophrenia".)


Psychosis can present with a wide variety of signs and symptoms [3], which are described below.

Delusions — Delusions are defined as strongly held false beliefs that are not typical of the patient’s cultural or religious background. They can be categorized as bizarre or non-bizarre based on their plausibility (eg, a belief that family members have been replaced by body-doubles is bizarre and a belief that a spouse is having an affair is non-bizarre). Frequently encountered types of delusions include:

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Literature review current through: Nov 2017. | This topic last updated: Aug 06, 2017.
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