Delirium Vs. Psychosis: Symptoms, Similarities, And Differences

Delirium and psychosis are two different conditions that can have similar symptoms. These similarities may cause challenges in differentiating between the two. In this article, we’ll explore the similarities and differences between delirium and psychosis.

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What is delirium?

Delirium symptoms

While each case is unique, a person with delirium may experience any of the following symptoms: 

• Memory difficulties
• Drowsiness
• Fatigue
• Disorientation
• Lethargy
• Changes in sight or hearing
• Confusion
• Difficulty concentrating
• Hallucinations 
• Lack of interest in one’s environment 
• Delusions
• Sensitivity to sounds and light and other sensory stimuli 

Types of delirium 

The symptoms that occur during delirium may change depending on the type of delirium one experiences and whether an individual is partaking in certain behaviors that can worsen delirium. These types include the following: 

• Hypoactive delirium: Those with hypoactive delirium may primarily experience reductions in energy or activity. This type can cause people to “feel out of it” or dazed, which may make it more difficult for them to communicate with medical professionals or members of their families. 
• Hyperactive delirium: Hyperactive delirium often presents with restlessness, rapid changes in mood, delusions, and hallucinations. Those with this type of delirium may move around frequently due to excess energy and may be resistant to care. 
• Mixed delirium: Individuals experiencing mixed delirium may have both hyperactive and hypoactive symptoms. They may switch between these states rapidly, alternating between restlessness and sluggishness. 

Depending on the type of delirium a person is experiencing, it may be easy to mistake this mental state for other disorders or conditions, such as psychosis. 

What is psychosis, and what are its risk factors? 

Psychosis is a collection of symptoms that may affect a person’s ability to perceive reality. Estimates tell us that every year between 15 to 100 people out of 100,000 develop psychosis. While the majority of people who develop psychosis are between their late teens to mid-20s, people of any age can experience psychosis, and some groups (including older adults living with a neurological disorder) may have a higher risk of developing psychosis.

Psychosis is associated with many different conditions and situations, including:

• Having a family history of psychosis 
• High levels of stress or anxiety long-term
• Sleep deprivation
• Mental health disorders like schizophrenia and bipolar disorder    

Psychosis symptoms

Symptoms of psychosis can vary depending on what mental illness, condition, or situation is causing a person’s psychosis. Symptoms of psychosis may include: 

• Difficulty thinking clearly
• Social withdrawal and isolation
• Sleep disruptions
• Difficulty maintaining personal hygiene
• Paranoia
• Changes in speech
• Discomfort in social situations
• Difficulty speaking 
• Racing thoughts
• Lack of motivation
• Changes in mood
• Unusual behavior

In addition, individuals with psychosis may experience hallucinations and delusions. Hallucinations may involve sensory experiences that impact a person’s sense of sight, hearing, taste, smell, or touch. For example, a person may see a deceased relative in their home and converse with them. 

Contrarily, delusions relate to what a person with psychosis believes. These beliefs are typically not based on reality and are difficult to sway. For instance, a person experiencing delusions may think that a celebrity is controlling their thoughts or that a government entity is persecuting them. They may become agitated when others try to convince them otherwise. 

Delirium vs. psychosis: How are they connected? 

Research suggests that delirium may cause psychotic symptoms. Delirium psychosis can cause delusions, hallucinations, and disordered thoughts, despite delirium being potentially excluded from the definition of mental disorders and psychotic disorders like schizophrenia, depression with psychotic features, and mania. Delirium and psychosis can also have several symptoms in common, which may make it difficult to tell the two states apart. 

Further research indicates that disorganized psychosis may be commonly mistaken for delirium. In a 2022 scientific article, researchers addressed this challenge by looking at four conditions with similar presentations to delirium—disorganized psychosis, delirious mania, catatonia, and Ganser syndrome. 

The researchers found that the disorganization of behaviors and thoughts present in disorganized psychosis can be mistaken for the sensory and behavioral dysregulation one typically sees in delirium. To distinguish these conditions, psychiatric professionals may benefit from administering a detailed delirium evaluation and differential diagnosis to determine whether someone is experiencing pseudo-delirium or delirium. It can also be crucial to check the diagnostic criteria of various conditions and states in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) by the American Psychiatric Association. 

Delirium vs. psychosis diagnosis: How can you tell delirium and psychosis apart? 

While a diagnosis can only be provided by a mental health or medical professional, there are ways to tell delirium and psychosis apart. One method is to observe how a person perceives and connects with themselves and their environment, as well as the risk factors they may have for mental health challenges.

Individuals experiencing delirium are often in an acute-onset state of confusion and disorientation that may not be present in those with psychosis. While psychosis may make it challenging to organize one’s thoughts, other symptoms can be experienced with a level of clarity. For example, some people living with psychosis may be sure of what they are seeing when experiencing hallucinations or be sure of what they are thinking when experiencing delusions.

Delirium also typically occurs temporarily or in response to a specific medical event, while psychosis may reoccur regularly. However, some individuals may have conditions that induce multiple instances of delirium, further complicating diagnosis and treatment.

How are delirium and psychosis treated? 

The treatments for delirium and psychosis can vary, depending on what is causing an individual to experience these conditions. For example, delirium may be related to temporary events or stimuli, such as alcohol withdrawal or reactions to medications. Other forms of delirium may relate to illnesses such as dementia. In those cases, treating the root cause may also treat an individual’s delirium.

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Contrarily, psychosis may be treated with a combination of medications (such as antipsychotic medications) and therapy. Because primary psychiatric disorders are among the most common risk factors for psychosis and perceptual disturbances, there are many options available to treat symptoms. Several forms of treatment may be effective, including but not limited to the following modalities. 

Art therapy

Art therapies can allow individuals with psychosis to increase their awareness of their condition by expressing themselves through various artistic mediums. This form of therapy may also help someone communicate what they are experiencing with friends and family while also connecting with other individuals who are experiencing psychotic symptoms (in the case of group therapy settings). 

Family intervention therapy

Family intervention therapy may involve not only the person experiencing psychosis but also their parents, partners, siblings, and friends. These sessions can allow those around the person with psychosis to express their feelings and needs. In addition, family therapy sessions can provide a space to discuss how to support a loved one with psychosis and coping methods that may help the entire family. 

Are you concerned about delirium or psychosis?

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Talk therapy to improve mental status or reduce symptoms of mental health disorders

While several forms of talk therapy may be effective, cognitive-behavioral therapy for psychosis (CBTp) may be designed to address the specific challenges of a psychotic episode. CBTp can help individuals understand the connection between their thought patterns and behaviors. Once this understanding is established, a therapist may help the person shift these patterns and alleviate the discomfort of their symptoms.

Online therapy is an effective treatment for people experiencing symptoms of psychosis

While therapy is often associated with in-person sessions, today, there are different ways to attend sessions with a licensed therapist. For example, some people may not live close enough to a specialist or have reliable transportation to reach their provider. Others may prefer to attend sessions from home or through other formats like live messaging, phone calls, and video chats. With online therapy, you can explore a range of treatment formats, such as online therapy through a video call. 

Research suggests that technology-based interventions (TBIs) may be effective in treating psychosis. In a 2022 meta-analysis, 58 studies were reviewed to compare TBIs to face-to-face interventions. Each intervention was assessed based on its impact on neurocognition, social cognition, and functioning. Researchers found that TBIs effectively managed symptomatology, neurocognition, social cognition, functioning, and quality of life outcomes.