Psychosis is generally defined in terms of “positive” symptoms. “Positive” symptoms are those symptoms which manifest outwardly, including hallucinations, delusions and speech disorder (also referred to as thought disorder). Many people who experience psychosis also experience additional types of symptoms: mood symptoms (relating to moods and energy levels), abnormal movements and behaviors, “negative” symptoms (things that aren’t there now that that used to be), and cognitive symptoms (having to do with information processing). Below is a more detailed description of each type of symptom. Below is a more detailed description of each type of symptom.
Insight
It’s important to understand that people usually are aware of some symptoms but not others. This is in part because of the nature of the symptoms themselves. Think of the analogy of an optical illusion. Your brain perceives and interprets information, but the information is interpreted incorrectly because of the way your brain constructs the information. Only when someone points out the error and when you use tools such as a ruler to “reality test” your perception do you recognize that it is an optical illusion. Psychosis is very similar. The brain perceives and interprets information erroneously, but the person is unaware that this is happening. Certain symptoms such as distressing hallucinations, paranoia and anxiety are often perceived as problematic to the person. However, most people do not recognize them as medical symptoms, and many of the other symptoms are recognized primarily by other people. For this reason it is critical for close family members and others who are known and trusted by the individual to be involved in the assessment and ongoing treatment process. Part of the process of treatment is helping the person to learn to distinguish and differentiate symptomatic perceptions from normal perceptions.
Positive Symptoms
Hallucinations
Seeing, hearing or feeling things that others don’t. This can range from an intense experience of color, blurring or distortion of visual images, to hearing sounds or voices with no apparent source, and seeing or feeling objects or phenomena which others do not.
Speech/thought disorder
These are symptoms related to the person’s ability to communicate. The person may experience changes to their use of speech and the way they construct sentences. Examples include:
- Frequent changes of ideas, making little sense to others (circumstantiality, tangentiality, derailment, looseness of association, flight of ideas)
- Incoherent jumble of words (word salad)
- Choosing words based on sound, such as rhyming or punning (clang associations)
- Making up words which mean something only to the speaker (neologism)
- Echoing others’ words (echolalia)
Abnormal movements and behaviors
A person may develop odd behaviors, movements or mannerisms, or may become unable to move on their own (catatonia, waxy flexibility or posturing).
Delusions
False beliefs based on incorrect inferences about reality, inconsistent with culture, experience and previous beliefs, and held with conviction despite evidence to the contrary. Delusions can be caused by a variety of information processing dysfunctions, involving sensory input, memory, attention, and interpretation. Some common delusions:
- Delusions of reference: Belief that day-to-day events or experiences refer directly to you; for example, that the people on the TV set are talking directly to you, that street signs, license plates, or behaviors (such as coughing) carry communications specifically aimed at you.
- Delusions of grandeur: Belief that you are able to do things which are beyond normal capacity, such as fly or act as royalty.
- Persecutory delusions: Belief that others are trying to hurt you, for example, by poisoning you or through a conspiracy to cause you harm.
- Nihilistic delusions: Belief that you or others do not exist.
- Thought broadcasting: Belief that your thoughts can be read by others.
- Thought insertion: Belief that others are placing thoughts in your head.
- Thought withdrawal: Belief that one’s thoughts are being extracted from the mind.
- Thought control: Belief that feelings, thoughts and actions are not one’s own, experienced as being imposed by an external source.
Negative Symptoms
Mood symptoms
Depression
Predominant mood is depressed and there is a loss of interest or pleasure in nearly all activities for at least 2 weeks. Depression in its severe forms can cause psychosis. Depression can also be an early warning sign of psychosis for people who have schizophrenia.
Suicidal thoughts
It is important to know that many people who experience psychosis also experience suicidal thoughts, and the risk of suicide is significantly greater than for people who do not experience psychosis.
Mania
Period of time in which a person’s mood is elevated or irritable, there is a lack of restraint in behavior, and highs in energy, requiring little or no sleep. Severe mania can cause psychosis, or a person can have both mania symptoms and psychosis symptoms distinctly from each other.
Anxiety
Extreme anxiety is common with psychosis.
Cognitive symptoms
Most people who experience psychosis also experiences difficulty with memory, attention, and organization of thoughts. These symptoms may improve but often do not disappear completely with treatment for psychosis.