- narrowest definition includes hallucinations and delusions (see below)
broader definitions include disorganized thought processes and loss of ego boundaries as well
- not being able to distinguish his or her own thoughts from the external world
- false sensory perceptions, with no external stimulus to sensory organs
- false belief or idea that is held firmly despite abundant evidence to the contrary
not delusional if other members of a culture believe likewise
most serious example of delusions is seen in schizophrenia
- quite unlikely and not based on usual life experiences
- delusion is theoretically possible (if extremely unlikely)
- disorganized thought process is often revealed by disorganized speech
common forms: flight of ideas, loosening of associations, circumstantiality, tangentiality, thought blocking, poverty of speech, preservation
Disorders where Psychosis is a Predominant Symptom
- all pretty uncommon
Brief psychotic disorder
sudden onset of psychosis, less than one month of symptoms, full return to function afterwards
could be brought on by overwhelming stress
can cause profound confusion and intense emotional turmoil; risk of suicide is increased
treat with antipsychotic medication
resembles schizophrenia but symptoms last only 1-6 months. Loss of social or occupational function is not required
good prognosis: acute onset, good premorbid function, full range of affect during illness, confusion during height of psychosis
Often will recur
; 1/3 will recover, 2/3 will go onto schizophrenia or schizoaffective disorder
treat with antipsychotic medication
combination of mood and psychotic symptoms; need two weeks of psychosis without mood symptoms; mood symptoms, however, have to be present in a substantial portion of the illness.
at least one month of a non-bizarre delusion
delusion is well-formed and internally consistent, but can adapt and expand to new circumstances with great rapidity
"ideas of reference" are common
- interpret random events and stimuli as having particular significance to the person, personalizing random events.
hallucinations may be present - auditory and visual hallucinations are brief, gustatory and olfactory can be prominent if consistent with delusion.
onset is middle age or later, remission occurs in 1/3 to ½ of cases.
- central theme is that another person (usually male) is in love with the person (usually female).
The delusional object is of higher status or fame than the patient, and the patient often persistently tries to communicate with the ‘lover’ by various means. Ideas of reference - patient finds small behaviors as "proof" of love. Violence may ensue if person becomes between him and lover. Ex. Dave Letterman’s stalker.
- person believes that he has made a great invention, has a unique ability, or is particularly important; ex. Field of Dreams - Kevin Costner
- othello syndrome; patient believes partner is unfaithful based on flimsy evidence. May restrict her activities. May end in violence. Ex. Othello
- patient believes he or she is a victim of organized conspiracy, thinks that they are being harassed, poisoned, maligned, cheated or spied on by government. Usually incited from a minor injustice, which gets totally exaggerated. Violence may ensue. Ex. Mulder from X-files
- Central theme revolves around bodily functions or sensations. Patients believe they are infested with insects, emit foul odor, or part of their body is not functioning. Close to hypochondriasis(which is not delusional because patient will admit the fact that there may not be a disease)
Shared Psychotic Disorder
- also known as ‘folie a deux’; one person develops delusion due to relationship with another seriously mentally ill patient. Dominant patient is schizophrenic or has delusional disorder and imposes delusion on partner. Submissive patient usually just needs time away from the dominant patient.
Other Diagnoses in Differential Diagnosis of Psychosis
Mood disorder with psychosis - severe depression and mania can present with psychosis
determined by history whether mood symptoms preceded psychosis; treat the mood disorder 1st, then psychosis
Substance-induced psychotic disorder
- direct physiological consequence of a drug, medication, or toxin
Can be intoxication (LSD, PCP, cocaine, cannabis, alcohol, amphetamines, hallucinogens, opiates); withdrawal (alcohol, sedatives, hypnotics); or toxicity (CO, organophosphates, volatile substances (paint, solvents, glues)
Psychotic disorder due to a General Medical Condition
distinct from delirium; can be neurologic (Huntington’s, epilepsy, migraine), endocrine, or autoimmune (lupus)