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The very nature of delirium is a fluctuant course: ie. the disorder changes along the same day: worse when the light is less, or there is less stimulation. It maybe characterized by hallucinations especially visual and those maybe frightening in case of delirium tremens (a disorder occurring to those who use alcohol for may years and suddenly stop for any reason. : that maybe why it may be misdiagnosed as a psychosis where the hallucinations occur in clear consciousness.
A key feature to distinguish is to test for attention. An easy way to do that is to ask the person to count from 1 to 10 and then backwards. If person is able to do it, then attention is intact.
Psychosis is a very broad term. Some scientists especially for researc purposes consider the term to be equal to: having delusions and hallucinations. There are other schools that consider an individual psychotic if their judgment is impaired, have no insight, are not functioning in the absence of a physical disability that may prevent their functioning. Detachment from reality is a term used to encompass a broad range of behaviors and experiences, that include but are not confined to experiencing hallucinations and delusions.
Psychosis maybe organic: ie. caused by a tangible, measurable, disorder that can be proved by investigations, eg blood samples, EEGs, CT and MRI, ...etcOr it maybe functional as in schizophrenia or mood disorders.
Psychosis may occur over and above a dementing process. Alzheimer's disease (the most commonly diagnosed dementia nowadays) may have superimposed psychosis (and delirium)
It is necessary to add that the demracation between functional and organic is becoming hazy. Everything now maybe viewed from a "biological" perspective. Attempts are being made to identify the disorders through measurable and tangible investigations eg. MRS, SPECT, PET.
Psychosis or delirium that comes and goes hourly or daily can be caused by conditions such as substance intoxication, medication side effects, metabolic imbalances, or infections affecting the brain. It is important to consult a healthcare professional for a proper evaluation and treatment.
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