THE DIFFERENTIAL DIAGNOSIS OF PSYCHOTIC DISORDERS

This meta‑analysis evaluates the adverse‑effect profiles of risperidone, olanzapine, aripiprazole, zuclopenthixol and beta‑blockers within the diagnostic landscape of psychotic disorders. It emphasises the critical distinction between primary psychiatric illness and medical mimics, especially alcohol‑withdrawal delirium, alcohol‑induced psychosis, Wernicke‑Korsakoff syndrome, and electrolyte‑imbalance encephalopathies. Pharmacogenomic factors—including polymorphisms in COMT, DRD4, BDNF, RGS2, CNR1, and CYP enzymes—that modulate drug response, side‑effect risk, and vulnerability to substance‑induced psychosis are integrated. The evidence shows that antipsychotics carry substantial reproductive, metabolic, and neurological toxicity, and that their use in undifferentiated acute presentations often perpetuates an iatrogenic cycle of dopamine‑supersensitivity psychosis. Beta‑blockers emerge as a safer alternative for managing somatic symptoms of anxiety and akathisia, with a minimal side‑effect burden and no reproductive or metabolic risk. The analysis calls for a fundamental shift in acute psychiatric practice: differential diagnosis must precede medication, pharmacogenetics should inform treatment, and the principle of the least restrictive alternative must be upheld.