by Dr. Raymond Zakhari, FNP-BC, PMHNP-BC
If you or someone you love has been told they have psychosis, schizophrenia, or bipolar disorder, it can be overwhelming. But not all hallucinations, paranoia, or delusional thoughts come from a primary psychiatric illness. Many medical conditions, neurological disorders, and stress-related syndromes can mimic psychosis—and if the underlying cause is missed, the treatment may fail.
As a dual-certified primary care and psychiatric mental health nurse practitioner in New York City, I combine comprehensive medical evaluation with advanced psychiatric assessment. That means I can distinguish between psychiatric disease and medical causes of psychiatric symptoms—reducing misdiagnosis, avoiding unnecessary medications, and getting you on the most direct path to recovery.
🎥 Watch my full lecture to psychiatric mental health nurse practitioner students on this topic: Psychiatric Manifestations of Underlying Medical Conditions
Why accurate diagnosis of psychosis matters
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Preventing misdiagnosis — Many patients are labeled with schizophrenia or bipolar disorder when the real cause is a treatable medical or neurological condition.
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Preserving therapeutic trust — Taking symptoms seriously, even when they don’t fit the textbook profile, builds trust and keeps patients engaged in care.
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Targeted treatment — The right diagnosis leads to faster, more effective treatment—and often, complete resolution of symptoms.
Common medical causes of psychiatric symptoms
When someone presents with hallucinations, paranoia, or delusional thinking, a whole-body evaluation is critical. Common non-psychiatric causes include:
Neurological & Medical Disorders
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Autoimmune encephalitis
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Epilepsy or seizure disorders
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Traumatic brain injury or concussion
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Endocrine problems (thyroid disease, adrenal disorders)
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Vitamin deficiencies (B-12, folate, niacin)
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Sleep apnea and severe insomnia
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Infections (including UTIs in older adults)
Medication & Substance-Related
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Cannabis (especially high-potency THC)
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Stimulants (prescription or illicit)
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Steroids and certain antibiotics
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Alcohol withdrawal
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Herbal and nutritional supplements with neuroactive effects
Psychiatric conditions that can mimic or include psychosis
Borderline Personality Disorder (BPD)
Short-lived hallucinations or paranoid thoughts tied to interpersonal stress. Resolve once the stressor passes. These are real symptoms—responding best to skills-based therapy and emotional regulation.
Post-Traumatic Stress Disorder (PTSD)
Paranoia or voices directly tied to trauma memories, often surfacing during flashbacks or hyperarousal.
Eating Disorders
Fixed false beliefs about weight or food contamination. Sometimes complicated by malnutrition-related delirium.
Obsessive–Compulsive Disorder (OCD)
Intrusive, distressing thoughts that feel absolute and can resemble delusions.
Dissociative Disorders
Memory gaps, depersonalization, or identity confusion misread as psychosis.
Primary Psychotic Disorders
Schizophrenia spectrum or bipolar mania—considered only after excluding medical and substance-related causes.
How I evaluate psychosis in my practice
Because I’m trained in both primary care and psychiatry, your assessment is more complete than what you’d get from most psychiatric offices:
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Detailed symptom timeline — when episodes start, duration, and recovery pattern
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Medical screening — vital signs, targeted physical and neurological exam
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Laboratory & diagnostic testing — thyroid, B-12/folate, inflammatory markers, EKG, sleep studies, brain imaging if indicated
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Mental status exam — evaluating thought process, perception, and insight
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Collateral information — with your consent, gathering observations from family or close contacts
My treatment approach
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Treat the root cause — correcting medical issues, stabilizing sleep, and addressing inflammation before labeling a psychiatric disorder
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Therapy matched to diagnosis — trauma-focused therapy, DBT, OCD-specific interventions, or psychosis-focused CBT
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Precise medication use — lowest effective dose, short-term if possible, with a plan to taper as the underlying issue resolves
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Clear documentation — protecting you from future misdiagnosis and ensuring coordinated care with other providers
When to seek urgent help
If you or a loved one is experiencing severe disconnection from reality, command hallucinations to harm self or others, or is unable to care for basic needs, call 988 or go to the nearest emergency department immediately. We can resume thorough outpatient care once safety is established.
Schedule a confidential consultation in NYC or via telehealth
Whether you’ve just received a psychiatric diagnosis or you’ve been struggling with symptoms that don’t quite fit, I can help you find clarity.
📍 In-person visits — discreet office in NoMad (1115 Broadway, Suite 1244 NY, NY 10010) or at-home psychiatry house calls in Manhattan
💻 Secure telehealth — available to New York residents
Contact Dr. Raymond Zakhari at Psychiatry House Calls to schedule your evaluation.