Fit and exclusions
Start with the deciding signal, then test chronology, competing explanations, and the effect on diagnostic wording.
- Delusions or hallucinations are clearly present during the mood episode.
- The content, conviction, and behavioural impact have been assessed rather than inferred from severe worry or guilt.
- The longitudinal relationship between mood and psychosis is documented.
- Unusual thoughts retain insight and do not reach delusional intensity.
- Psychosis persists outside mood episodes in a way that suggests a different primary diagnosis.
- Assess command content and immediate risk
- Map psychosis against mood chronology
- Describe congruence without forcing it
- “I know I have ruined everyone”
- “A voice says I deserve punishment”
- “I have a special mission”
Escalate assessment and treatment intensity; document safety, capacity, and the mood–psychosis timeline.