Psychotic states of mania are characterized by greater pressure of speech, more open hostility, severe agitation, no need for sleep, flight of thoughts, severe distractibility, and grandiose delusions. In younger people psychotic mania is often misdiagnosed as schizophrenia. (30)
In hospital the increased social contact of manic patients is clearly different from the emotional bluntness of schizophrenics. The intrusive behaviour seen in severe mania is of an extremely dominating and manipulative nature, out of context with the setting. Secondary persecutory delusions often develop. The expansive religious delusion 'hearing God' should be differentiated from the schizophrenic patient's religious hallucinations.
Both DSM-IV and ICD-10 differentiate between mood-congruent psychotic symptoms (such as grandiose delusions of religion and voices supporting the patient's superhuman powers) and mood-incongruent psychotic symptoms (which are often the secondary delusions of persecution mentioned above).
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