Delirium is a serious disturbance in mental abilities that results in confused thinking and reduced awareness of the environment. The start of delirium is usually rapid — within hours or a few days

Delirium can often be traced to one or more contributing factors, such as a severe or chronic illness, changes in metabolic balance (such as low sodium), medication, infection, surgery, or alcohol or drug intoxication or withdrawal.

Poor thinking skills (cognitive impairment)

This may appear as:

  • Poor memory, particularly of recent events
  • Disorientation — for example, not knowing where you are or who you are
  • Difficulty speaking or recalling words
  • Rambling or nonsense speech
  • Trouble understanding speech
  • Difficulty reading or writing

Behavior changes

These may include:

  • Seeing things that don’t exist (hallucinations)
  • Restlessness, agitation or combative behavior
  • Calling out, moaning or making other sounds
  • Being quiet and withdrawn — especially in older adults
  • Slowed movement or lethargy
  • Disturbed sleep habits
  • Reversal of night-day sleep-wake cycle

Emotional disturbances

These may appear as:

  • Anxiety, fear or paranoia
  • Depression
  • Irritability or anger
  • A sense of feeling elated (euphoria)
  • Apathy
  • Rapid and unpredictable mood shifts
  • Personality changes

What Is a Psychotic Disorder?

Psychotic disorders are a group of serious illnesses that affect the mind. They make it hard for someone to think clearly, make good judgments, respond emotionally, communicate effectively, understand reality, and behave appropriately.

When symptoms are severe, people with psychotic disorders have trouble staying in touch with reality and often are unable to handle daily life. But even severe psychotic disorders usually can be treated.


There are different types of psychotic disorders, including:

Schizophrenia: People with this illness have changes in behavior and other symptoms — such as delusions and hallucinations — that last longer than 6 months. It usually affects them at work or school, as well as their relationships. Know the early warning signs of schizophrenia.

Schizoaffective disorder: People have symptoms of both schizophrenia and a mood disorder, such as depression or bipolar disorder. Learn more about the symptoms of schizoaffective disorder.

Schizophreniform disorder: This includes symptoms of schizophrenia, but the symptoms last for a shorter time: between 1 and 6 months. Find out more on schizophreniform disorder symptoms to look for.

Brief psychotic disorder: People with this illness have a sudden, short period of psychotic behavior, often in response to a very stressful event, such as a death in the family. Recovery is often quick — usually less than a month. Get more information about the different forms of brief psychotic disorder.

Delusional disorder  The key symptom is having a delusion (a false, fixed belief) involving a real-life situation that could be true but isn’t, such as being followed, being plotted against, or having a disease. The delusion lasts for at least 1 month. Read more on the types of delusions.

Shared psychotic disorder (also called folie à deux): This illness happens when one person in a relationship has a delusion and the other person in the relationship adopts it, too. Learn more about shared psychotic disorder and how it develops.

Substance-induced psychotic disorder: This condition is caused by the use of or withdrawal from drugs, such as hallucinogens and crack cocaine, that cause hallucinations, delusions, or confused speech. Find out more on substance-induced psychosis and other causes of secondary psychosis.

Psychotic disorder due to another medical condition: Hallucinations, delusions, or other symptoms may happen because of another illness that affects brain function, such as a head injury or brain tumor.

Paraphrenia: This condition has symptoms similar to schizophrenia. It starts late in life, when people are elderly.

Delusional Disorder and Addiction to Alcohol

Delusional disorder, also known as paranoia disorder, is a relatively uncommon condition. Delusional disorder patients have delusions but do not have hallucinations, mood or thought disturbances, or any primary signs of mental illnesses such as schizophrenia.

These delusions are also another type of insanity in which a person believes that something has happened, ( will happen or is happening) that is not true. These delusions are often delusional – for example, the individual might believe they are being watched. Delusional disorder does not necessarily make it difficult for a person to act normally, but it has the potential to do so. Delusional disorder is divided into many subtypes.

Disregard for others

People with antisocial personality disorder may express their disregard for others and for the law by destroying property, harassing others, or stealing. They may deceive, exploit, con, or manipulate people to get what they want—whether it be money, power, sex, or personal gratification. They may use an alias to accomplish their goals.

People with this disorder do not often feel remorse or guilt for what they have done. They may rationalize their actions by blaming those they hurt (for example, by thinking they deserved it) or the way life is (for example, by thinking that it is unfair). They are determined not to be pushed around and to do what they think is best for themselves at any cost; this attitude may stem from pervasive mistrust of others.

People with antisocial personality disorder lack empathy for others and may be contemptuous of or indifferent to the feelings, rights, and suffering of others.

Family interventions in psychosis

Approximately 40 per cent of people who present with psychosis also misuse substances at some stage of their life (NICE, 2011). Substance misuse in families is associated with additional stresses and burdens, including increased conflicts and abuse; disrupted routines and communication; financial pressures; criminal justice involvement; isolation and emotional problems (Orford et al., 2010). As a service-user explained, ‘a normal lifestyle isn’t possible, it’s a constant battle. People end up not eating, staying up all night, borrowing or stealing money or even sex working to fund use.’

Dissociative Identity Disorder

Dissociative Identity Disorder

Dissociative identity disorder is associated with overwhelming experiences, traumatic events and/or abuse that occurred in childhood. Dissociative identity disorder was previously referred to as multiple personality disorder.

Symptoms of dissociative identity disorder (criteria for diagnosis) include:

  • The existence of two or more distinct identities (or “personality states”). The distinct identities are accompanied by changes in behavior, memory and thinking. The signs and symptoms may be observed by others or reported by the individual.
  • Ongoing gaps in memory about everyday events, personal information and/or past traumatic events.
  • The symptoms cause significant distress or problems in social, occupational or other areas of functioning.

In addition, the disturbance must not be a normal part of a broadly accepted cultural or religious practice. As noted in the DSM-51, in many cultures around the world, experiences of being possessed are a normal part of spiritual practice and are not dissociative disorders.

Dissociative identity disorder (DID)

Dissociative identity disorder (DID), previously known as multiple personality disorder(MPD), is a mental disorder characterized by the maintenance of at least two distinct and relatively enduring personality states. The disorder is accompanied by memory gaps beyond what would be explained by ordinary forgetfulness.

Mental health professionals recognise four main types of dissociative disorder, including:

  • Dissociative amnesia.
  • Dissociative fugue.
  • Depersonalisation disorder.
  • Dissociative identity disorder.

Atlas of Personality, Emotion and Behaviour

The Atlas of Personality, Emotion and Behaviour[113] is a catalogue of 20,500 words descriptive of personality, emotion and behaviour. The words in the catalogue were scored according to a two dimensional matrix taxonomy with orthogonal dimensions of affiliation and dominance. Adjectives representing the behavioural patterns described by the Dark Triad were scored according to the atlas and visualised using kernel density plots in two dimensions. The atlas clearly delineates the three components of the Dark Triad, narcissism (green), Machiavellianism (blue), and psychopathy (red).

Clausewitz, On War

A prince or general who knows exactly how to organise his war according to his object and means, who does neither too little nor too much, gives by that the greatest proof of his genius.

But the effects of this talent are exhibited not so much by the invention of new modes of action, which might strike the eye immediately, as in the successful final result of the whole.

It is the exact fulfilment of silent suppositions, it is the noiseless harmony of the whole action which we should admire, and which only makes itself known in the total result.—

 Clausewitz, On War, Book III, Chapter 1

Haltlose personality disorder

Haltlose personality disorder is an ICD-10 personality disorder[27] in which affected individuals possess psychopathic traits built upon short-sighted selfishness[20] and irresponsible hedonism, combined with an inability to anchor one’s identity to a future or past.[28][29] The symptoms of Haltlose share similarites with frontal lobe syndromesociopathic and histrionic personality traits,[28][30] and are characterized by a lack of inhibition[31] and “the immaturity of moral and volitional qualities…and the absence of positive ethical attitudes.”[32]

Described by Emil Kraepelin and Gustav Aschaffenburg in the early twentieth century as one of seven classes of psychopath,[33][34][35] and further distinguished by Karl JaspersEugen and Manfred Bleuler, it has been colloquially dubbed psychopathy with an “absence of intent or lack of will”.[3]

With other hyperthymics, Haltlose personalities were considered to make up “the main component of serious crime”,[21] and are studied as one of the strains of psychopathy relevant to criminology[36][37][38] as they are “very easily involved in the criminal history”[39] and may become aggressors[4][40] or homicidal.[41] A 2020 characterization of psychopathies noted of the Haltlose that “these people constantly need vigilant control, leadership, authoritarian mentor, encouragement and behavior correction” to avoid an idle lifestyle, involvement in antisocial groups, crime and substance abuse.[32][42] The marked tendencies towards suggestibility are off-set by demonstrations of “abnormal rigidity and intransigence and firmness”.[43]

After discovering a guilty conscience due to some act or omission they have committed, “they then live under constant fear of the consequences of their action or inaction, fear of something bad that might strike them” in stark opposition to their apparent carelessness or hyperthymic temperament,[44] which is itself frequently a subconscious reaction to overwhelming fear.[9] They frequently withdraw from society.[45] Given their tendency to “exaggerate, to embroider their narratives, to picture themselves in ideal situations, to invent stories”,[25] this fear then manifests as being “apt to blame others for their offences, frequently seeking to avoid responsibility for their actions”.[46] They do not hold themselves responsible for their failed life, instead identifying as an ill-treated martyr.[20]

They were characterized as Dégénérés supérieurs,[13] demonstrating normal or heightened intellect but degraded moral standards.[47] Of the ten types of psychopaths defined by Schneider, only the Gemutlose (compassionless) and the Haltlose “had high levels of criminal behavior” without external influence, and thus made up the minority of psychopaths who are “virtually doomed to commit crimes” by virtue only of their own constitution.[48] Frequently changing their determined goals,[9] a haltlose psychopath is “constantly looking for an external hold, it doesn’t really matter whether they join occult or fascist movements”.[49] The ability to moderate external influence was considered one of three characteristics necessary to form an overall personality, thus leaving Haltlose patients without a functional personality of their own.[50] A study of those with haltlose personality disorder concludes “In all of those cases, the result was a continuous social decline that ended in asocial-parasitic existence or an antisocial-criminal life”.[48][51][52]