schizophrenia; (ii) brief psychotic episode; and (iii) mood, anxiety, or trauma disorders Developmental and cultural factors contribute to the difficulty in accurately diagnosing psychosis Hallucinations can be seen in various normal developmental conditions and cultural and religious beliefs, taken out of context may be misconstrued as psychotic symptoms Patients with new onset or sudden change in psychotic symptoms need careful evaluation for underlying medical conditions in addition to psychiatry consultation Clinical Recognition: Psychosis due to a Medical Condition Psychosis caused by medical conditions indicates that the underlying etiology is known, and resolution depends on improvement in the underlying medical problem Psychiatrically based psychoses, in contrast, are those in which specific medical causes have not yet been determined Differentiating between medical and psychiatric psychoses can be difficult Certain features of the history and physical and mental status examinations are often helpful ( Table 126.23 ) Psychosis caused by medical conditions includes acute or chronic illnesses, trauma, or intoxications with an exogenous substance ( Tables 126.24 to 126.26 ) Patients with psychosis due to a medical condition often present in an agitated, confused state The patient’s orientation to time and place is often disturbed; they may be highly distractible, with significant disturbance of recent memory Evidence of bizarre and distorted thoughts is apparent, and disconnected ideas may be juxtaposed The child may have significant difficulty controlling behavior and has little regard for personal safety Intellectual functioning may also be impaired Visual and/or tactile hallucinations may be present Auditory hallucinations are less common in medically based psychoses As a result of impaired reality testing, these patients are often extremely difficult to control and may strike out at family or staff when attempts are made to control their behavior A thorough history and physical examination is essential looking for underlying disease A complete medical history helps determine whether the psychosis is a concomitant feature of an already existing chronic illness (e.g., lupus cerebritis), a result of medication or toxin exposure, elevated intracranial pressure, seizure, trauma, or infections No specific features of the mental status examination differentiate the various causes of psychosis