Narrative Review. This page provides the verified citation, abstract, and full-text PDF for the journal article.
Clinical boundary: New or atypical psychosis, fluctuating consciousness, neurological signs, catatonia, severe behavioral change, or immediate risk may require urgent medical and psychiatric assessment. This page cannot establish a cause.
Publication Details
- Author: Christian Jonathan Haverkampf
- Journal: The Journal of Psychiatry Psychotherapy and Communication
- Publication date: 2025-06-30
- Volume, issue, pages: 14(2), 41–50
- Article type: Narrative Review
Recommended citation: Haverkampf, C. J. (2025). Misdiagnosis of Psychosis: Differential Diagnosis, Medical Causes, and Diagnostic Safety. The Journal of Psychiatry Psychotherapy and Communication, 14(2), 41–50.
Abstract
Psychosis is a syndrome rather than a single disease entity, and its causes range from primary psychotic disorders to mood, substance-related, neurological, autoimmune, endocrine, developmental, trauma-related, and culturally mediated presentations. Diagnostic error occurs in both directions: a schizophrenia-spectrum diagnosis may be assigned prematurely, or clinically important psychotic phenomena may be minimized, attributed too narrowly, or mistaken for culturally normative experience. This narrative review examines diagnostic safety in first and atypical presentations, emphasizing collateral chronology, physical and neurological examination, hypothesis-led investigation, toxicology when indicated, medication and substance timelines, and longitudinal reassessment. Abrupt onset, fluctuating attention or consciousness, autonomic instability, seizures, focal neurological signs, abnormal movements, catatonia, or unexpected cognitive change should heighten concern for a secondary medical or neurological cause. Because first-episode diagnoses vary in stability, early formulations should remain provisional when evidence is incomplete. Racial disparities in schizophrenia diagnosis also support systematic assessment of mood, trauma, culture, language, and service context. Communication should validate distress without either aggressively disputing a belief or affirming unverified content. The review proposes that diagnostic safety is a longitudinal process with four linked tasks: precise description of psychotic phenomena, proportionate investigation of high-consequence alternatives, treatment of immediate risk without overstating etiological certainty, and scheduled revision against the observed course. Diagnostic uncertainty becomes clinically useful only when it is explicit and tied to investigation, treatment, and review.
Keywords
psychosis; differential diagnosis; first-episode psychosis; misdiagnosis; delirium; autoimmune encephalitis; substance-induced psychosis; provisional diagnosis; diagnostic safety
Full Text
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Website copy first made available on 26 August 2026. The journal citation retains the article’s issue date.