Psychotic Disorders

Symptomatology

Psychotic disorders comprise literally scores of symptoms, many of which have a variety of distinct manifestations. The symptoms are not specific and occasionally can be observed in other disorders, including cognitive disorders and mood disorders. Psychotic symptoms can be categorized into four broad categories, according to functional domain.

Disturbances of Cognition. These can be divided into disturbances of thought content (i.e., what a person thinks or talks about) versus disturbances of thought form (i.e., the way in which a person thinks or speaks). Symptoms related to thought content include delusions (beliefs held with certainty that are demonstrably false and culturally abnormal) and ideation (overvalued beliefs). Specific symptoms that occur with some frequency include thought insertion (others are placing thoughts in the person's head), thought withdrawal (thoughts are being taken out of the person's head), thought broadcasting (others can hear the person's thoughts), misidentification (others are impersonating the person's loved ones), and thoughts of reference (ordinary occurrences have a special meaning or were arranged just for the person). Disturbances of thought content are often characterized according to thematic content (e.g., persecutory, grandiose, erotomanic, jealous, somatic, or nihilistic) or according to whether they are bizarre (strange and impossible, totally implausible), fixed (stable over time), and systematized (complex and internally coherent).

[Page 651]Symptoms related to thought form include loose associations (jumping quickly from topic to topic), tangentiality (keeps wandering off the topic), circumstantiality (speech is only indirectly relevant to the topic being discussed), derailment (loses track of the topic completely), perseveration (keeps returning to the same topic), thought blocking (abruptly stops talking), neologisms (makes up new words), clanging (speech is full of rhymes), pressured speech (talks quickly and loudly), incoherence (speech is unintelligible), and echolalia (repeating words spoken by others).

Disturbances of Perception. These also can be divided into two major types. First, hallucinations are sensations in the absence of an external stimulus. They may occur in any sensory modality. The most common are auditory (e.g., hearing voices that other people can't hear, often several people conversing in negative terms with or about the person or telling the person what to do) and visual (e.g., seeing things that other people can't see, such as lurking strangers, ghosts, or visions). Second, depersonalization and derealization are abnormalities in perception of self and the environment, respectively. Depersonalization often involves “out-of-body” experiences (e.g., people perceive that their minds have left their bodies and are floating around the room or that they no longer have control over the movement of their own bodies). Derealization, in contrast, often involves the perception that the outside world is unreal or a sham (e.g., other people are automatons).

...