“What do you need?” she asked her son who was in a bizarre state of psychosis. “Solidarity,” he replied. He needed unity of self, unity of family. He was coming apart, having disorganized thoughts, drifting away from the person he had always been.
For many years, a person with psychosis was diagnosed with schizophrenia. Today the mental health professionals know that psychotic features are not limited to schizophrenia. People in acute stages of mania and depression also can experience psychosis.
The following are symptoms of schizophrenia that can also be characteristic of psychosis in depression and mania.
DELUSIONS: These are disturbances in thought involving the misinterpretation of perceptions and experiences. These false beliefs usually have a theme of one or more of the following: persecution, religion, feelings of being cosmically important.
HALLUCINATIONS: Most commonly, hallucinations involve hearing one or several voices which make a running comment on the person’s behavior and thoughts. The voices are perceived as distinct from the person’s own thoughts, and are often experienced as critical or threatening. Hallucinations can also occur in the other senses (bizarre interpretations of sight, smell, taste, and touch).
DISORGANIZED SPEECH: This is totally illogical thinking as evidenced in the person’s speech. Answers to questions may be totally unrelated or severely disorganized (incoherence, “word salad,” loose associations).
GROSSLY DISORGANIZED OR CATATONIC BEHAVIOR: Disorganized behavior ranges from childlike silliness and inappropriate reactions, to totally unpredictable agitation. There are problems in goal directed behavior and great difficulties in performing the activities of daily living. Behavior is often strangely disturbed (posturing, grimacing), appearance disheveled, with frequent untriggered agitation, particularly swearing, shouting, and negativism. Catatonic motor behaviors involve a marked decrease in reacting to the environment (stupor, muteness, rigidity), or excessive, purposeless motor activity (catatonic excitement).
NEGATIVE SYMPTOMS; These appear as affective flattening or blunting (face is immobile, unresponsive, expressionless); difficulty expressing oneself (short, empty replies, lack of fluency); inability to initiate and persist in goal-directed activity; little interest in participating in work and social activities; inability to relate to others.
All of these characteristics do not have to be present to constitute a psychotic state.
When psychosis strikes, it is difficult to reason with the person on the basis of shared understanding. This will frustrate the family member’s efforts to aid and assist their ill loved one.
It is important to know that these delusions and hallucinations are real to the person in psychosis. It is futile to argue with them about their perceptions; however, there are some actions one can take to help or avoid the potential for disaster. The idea is to reverse any escalation of the psychotic symptoms and provide immediate protection and support to the individual with the mental illness. There will be more on this next month.