Usually chronic, internally generated but experienced as alien, embedded in broader psychotic syndrome.
Helpful clues1 clue
Inattention and fluctuation dominate. Psychotic content is often fragmented or changeable.
Immediate action
Applies to the Hallucinations group. Whole group
In older or medically unwell patients, assume delirium until proved otherwise Cannabis and stimulants can closely mimic primary psychosis Reassess once partially cleared Escalate early to medical/neurology review if red flags are present Consider MRI, EEG, CSF, and autoimmune testing when the syndrome is atypical Clarify positive symptoms, negative symptoms, cognition, and functional trajectory
Priority steps8 steps
1Do not just ask "any voices" — clarify form, content, controllability, conviction
2Prominent visual or tactile hallucinations widen the toxic/organic differential
3Acutely unwell or older patients with new hallucinations need a delirium lens first
4Think Lewy body dementia early when visual hallucinations and fluctuation coexist
5In older or medically unwell patients, assume delirium until proved otherwise
6Cannabis and stimulants can closely mimic primary psychosis
7Reassess once partially cleared
8Escalate early to medical/neurology review if red flags are present