A 22 year old boy was all alright 2 days back. But since then he claims that people are abusing him and he c/o hearing of voices when no one is around, aggressive behavior since 2 days. He has fever since only 2 days. No past history. Which is the most likely diagnosis?
**Core Concept**
Acute psychosis is a condition characterized by a sudden onset of loss of contact with reality, often involving hallucinations, delusions, and disorganized thinking or behavior. This can be caused by a variety of factors, including psychiatric disorders, medical conditions, substance use, or withdrawal.
**Why the Correct Answer is Right**
The patient's symptoms of hearing voices when no one is around, aggressive behavior, and the onset of these symptoms over a short period suggest a sudden and severe disruption in mental status. Acute psychosis is a condition where the individual loses touch with reality, often experiencing hallucinations (in this case, hearing voices) and delusions. The presence of fever, although mild, could be a contributing factor to the acute onset of psychosis. The sudden onset and severity of symptoms, combined with the lack of past medical history, make acute psychosis the most likely diagnosis.
**Why Each Wrong Option is Incorrect**
**Option A:** Dementia is a chronic and progressive condition, often associated with older adults, characterized by a decline in cognitive function. The patient's age and acute onset of symptoms make dementia an unlikely diagnosis.
**Option C:** Delirium is a condition characterized by a sudden and fluctuating disturbance in mental status, often associated with a medical condition, medication, or substance use. While delirium can present with similar symptoms, the patient's lack of past medical history and the presence of fever make acute psychosis a more likely diagnosis.
**Option D:** Delusion is a specific type of thought disorder, where an individual holds a fixed, false belief despite evidence to the contrary. While delusions can be a component of acute psychosis, the term delusion alone does not capture the full range of symptoms and the sudden onset of the condition.
**Clinical Pearl / High-Yield Fact**
When assessing a patient with acute psychosis, it is essential to consider potential underlying medical conditions, substance use, or withdrawal as contributing factors. A thorough medical history, laboratory tests, and a psychiatric evaluation can help identify the underlying cause and guide treatment.
**✓ Correct Answer: B. Acute psychosis**