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Delirium due to medical illness — RCPSC EM MCQ

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HardPsychiatric emergenciesDelirium due to medical illnessRCPSC EM

A 58-year-old with no psychiatric history develops abrupt paranoia, visual hallucinations and fluctuating attention over one day. What is the most appropriate initial diagnostic approach?

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Correct answer: EAssess urgently for medical delirium and reversible organic causes

The best answer is “Assess urgently for medical delirium and reversible organic causes”. New, acute and fluctuating psychotic symptoms in later life are more likely to have a medical cause than a new primary psychotic disorder. Evaluate for delirium, infection, intoxication or withdrawal, metabolic disturbance and neurological disease before assigning a psychiatric diagnosis. A normal glucose is useful but does not rule out the broad organic differential.

Reference: Emergency Care BC: Acute Psychosis—Diagnosis: https://emergencycarebc.ca/clinical_resource/clinical-summary/acute-psychosis-diagnosis/