ABSTRACT
Psychotic disorders need to be recognized when patients with these present to the emergency department. This chapter outlines the common causes, presentations, and management of this group of disorders. Most states of intoxication are usually not difficult to diagnose, but intoxications from alcohol, cannabis, cocaine, and amphetamines can mimic the delusions, paranoia, hallucinations, and agitation caused by de-compensated psychotic illnesses. The majority of children/adolescents displaying "psychotic" behavior are likely to be delirious because of drug-induced states, and sometimes, physical illness such as cerebral tumors, lobar pneumonia, encephalitis, seizures, and electrolyte abnormalities. Children and adolescents may develop other psychotic disorders, such as delusional disorders, but these are rare. Instances of amok may occur among individuals with pre-existing psychotic disorders, during a brief psychotic episode, or may represent the onset or exacerbation of a chronic psychotic process. As a diagnosis-by-exclusion, schizophrenia must be distinguished from the numerous psychiatric and organic disorders that can lead to psychotic disturbances in thinking and behavior.
