What are the symptoms of a psychosis?

During a psychotic episode, individuals are unable to think clearly and reasonably, and lose touch with reality. A psychosis affects different people differently, but there are five main groups of symptoms that people can experience during a psychotic episode.

Thinking problems

During a psychotic episode, people may have difficulty concentrating and are unable to think clearly. Their thoughts may come and go very quickly, or their thinking might slow down and, in some cases, almost stop. Having a conversation with people experiencing a psychosis can be difficult, as they may jump from topic to topic, and sentences may not make sense. Sometimes they may talk strangely; they may make up new words, or they may use words just because they rhyme with each other. Some people may talk very little and usually people show some lack of insight into these things or any awareness that anything is wrong.

Delusions

It is common for a person experiencing a psychosis to have delusions. Delusions are false beliefs, held with total conviction, and not a normal part of the person's cultural or religious environment - i.e. not shared by other people from the same religious or cultural group. The person is firmly convinced of the truth of the delusion, and even the most logical discussion will not budge the false idea. Delusions are usually hard for family and friends to understand. Types of delusions are outlined below.

Persecutory delusions

These delusions are the most common, and usually the individual believes that he/she (or someone close) are being persecuted, spied on, tormented, or followed, e.g. the person might believe that a government agency is following him/her.

Referential delusions

These are also common delusions, and usually the individual believes that events, objects, the behaviour of others, or other information in the environment (such as television or radio content, songs, or billboards) contain messages which are specifically meant for him/her, e.g. the person might believe that the nightly weather forecast contains a special message, just for him/her and no one else.

Grandiose delusions

Individuals believe that they have extraordinary abilities or powers, or that they are somebody very important, e.g. related to royalty, or are friends with famous people. They may believe that they are chosen by God, or that they are very rich, or more powerful or more intelligent than other people.

Religious delusions

These delusions have a strong religious theme, e.g. the person may believe that he/she is receiving instructions from God.

Somatic delusions

Individuals believe that something odd is happening within their body, or that they have a disease, despite medical evidence that indicates that nothing is wrong. They may believe that a part of their body is missing, or has been changed in some way.

Delusions of control

Individuals believe that others are controlling their mind or body. People may believe that thoughts have been inserted into their mind by an external force, or they may believe that their private thoughts are being broadcast, so that others can hear them. Sometimes people believe that their thoughts are being removed or 'stolen' from their mind by an external force, and they may blame this on other people.

Depressive delusions

Here the sufferer is convinced that they are very bad or worthless people (and may even confess to crimes they have not committed). Guilt may be enormous over trivial or imagined errors. They may think their bodies are rotting or disappearing, or that they have no family or children or money (when they do have these things) or that there is only emptiness inside their head or body. Such delusions of 'having nothing' are often referred to as nihilistic delusions.

Hallucinations

A hallucination is when a person experiences a sensation of something that is not objectively present. Hallucinations can occur in all of the senses – hearing (auditory), seeing (visual), smelling (olfactory), touching (tactile) and tasting (gustatory), but the most common hallucinations are auditory. These forms of hallucinations are described briefly below:

Auditory hallucinations

When sound noises may be heard and may seem louder than normal or the person may hear different sounds such as footsteps or voices. When people hear voices, they sound so real that the person is convinced that they come from outside, e.g. from loudspeakers or from the spirit world. Sometimes the voices seem to be coming from inside the individual. The voices that are heard may be: frightening, threatening or critical; or they may be kind, comforting or neutral. Some voices command a person to do something; comment on what he/she is doing, or may repeat the person's thoughts. Sometimes the person may hear two or more voices having a conversation about them or several voices at once shouting or yelling at them. Voices may order the sufferer to do things and do so with compelling force - hence they are often termed 'command' hallucinations.

Visual hallucinations

If people experience visual hallucinations they may see things that are not there.

Olfactory (smelling) and gustatory (tasting) hallucinations

If a person experiences smelling or tasting hallucinations, things may smell or taste as if they are bad, contaminated, or poisoned.

Tactile (touch) hallucinations

In this kind of hallucination, people feel sensations that have not actually occurred, or experience sensations differently from the way they usually would, e.g. they may feel as though spiders are crawling over their skin, or that they are being touched.

Changes in behaviour

When people are experiencing a psychosis, they behave in ways that are different from the ways in which they would usually behave. Often they will lack motivation and will be very lethargic- wanting only to sit around.

People will often have trouble starting projects, or completing projects they have started. Individuals may not look after themselves as well as they usually do and may neglect their personal hygiene, or stop tidying up after themselves. Other individuals become very active, and seem unable to sit still.

People may also find it very difficult to manage their responsibilities such as work, their finances, or study. Sometimes people can behave recklessly, impulsively, aggressively, or may engage in inappropriate sexual behaviour.

Some of the other symptoms described above can also have an effect on behaviour, e.g. people experiencing a delusion that their food is contaminated they may not eat. Sometimes people may show unusual facial expressions, or may make the same movements repeatedly.

Movements, odd facial expressions or talking as if addressing someone who isn't there, are usually in response to hallucinations or delusions.

Changes in emotions

Frequently people who are experiencing a psychotic episode express emotions differently from the way they usually would. Some individuals seem to have trouble experiencing the usual range of emotions, and may speak in a flat, emotionless way. People who are experiencing a psychosis often see the world as uninteresting and can feel quite removed from people and their usual daily activities. People may also express emotions that don't fit the situation, e.g. they may laugh when describing a sad event. Mood swings can also occur, and people may feel very excited or depressed in a way that is not appropriate to their situation or environment. Such people are described as experiencing or showing emotional incongruity or incongruity of emotion.

Changes in understanding for people with a psychotic disorder

A difficulty grasping what is going on or changes in understanding are most often seen when people have a severe disease of the brain. People with these disorders may not understand fully what is said to them or appreciate the significance of a situation or event. The may have no awareness of the time, date or place they are in. They may often fail to know or recognize relatives and loved ones and, in severe cases, may not know who they themselves are.

Not all people will experience all of these symptoms, and the kind of symptoms experienced and their severity will vary from person to person. It is important for friends and family to remember that:

• experiencing psychotic symptoms is very distressing, scary and confusing;
• people do not choose to experience these symptoms;
• the symptoms are not signs of laziness, character flaws or weaknesses; and
• the symptoms are not a ploy to gain attention.

These symptoms are part of genuine psychiatric disorders that require immediate medical assistance.