Editing Psychosis (section)

== Signs and symptoms ==

=== Hallucinations ===
A [[hallucination]] is defined as sensory perception in the absence of external stimuli. Hallucinations are different from [[illusion]]s and perceptual distortions, which are the misperception of external stimuli. Hallucinations may occur in any of the senses and take on almost any form. They may consist of simple sensations (such as lights, colors, sounds, tastes, or smells) or more detailed experiences (such as seeing and interacting with animals and people, [[Auditory verbal hallucinations|hearing voices]], and having complex tactile sensations). Hallucinations are generally characterized as being vivid and uncontrollable.<ref name="DSM"/> [[Auditory hallucination]]s, particularly experiences of hearing voices, are the most common and often prominent feature of psychosis.

Up to 15% of the general population may experience auditory hallucinations (though not all are due to psychosis). The prevalence of auditory hallucinations in patients with schizophrenia is generally put around 70%, but may go as high as 98%. Reported prevalence in bipolar disorder ranges between 11% and 68%.<ref name="Toh">{{cite journal | vauthors = Toh WL, Thomas N, Rossell SL | title = Auditory verbal hallucinations in bipolar disorder (BD) and major depressive disorder (MDD): A systematic review | journal = Journal of Affective Disorders | volume = 184 | pages = 18–28 | date = September 2015 | pmid = 26066781 | doi = 10.1016/j.jad.2015.05.040 }}</ref> During the early 20th century, auditory hallucinations were second to [[Visual hallucinations in psychosis|visual hallucinations]] in frequency, but they are now the most common manifestation of schizophrenia, although rates vary between cultures and regions. Auditory hallucinations are most commonly intelligible voices. When voices are present, the average number has been estimated at three. Content, like frequency, differs significantly, especially across cultures and demographics. People who experience auditory hallucinations can frequently identify the loudness, location of origin, and may settle on identities for voices. Western cultures are associated with auditory experiences concerning religious content, frequently related to sin. Hallucinations may command a person to do something potentially dangerous when combined with delusions.<ref name="Sadock Psychosis">{{cite book|title=Kaplan and Sadock's Comprehensive Textbook of Psychiatry|vauthors=Lewis S, Escalona R, Keith S|publisher=Wolters Kluwer|year=2017|isbn=978-1-45-110047-1|veditors=Sadock V, Sadock B, Ruiz P|chapter=Phenomenology of Schizophrenia}}</ref>

So-called "minor hallucinations", such as extracampine hallucinations, or false perceptions of people or movement occurring outside of one's visual field, frequently occur in neurocognitive disorders, such as Parkinson's disease.<ref>{{cite journal | vauthors = Lenka A, Pagonabarraga J, Pal PK, Bejr-Kasem H, Kulisvesky J | title = Minor hallucinations in Parkinson disease: A subtle symptom with major clinical implications | journal = Neurology | volume = 93 | issue = 6 | pages = 259–266 | date = August 2019 | pmid = 31289146 | pmc = 6709995 | doi = 10.1212/WNL.0000000000007913 }}</ref>

Visual hallucinations occur in roughly a third of people with schizophrenia, although rates as high as 55% are reported. The prevalence in bipolar disorder is around 15%. Content commonly involves animate objects, although perceptual abnormalities such as changes in lighting, shading, streaks, or lines may be seen. Visual abnormalities may conflict with [[proprioceptive]] information, and visions may include experiences such as the ground tilting. [[Lilliputian hallucinations]] are less common in schizophrenia, and are more common in various types of [[encephalopathy]], such as [[peduncular hallucinosis]].<ref name="Sadock Psychosis"/><ref name="Blom2021">{{cite journal | vauthors = Blom JD | title = Leroy's elusive little people: A systematic review on lilliputian hallucinations | journal = Neurosci Biobehav Rev | volume = 125 | issue = | pages = 627–636 | date = June 2021 | pmid = 33676962 | doi = 10.1016/j.neubiorev.2021.03.002 | url = }}</ref>

A visceral hallucination, also called a cenesthetic hallucination, is characterized by visceral sensations in the absence of stimuli. Cenesthetic hallucinations may include sensations of burning, or re-arrangement of internal organs.<ref name="Sadock Psychosis"/>

=== Delusions ===
Psychosis may involve [[delusion]]al beliefs. A delusion is a ''fixed, false idiosyncratic belief'', which does not change even when presented with incontrovertible evidence to the contrary. Delusions are context- and culture-dependent: a belief that inhibits critical functioning and is widely considered delusional in one population may be common (and even adaptive) in another, or in the same population at a later time.<ref>{{cite book |last1=Joseph |first1=Shawn M. |last2=Siddiqui |first2=Waquar |title=StatPearls |date=2024 |publisher=StatPearls Publishing |url=https://www.ncbi.nlm.nih.gov/books/NBK539855/ |access-date=19 August 2024 |chapter=Delusional Disorder|pmid=30969677 }}</ref><ref>{{cite journal |last1=Ashinoff |first1=Brandon K. |last2=Singletary |first2=Nicholas M. |last3=Baker |first3=Seth C. |last4=Horga |first4=Guillermo |title=Rethinking delusions: A selective review of delusion research through a computational lens |journal=Schizophrenia Research |date=July 2022 |volume=245 |pages=23–41 |doi=10.1016/j.schres.2021.01.023 |pmid=33676820 |pmc=8413395 }}</ref> Since [[Norm (philosophy)|normative]] views may contradict available evidence, a belief need not contravene cultural standards in order to be considered delusional. However, the DSM-5 considers a belief delusional only if it is not widely accepted within a cultural or subcultural context.<ref>{{Citation |title=Schizophrenia Spectrum and Other Psychotic Disorders |date=2013-08-11 |work=DSM-5® Clinical Cases |url=https://doi.org/10.1176/appi.books.9781585624836.jb02 |access-date=2025-03-17 |publisher=American Psychiatric Publishing |doi=10.1176/appi.books.9781585624836.jb02 |isbn=978-1-58562-463-8}}</ref>

Prevalence in schizophrenia is generally considered at least 90%, and around 50% in bipolar disorder.

The DSM-5 characterizes certain delusions as "bizarre" if they are clearly implausible, or are incompatible with the surrounding cultural context. The concept of bizarre delusions has many criticisms, the most prominent being judging its presence is not highly reliable even among trained individuals.<ref name="Sadock Psychosis"/>

A delusion may involve diverse thematic content. The most common type is a [[persecutory delusion]], in which a person believes that an entity seeks to harm them. Others include [[delusions of reference]] (the belief that some element of one's experience represents a deliberate and specific act by or message from some other entity), [[delusions of grandeur]] (the belief that one possesses special power or influence beyond one's actual limits), [[thought broadcasting]] (the belief that one's thoughts are audible) and [[thought insertion]] (the belief that one's thoughts are not one's own). A delusion may also involve [[Delusional misidentification syndrome|misidentification]] of objects, persons, or environs that the afflicted should reasonably be able to recognize; such examples include [[Cotard's syndrome]] (the belief that oneself is partly or wholly [[dead]]) and [[clinical lycanthropy]] (the belief that oneself is or has transformed into an animal).

The subject matter of delusions seems to reflect the current culture in a particular time and location. For example, in the early 1900s in the United States, [[syphilis]] was a common theme in delusions. During the Second World War, it was Germany. In the [[Cold War]] era, communists became a frequent focus. Now, in recent years, technology is a common subject matter of delusions.<ref name="Cannon Kramer pp. 323–327">{{cite journal | vauthors = Cannon BJ, Kramer LM | title = Delusion content across the 20th century in an American psychiatric hospital | journal = The International Journal of Social Psychiatry | volume = 58 | issue = 3 | pages = 323–327 | date = May 2012 | pmid = 21421637 | doi = 10.1177/0020764010396413 | publisher = SAGE Publications | s2cid = 42421925 }}</ref> Some psychologists, such as those who practice the [[Open Dialogue]] method, believe that the content of psychosis represents an underlying thought process, that may in part, be responsible for psychosis,<ref name="Seikkula, Birgitta Alakare, Jukka A 2001 pp. 247–265">{{cite journal| vauthors = Seikkula J, Alakare B, Aaltonen J |title=Open Dialogue in Psychosis I: An Introduction and Case Illustration |journal=Journal of Constructivist Psychology |volume=14 |issue=4 |year=2001 |pages=247–265 |issn=1072-0537|doi=10.1080/10720530125965|s2cid=216136239 }}</ref> though the accepted medical position is that psychosis is due to a brain disorder.<ref>{{Cite journal |last=Saugstad |first=Letten F. |date=June 2008 |title=What is a psychosis and where is it located? |url=https://pubmed.ncbi.nlm.nih.gov/18516523/ |journal=European Archives of Psychiatry and Clinical Neuroscience |volume=258 Suppl 2 |pages=111–117 |doi=10.1007/s00406-008-2014-1 |issn=0940-1334 |pmid=18516523}}</ref>

Historically, [[Karl Jaspers]] classified psychotic delusions into ''primary'' and ''secondary'' types. Primary delusions are defined as arising suddenly and not being comprehensible in terms of normal mental processes, whereas secondary delusions are typically understood as being influenced by the person's background or current situation (e.g., ethnicity, religious, superstitious, or political beliefs).<ref name=Jaspers>{{cite book | vauthors = Jaspers K |author-link=Karl Jaspers | translator-last1 = Hoenig J, Hamilton M | language = German |title=Allgemeine Psychopathologie | trans-title = General Psychopathology |orig-year=1963 | edition = Reprint |date=1997-11-27 |publisher=Johns Hopkins University Press |location=Baltimore, Maryland |isbn=978-0-8018-5775-1}}</ref>

=== Disorganized speech/thought and Disorganized behavior ===
Disorganization is categorized into either disorganized speech (disorganized speech stemming from disorganized thought), and grossly disorganized motor behavior. Disorganized speech or thought, also formally called [[thought disorder]], is disorganization of thinking that is ''inferred'' from speech. Characteristics of disorganized speech include rapidly switching topics which is called derailment or loose association, switching to topics that are unrelated which is called tangential thinking, incomprehensible speech which is called inchoherence and referred to as a [[word salad]]. Disorganized motor behavior includes repetitive, odd, or sometimes purposeless movement. Disorganized motor behavior rarely includes catatonia, and although it was a prominent symptom historically, it is rarely seen today. Whether this may be due to the use of historical treatments or the lack thereof is unknown.<ref name="Sadock Psychosis"/><ref name="DSM"/>

[[Catatonia]] describes a profoundly agitated state in which the experience of reality is generally considered impaired. There are two primary manifestations of catatonic behavior. The classic presentation is a person who does not move or interact with the world in any way while awake. This type of catatonia presents with [[waxy flexibility]]. Waxy flexibility is when someone physically moves part of a catatonic person's body and the person stays in the position even if it is bizarre and otherwise nonfunctional (such as moving a person's arm straight up in the air and the arm staying there).

The other type of catatonia is more of an outward presentation of the profoundly agitated state described above. It involves excessive and purposeless motor behaviour, as well as an extreme mental preoccupation that prevents an intact experience of reality. An example is someone walking very fast in circles to the exclusion of anything else with a level of mental preoccupation (meaning not focused on anything relevant to the situation) that was not typical of the person prior to the symptom onset. In both types of catatonia, there is generally no reaction to anything that happens outside of them. It is important to distinguish catatonic agitation from severe bipolar mania, although someone could have both.

=== Negative symptoms ===
{{See also|Clouding of consciousness|Depression (mood)}}
Negative symptoms include [[Reduced affect display|reduced emotional expression]], [[avolition|decreased motivation]] ([[avolition]]), and [[alogia|reduced spontaneous speech]] (poverty of speech, [[alogia]]). Individuals with this condition lack interest and spontaneity, and have the [[anhedonia|inability to feel pleasure]] ([[anhedonia]]).<ref>{{cite journal | vauthors = Lyne J, O'Donoghue B, Roche E, Renwick L, Cannon M, Clarke M | title = Negative symptoms of psychosis: A life course approach and implications for prevention and treatment | journal = Early Intervention in Psychiatry | volume = 12 | issue = 4 | pages = 561–571 | date = August 2018 | pmid = 29076240 | doi = 10.1111/eip.12501 | s2cid = 38777906 | hdl = 11343/293781 | url = https://pure.manchester.ac.uk/ws/files/59921199/Negative_Symtpoms_Accepted_Revision.pdf | hdl-access = free }}</ref> Altered Behavioral Inhibition System functioning could possibly cause reduced sustained attention in psychosis and overall contribute to more negative reactions.<ref>{{Cite journal |last1=Osborne |first1=K. Juston |last2=Zhang |first2=Wendy |last3=Gupta |first3=Tina |last4=Farrens |first4=Jaclyn |last5=Geiger |first5=McKena |last6=Kraus |first6=Brian |last7=Krugel |first7=Chloe |last8=Nusslock |first8=Robin |last9=Kappenman |first9=Emily S. |last10=Mittal |first10=Vijay A. |date=November 2023 |title=Clinical high risk for psychosis syndrome is associated with reduced neural responding to unpleasant images. |journal=Journal of Psychopathology and Clinical Science |language=en |volume=132 |issue=8 |pages=1060–1071 |doi=10.1037/abn0000862 |pmid=37796541 |s2cid=263669772 |issn=2769-755X|doi-access=free |pmc=11812458 }}</ref>

=== Psychosis in adolescents ===
Psychosis is rare in adolescents.<ref name=":3">{{cite journal | vauthors = Datta SS, Daruvala R, Kumar A | title = Psychological interventions for psychosis in adolescents | journal = The Cochrane Database of Systematic Reviews | volume = 7 | pages = CD009533 | date = July 2020 | issue = 7 | pmid = 32633858 | pmc = 7388907 | doi = 10.1002/14651858.CD009533.pub2 | collaboration = Cochrane Schizophrenia Group }}</ref>  Young people who have psychosis may have trouble connecting with the world around them and may experience hallucinations or delusions.<ref name=":3" /> Adolescents with psychosis may also have cognitive deficits that may make it harder for the youth to socialize and work.<ref name=":3" /> Potential impairments include a reduced speed of mental processing, the lack of ability to focus without getting distracted (limited [[attention span]]), and deficits in [[verbal memory]].<ref name=":3" /> If an adolescent is experiencing psychosis, they most likely have comorbidity, meaning that they could have multiple mental illnesses.<ref name=":11">{{cite journal | vauthors = Joyce EM | title = Organic psychosis: The pathobiology and treatment of delusions | journal = CNS Neuroscience & Therapeutics | volume = 24 | issue = 7 | pages = 598–603 | date = July 2018 | pmid = 29766653 | pmc = 6489844 | doi = 10.1111/cns.12973 }}</ref> Because of this, it may be difficult to determine whether it is psychosis or autism spectrum disorder, social or generalized anxiety disorder, or obsessive-compulsive disorder.<ref name=":11" />