Psychosis in delirium has been an underresearched area. The authors retrospectively examined the prevalence of psychotic symptoms and possible associated factors in the records of 227 consecutive hospitalized patients. These patients had been diagnosed with delirium, according to the DSM-IV criteria and referred to a psychiatry consult service. The authors compared patients, with or without psychosis, on demographic variables, medical and psychiatric history; number of medications, etiology of delirium, and cognitive state. The prevalence of psychotic symptoms was 42.7% (n = 97) with 27% of patients (n = 61) having visual hallucinations, 12.4% (n = 28) having auditory hallucinations, 2.7% (n = 6) having tactile hallucinations, and 25.6% (n = 58) having delusions. The presence of visual hallucinations, but not delusions or auditory hallucinations, was significantly associated with more active medical diagnoses and multiple etiologies causing the delirium. Psychotic symptoms are not uncommon in delirium, but specific psychotic symptoms may have different factors contributing to their development. Visual hallucinations appear to be associated with a greater number of active medical disorders, but other factors associated with the development of psychotic symptoms in delirium are currently unknown.