Presentations

Safety cues

• Delirium
• Substance intoxication
• Substance withdrawal

Safety cues

• Catatonia in mood disorder
• Catatonia in psychotic disorder
• Hypoactive delirium

Safety cues

• Bipolar I mania
• Hypomania
• Mixed state

Safety cues

• Postpartum psychosis, Postnatal depression, Perinatal OCD / intrusive infant-harm thoughts
• CLINICAL HINGE: Psychotic or manic syndrome with abrupt change from baseline in the postpartum period.

Safety cues

• Akathisia, Bipolar mania / mixed state, Acute psychosis
• CLINICAL HINGE: Subjective bodily torment and urge to move dominate. Mood or psychosis may be absent.

Safety cues

• Catatonia, Psychotic depression / severe melancholic depression, Hypoactive delirium
• CLINICAL HINGE: Motor syndrome with characteristic catatonic signs. Not simply very depressed or non-engaging.

Safety cues

• Antipsychotic adverse effects
• Clozapine-specific adverse effects / toxicity
• SSRI / SNRI adverse effects

Safety cues

• Anorexia nervosa, Bulimia nervosa / binge-purge pattern, ARFID
• CLINICAL HINGE: Weight/shape psychopathology is the key psychological discriminator.

Safety cues

• Alcohol
• Cannabis
• Methamphetamine / stimulant

Safety cues

• Alcohol withdrawal
• Benzodiazepine withdrawal
• Opioid withdrawal

Safety cues

• Major depressive disorder
• Bipolar depression / mixed state
• Psychosis-driven suicidality

Safety cues

• Acute psychosis
• Mania / mixed state
• Substance intoxication or withdrawal

Safety cues

• Schizophrenia-spectrum delusions, Delusional disorder, Paranoid personality disorder / overvalued suspiciousness
• CLINICAL HINGE: Often fixed, systematised, accompanied by hallucinations, thought disorder, or negative symptoms.

Safety cues

• Major depressive disorder, Bipolar depression, Persistent depressive disorder
• CLINICAL HINGE: Sustained mood syndrome with guilt, hopelessness, reduced energy, impaired concentration, change in sleep/appetite.

Safety cues

• Schizophrenia, Mania, Delirium
• CLINICAL HINGE: Formal thought disorder plus broader psychotic syndrome and functional deterioration.

Safety cues

• Delirium / medical psychosis
• Substance-induced psychosis
• Autoimmune encephalitis / autoimmune psychosis

Safety cues

• Review must-not-miss causes

Safety cues

• Review must-not-miss causes

Safety cues

• Schizophrenia-spectrum disorder
• Substance-induced hallucinations
• Delirium

Safety cues

• Akathisia
• Drug-induced parkinsonism
• Acute dystonia

Safety cues

• Borderline personality disorder, Bipolar disorder, Cyclothymia / subthreshold bipolarity
• CLINICAL HINGE: Shifts are reactive, brief, and relationship-linked rather than sustained episodic elevation with reduced need for sleep.

Safety cues

• Delirium, DLB/Parkinson disease dementia, Alzheimer/vascular/FTD with psychosis/behavioural change
• CLINICAL HINGE: Inattention and fluctuating awareness are the key separators; psychotic content is often fragmentary.

Safety cues

• Major depressive disorder, GAD/panic, PTSD/hyperarousal/nightmares
• CLINICAL HINGE: Sleep disturbance sits inside a broader syndrome. Reduced need for sleep is one of the most decisive bipolar bedside clues.

Safety cues

• PTSD, Complex PTSD, Dissociative disorder
• CLINICAL HINGE: Trauma-linked clusters dominate and often worsen with reminders.

Safety cues

• Panic disorder, Generalised anxiety disorder, OCD
• CLINICAL HINGE: Abrupt peak over minutes, recurrent unexpected attacks, anticipatory anxiety or avoidance.

Safety cues

• Delirium, Alzheimer disease, Lewy body dementia / Parkinson disease dementia
• CLINICAL HINGE: Acute and fluctuating with inattention = delirium (medical/toxic cause).

Safety cues

• Somatic symptom disorder, Illness anxiety disorder, Functional neurological symptom disorder
• CLINICAL HINGE: Driven by excessive time, energy, and distress around symptoms, not by symptoms being fake.

Safety cues

• Schizophrenia negative syndrome, Depression, Dementia / neurocognitive disorder
• CLINICAL HINGE: Chronicity and psychosis history support primary negative symptoms.

Safety cues

• Borderline PD, Narcissistic PD, Antisocial PD
• CLINICAL HINGE: Interpersonal sensitivity, fear of abandonment, identity disturbance, recurrent dysregulation.

Safety cues

• Autism spectrum disorder, Intellectual disability, ADHD
• CLINICAL HINGE: Developmental onset and restricted/repetitive or sensory features are central.

Safety cues

• Psychosis-related poor insight, Mania/hypomania, Adverse-effect-driven non-adherence
• CLINICAL HINGE: Altered reality testing drives refusal rather than simple preference.