Psychosis: Types of Hallucinations and Thought Disorders

Schizophrenia and Psychosis

• Visual hallucinations: less common in schizophrenia, more common in chemically induced psychosis
• Olfactory hallucinations: rare, unpleasant odors
• Tactile hallucinations: common in alcohol delirium psychotic disorder, e.g. being touched
• Gustatory hallucinations: unpleasant tastes
• General somatic hallucinations: feelings of body being mutilated or seriously injured, e.g. bugs crawling inside veins

Disorganized Thinking and Speech

• Formal thought disorder: manifested as disorganized speech
• Symptoms:
  • Shifts from one topic to another (derailment)
  • Little connections in thoughts (loose association)
  • Responses to questions not exactly related or completely unrelated (tangential)
  • Incomprehensible and resembles receptive aphasia in its linguistic disorganization (incoherence or "word salad")
• Impairs communication
• Affected by sensitivity to dominant associations to words and less by context

Disorganized Behavior

• Grossly disorganized or abnormal motor behavior
• Variety of manifestations: childlike laughing aloud, unpredictable agitation, poor hygiene, wearing inappropriate clothes or excess clothing
• Catatonic behavior: most bizarre of all disorganized behaviors, less common due to medication, can occur in several disorders, including neurodevelopmental, psychotic, bipolar, depressive

Catatonia

• Marked decrease in reactivity to the environment
• Symptoms:
  • Resistance to instructions (negativism or opposition)
  • Lack of movement, frozen like (stupor)
  • Lack of communication (mutism)
  • Allowing to be placed in uncomfortable position (waxy flexibility)
• Can also manifest as purposeless and excessive motor activity without obvious cause (catatonic excitement)
• Stereotyped movements, staring, grimacing, and echoing of speech

Negative Symptoms

• A reduction in normal behavior
• Usually appear before positive symptoms
• Associated with schizophrenia
• Less manifested in other psychotic disorders
• Two prominent negative symptoms in schizophrenia:
  • Diminished emotional expression: blunted, flattened affect, lack of facial expression, monotonous voice, emotionally unresponsive
  • Avolition: lack of energy and interest in activities, without engagement

Personality Disorders

• Cluster A: Odd or eccentric
  • Paranoid PD: pattern of distrust and suspiciousness
  • Schizoid PD: characterized by a lack of emotional expression
  • Schizotypal PD: characterized by a lack of emotional expression and odd behavior
• Cluster B: Dramatic, emotional, or erratic
  • Antisocial PD: lack of empathy and impulsivity
  • Borderline PD: intense emotional dysregulation and impulsivity
  • Histrionic PD: excessive emotionality and attention-seeking
  • Narcissistic PD: grandiosity and lack of empathy
• Cluster C: Anxious or fearful
  • Avoidant PD: fear of social rejection and criticism
  • Dependent PD: fear of being alone and submissive behavior
  • Obsessive-Compulsive PD: perfectionism and rigidity

Reactive Attachment Disorder

• A response to trauma, neglect, and attachment deprivation
• Symptoms:
  • Inhibited, emotionally withdrawn behavior toward adult caregivers
  • Minimal social and emotional responsiveness to others
  • Episodes of unexplained irritability, sadness, or fearfulness
• Can be diagnosed in children as young as 9 months

PTSD

• Symptoms:
  • Depersonalization: feeling detached from one's mental processes or body
  • Derealization: feeling of unreality of surroundings
  • Flashbacks with auditory pseudo-hallucinations
• Criteria for children younger than 6 years old:
  • Directly experiencing the traumatic event(s)
  • Witnessing the event(s) as it occurred to others, especially primary caregivers
  • Expressions:
    • Repetitive play of the trauma themes
    • Frightening dreams don't have to be explicitly representing trauma
    • Specific trauma re-enactment in play
    • Developmental regression