Acute psychosis

Fearful, suspicious, internally preoccupied, command-driven pacing/guarding/aggression

EmergentReview due

Compare (8)

At a glance

High-risk causes: 8
Immediate actions: 5
Related differentials: 8

Safety snapshot

Watch forViolenceself-harmfood/fluid refusalfirst-episode medical psychosis red flagsWeaponscommand voices

Presentation hinge

Subjective bodily torment and urge to move dominate. Mood or psychosis may be absent.

Separates the Psychomotor Agitation group. It is not specific to Acute psychosis.

Points for this presentation

Applies to the Psychomotor Agitation group — not specific to Acute psychosis

Violence in psychosis is often defensive from perceived threat
Mixed irritability is easy to underestimate
One of the commonest reversible drivers of acute violence
Agitation in dementia is frequently delirium, pain, or environment-driven

Clinical review

Rows marked “Whole group”: Applies to the Psychomotor Agitation group — not specific to Acute psychosis

Why it fits

Fearful, suspicious, internally preoccupied, command-driven pacing/guarding/aggression

Key features2 features

Paranoia, internal preoccupation, threat misinterpretation
Aggression is often fear- or belief-driven rather than predatory.

Must-not-miss

Violence, self-harm, food/fluid refusal, first-episode medical psychosis red flags.

High-risk causes8 causes

Violence
self-harm
food/fluid refusal
first-episode medical psychosis red flags
Weapons
command voices
victim-specific delusions
severe disorganisation

Bedside question

Applies to the Psychomotor Agitation group.

Subjective bodily torment and urge to move dominate. Mood or psychosis may be absent.

Helpful clues1 clue

Aggression is often fear- or belief-driven rather than predatory.

Immediate action

Applies to the Psychomotor Agitation group.

Violence in psychosis is often defensive from perceived threat Mixed irritability is easy to underestimate One of the commonest reversible drivers of acute violence Agitation in dementia is frequently delirium, pain, or environment-driven Recognising the interpersonal trigger can prevent the next escalation

Priority steps5 steps

1Violence in psychosis is often defensive from perceived threat
2Mixed irritability is easy to underestimate
3One of the commonest reversible drivers of acute violence
4Agitation in dementia is frequently delirium, pain, or environment-driven
5Recognising the interpersonal trigger can prevent the next escalation

Investigations

Applies to the Psychomotor Agitation group.

None listed

Core tests

Mimics / overlap

Applies to the Psychomotor Agitation group.

None listed

Consider

Clinical reference — not validated decision support. Review before use.