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Presentation comparison
Urgent4 of 8 diagnoses compared
| CriteriaComparison detail | DeliriumEmergency |
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Inattention and fluctuating awareness are the key separators; psychotic content is often fragmentary.
Clinical reference — not validated decision support. Review before use.
| Dementia with Lewy bodiesUrgent |
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| AlzheimerUrgent |
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| Medication toxicityUrgent |
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| Sensory impairmentUrgentNot selected |
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| Late-life psychotic depressionUrgentNot selected |
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| Very-late-onset schizophrenia-like psychosisUrgentNot selected |
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| StructuralUrgentNot selected |
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| Why it fits | Abrupt hallucinations, paranoia, behavioural change, sleep reversal, fluctuation | Visual hallucinations, fluctuation, parkinsonism, dream enactment, antipsychotic sensitivity | Paranoia, theft beliefs, jealousy, disinhibition, progressive cognitive decline | New confusion/hallucinations/paranoia after medication changes, polypharmacy | Visual/auditory phenomena with major sight/hearing loss, partially preserved insight | Severe depression with guilt/nihilism/psychosis, or activation with reduced need for sleep | Late-onset persecutory beliefs, partition delusions, preserved cognition | Late-onset/atypical psychosis with headache, seizures, focal signs, rapid progression |
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| What argues against | Applies to the whole presentationReview locally. | |||||||
| Must-not-miss | Sepsis, hypoxia, stroke, haemorrhage, urinary retention, faecal impaction, medication toxicity | Severe antipsychotic sensitivity, falls, autonomic instability, NMS | Rapid decline, focal neurology | |||||
| Bedside question | Applies to the whole presentationInattention and fluctuating awareness are the key separators; psychotic content is often fragmentary. | |||||||
| Immediate action | Applies to the whole presentationAcute change in an older person is delirium until proved otherwise Lewy body disease is a classic trap in late-life psychiatry | |||||||
| Investigations | Applies to the whole presentationGuided by presentation. | |||||||
| Mimics / overlap | Applies to the whole presentationReview overlap locally. | |||||||
Scroll horizontally to review more candidate differentials. Clinical reference — not validated decision support. Review before use.
Review locally.
Inattention and fluctuating awareness are the key separators; psychotic content is often fragmentary.
Acute change in an older person is delirium until proved otherwise Lewy body disease is a classic trap in late-life psychiatry
Guided by presentation.
Review overlap locally.
Abrupt hallucinations, paranoia, behavioural change, sleep reversal, fluctuation
Sepsis, hypoxia, stroke, haemorrhage, urinary retention, faecal impaction, medication toxicity
Visual hallucinations, fluctuation, parkinsonism, dream enactment, antipsychotic sensitivity
Severe antipsychotic sensitivity,
Paranoia, theft beliefs, jealousy, disinhibition, progressive cognitive decline
Rapid decline, focal neurology,
New confusion/hallucinations/paranoia after medication changes, polypharmacy
Based on current selection
Create a concise comparison summary for documentation or handoff.
Source pending review
v10 | Local content only
Last updated: Pending review
Open a selected differential to review its clinical record.
Based on current selection
Create a concise comparison summary for documentation or handoff.
Source pending review
v10 | Local content only
Last updated: Pending review
| Anticholinergic delirium, steroid mania/psychosis, opioid toxicity, falls, urinary retention |
| Occult delirium, dementia, true psychosis, elder abuse misread as paranoia |
| High suicide risk, refusal of intake, mixed state, dangerous mania |
| Missed sensory impairment, dementia, medication toxicity, elder abuse |
| Tumour, stroke, encephalitis, autoimmune encephalitis, temporal lobe epilepsy |