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Delirium misdiagnosed as psychosis — ABEM Board MCQ

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ModeratePsychiatric emergenciesDelirium misdiagnosed as psychosisABEM Board

A 47-year-old woman presents as triage level 2 with new paranoia and visual hallucinations. She is febrile, inattentive, tachycardic, and unable to recite months backward. Urinalysis is positive for infection. Which of the following is the most appropriate initial action?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Treat as delirium from medical illness and evaluate for sepsis

New psychotic symptoms with inattention, fever, and abnormal vitals should be presumed delirium due to medical illness until proven otherwise.

Reference: ACEP Clinical Policy: Psychiatric Patient; ABEM EM Model