Symptoms of Psychosis

The main feature is the presence of psychotic symptoms- i.e. hallucinations/delusions.  These are different from mood disorders in that they are qualitatively different from normal rather than quantitively different.

The symptoms of psychosis can also be split into two main groups:

  • Positive symptoms– an excess or distortion of ‘normal’

e.g. Delusions

In schizophrenia, these are commonly persecutory, thought interference or passivity delusions.

Hallucinations

In SZD, these are commonly auditory 3rd person narrative, thought echo/discussion and/or persecutory

Formal though disorder

A loss of the normal flow of thinking as shown through writing/speech.  Commonly a feature associated with thought broadcasting, thought insertion, thought withdrawal etc.

  • Negative symptoms– decrease or loss of normal function

Loss of motivation/spontaneous behaviour; flattened mood, blunting of affect and anhedonia; poverty of thought/speech.

Self-referential experiences

Belief that external events are related to oneself.  They can vary in intensity from a brief thought to frequent and intrusive thoughts to delusional intensity (self-referential delusions or delusions of reference).  E.g. others are speaking/laughing about me; the tv/radio are transmitting informatioin for me; the car registration contains coded messages for me.

In psychosis, there is a general lack of insight– i.e. the patient does not recognise that this is abnormal.

Schneider’s First Rank Symptoms of SZD

  • Auditory hallucinations- 3rd person- arguing/discussing, running commentary or thought echo
  • Passivity phenomenon– may have thought alienation (insertion/withdrawal/broadcasting)
  • Delusional perception- a fully formed delusion which arises from a real/genuine perception
    • e.g. the door closed so the FBI must be holding me here

NB must be in the absence of organic impairment or psychoactive drug use and must last >1 month (otherwise a psychotic episode).  The presence of one or more of these symptoms is positive evidence for a diagnosis of SZD (BUT 20% of mania will present with one too).

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