Medication toxicity

New confusion/hallucinations/paranoia after medication changes, polypharmacy

UrgentReview due

Compare (7)

At a glance

High-risk causes: 5
Immediate actions: 4
Related differentials: 6

Safety snapshot

Anticholinergic delirium, steroid mania/psychosis, opioid toxicity, falls, urinary retention.

Watch forAnticholinergic deliriumsteroid mania/psychosisopioid toxicityfalls

Presentation hinge

Inattention and fluctuating awareness are the key separators; psychotic content is often fragmentary.

Separates the Older-Adult First-Presentation Psychosis Traps group. It is not specific to Medication toxicity.

Points for this presentation

Applies to the Older-Adult First-Presentation Psychosis Traps group — not specific to Medication toxicity

Acute change in an older person is delirium until proved otherwise
Lewy body disease is a classic trap in late-life psychiatry
The medication list is one of the highest-yield late-life investigations
Even modest recent changes or cumulative burden can precipitate delirium

Clinical review

Rows marked “Whole group”: Applies to the Older-Adult First-Presentation Psychosis Traps group — not specific to Medication toxicity

Why it fits

New confusion/hallucinations/paranoia after medication changes, polypharmacy

Key features

Must-not-miss

Anticholinergic delirium, steroid mania/psychosis, opioid toxicity, falls, urinary retention.

High-risk causes5 causes

Anticholinergic delirium
steroid mania/psychosis
opioid toxicity
falls
urinary retention

Bedside question

Applies to the Older-Adult First-Presentation Psychosis Traps group.

Inattention and fluctuating awareness are the key separators; psychotic content is often fragmentary.

Helpful clues

Immediate action

Applies to the Older-Adult First-Presentation Psychosis Traps group.

Acute change in an older person is delirium until proved otherwise Lewy body disease is a classic trap in late-life psychiatry The medication list is one of the highest-yield late-life investigations Even modest recent changes or cumulative burden can precipitate delirium

Priority steps4 steps

1Acute change in an older person is delirium until proved otherwise
2Lewy body disease is a classic trap in late-life psychiatry
3The medication list is one of the highest-yield late-life investigations
4Even modest recent changes or cumulative burden can precipitate delirium

Investigations

Applies to the Older-Adult First-Presentation Psychosis Traps group.

None listed

Core tests

Mimics / overlap

Applies to the Older-Adult First-Presentation Psychosis Traps group.

None listed

Consider

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