DIAGNOSIS CHECKLIST
for Delusions

Why: to determine if acute or chronic. If acute in nature must consider delirium or a new onset of psychiatric illness as a possible cause of delusion. Delirium is an acute confusional state due to many causes e.g. infection, drug intoxication, alcohol withdrawal, liver failure, kidney failure, hypoxia (reduced oxygen levels in the blood), low blood sugar, stroke, heart attack or head injury. If the onset is chronic a diagnosis of psychiatric illness or dementia may be more likely.

Why: delusions are false beliefs that are firmly held despite objective and contradictory evidence, and despite the fact that other members of the culture do not share the same beliefs.

Why: e.g. grandiose, nihilistic, delusion of reference.

Why: e.g. symptoms worse in the late afternoon and at night are typical of delirium.

Why: e.g. physical illness, recent surgery, starting a different medication, abstaining from alcohol.

Why: may suggest subdural haematoma, extradural haematoma or concussion.

Why: e.g. schizophrenia, bipolar affective disorder, paranoid disorder - may be sometimes difficult to differentiate between delirium and these disorders if delusions and hallucinations are present.

Why: certain medications may cause intoxication e.g. anticonvulsants, anticholinergics, anti-anxiety medications, opiates; or may cause delirium on drug withdrawal.

Why: e.g. high blood pressure, high cholesterol, diabetes, smoking, family history - can assess risk of multi-infarct dementia.

Why: e.g. Alzheimer's disease, Huntington's disease, multiple sclerosis, stroke, heart attack, schizophrenia, bipolar affective disorder and depression.

Why: to assess chance of alcohol withdrawal, alcohol abuse, Wernicke-Korsakoff syndrome, hepatic encephalopathy, subdural or extradural haematoma due to head injury.

Why: amphetamine, marijuana, cocaine, LSD, PCP may cause delirium and may also precipitate acute psychosis.

Why: may determine risk of HIV and syphilis infection which may cause cognitive impairment with confusion.

Why: e.g. carbon monoxide, chronic barbiturate intoxication, heavy metals such as mercury and manganese.

Why: include beliefs that you have special powers, are chosen by God, or have been sent to save the world. Such beliefs are particularly likely to occur in manic people, but are also found in schizophrenia, dementia and delirium.

Why: include the belief that you are losing your physical or mental functions due to disease, or that you are already dead. Such beliefs may occur in severe depression.

Why: include beliefs that events in the environment have special meaning for you and refer particularly to you. Such beliefs occur in a wide range of disorders, including depression, mania and schizophrenia.

Why: include beliefs that centre around the theme that you are being deliberately wronged, or conspired against, or harmed by another person or agency. Such beliefs are often associated with schizophrenia.

Why: belief, without good reason, that your partner is unfaithful. May be associated with Delusional disorder.

Why: may be present in schizophrenia, bipolar affective disorder, psychotic depression, paranoid delusional disorder, paranoid personality disorder, schizotypal personality disorder, brain damage, abuse of stimulant of hallucinogenic drugs, dementia and cultural isolation.

Why: false sensory perception in which you see, hear, smell, sense or taste something that other people do not see, hear, smell or taste. Auditory hallucinations may occur with schizophrenia, bipolar affective disorder, dementia or delirium, and their content tends to be related to the nature of the disorder. Visual hallucinations are most common with delirium.

Why: e.g. impaired memory, impaired judgement and thinking, impaired verbal fluency and impaired ability to perform complex tasks. Personality may change, impulse control may be lost and personal care deteriorates. People with dementia may also have psychiatric symptoms such as delusions, paranoid ideas, hallucinations, mood disturbance and behavioral disturbance.

Why: e.g. impaired conscious level with onset over hours or days, disorientation in time and/or place, unusually quite, drowsy, agitated, delusions, auditory hallucinations, visual hallucinations.

Why: e.g. sadness, crying spells, lack of interest in activities, poor energy, poor concentration and attention span, poor sleep, reduced libido, poor self esteem and sometimes suicidal thoughts. In severe depression may also have delusions of guilt, self-blame, poverty, infestation and infection and reflect the low self-esteem and hopelessness for the future which are characteristic of that mood.

Why: can suggest any infection that may cause delirium or meningitis, encephalitis, brain abscess or brain hemorrhage.

Why: e.g. limb weakness or paralysis, facial muscle weakness or paralysis, difficulty with speech and swallow - may suggest delirium as cause of delusions.

Why: may suggest brain cancer or acute stroke.

Why: e.g. delusions, hallucinations and disordered thinking - may suggest schizophrenia or bipolar disorder but these symptoms may also be present with delirium, dementia and severe depression.