Psychotic Disorders

Abstract

Introduction Psychotic spectrum disorders include schizotypal personality disorder, delusional disorder, brief psychotic disorder, schizophreniform disorder, schizophrenia, and schizoaffective disorder. The core symptoms that are indicative of psychosis include: • Delusions are fixed, false beliefs that do not change with the presentation of conflicting evidence. They can often have various themes, including persecutory (belief that one will be harmed or harassed by another person or group), referential (belief that certain cues are directed at the individual), grandiose (belief that the person has exceptional abilities, wealth, fame), erotomanic (belief that another individual is in love with them), nihilistic (belief that a catastrophe will occur), and/or somatic (preoccupation with health and symptoms). Delusions can also be o Bizarre, or clearly impossible or implausible, or o Non-bizarre, or beliefs that are plausible but have a lack of evidence. Thought insertion, thought withdrawal, or ideas of reference are considered delusions. • Hallucinations are a false perception that occurs without an external stimulus (in contrast to an illusion, which is a misinterpretation by the brain of a real external stimulus). They can occur in any of the sensory modalities, but auditory are most common, followed by visual hallucinations. • Disorganized thinking and speech is another common feature, which can be observed typically during evaluation by what the patient says and how he responds to questions. Patients may switch quickly between topics in a seemingly illogical manner, or may give odd, unrelated answers to questions. In extreme situations, loose associations or word salad can be seen. • Psychosis can also manifest with grossly disorganized or abnormal motor behavior, which can range from childlike behaviors to agitation. Behavior can be very unpredictable, and can also include catatonic behaviors. These changes in behavior can lead to difficulty in completing ADL’s. Catatonia can include a range of behaviors characterized by decreased activity, including negativism (resistance to instructions), to rigid posturing, to mutism (lack of verbal response). • Negative symptoms can also be seen, with diminished emotional expression (reductions in expression of emotion in the face, eye contact, speech, movements of hand/head/face that normally give emotional emphasis in speech), and avolition (decrease in motivated self-initiated and purposeful activities). Anhedonia (diminished ability to experience pleasure) and alogia (diminished verbal output) can also be seen.