Text adapted from "The patient with Psychosis" in Psychiatry in primary care by George Foussias and Z. Jeff Daskalakis (CAMH, 2019).
Psychosis affects the way a person thinks, feels and behaves. The experience of psychosis varies greatly from person to person. Psychosis can come on suddenly or can develop very gradually.
The symptoms of psychosis are often categorized as either “positive” or “negative.”
Positive symptoms are those that add to or distort the person’s normal functioning. They include:
- delusions (false beliefs that are firmly held and are out of keeping with the person’s culture)
- hallucinations (hearing, seeing, tasting, smelling or feeling something that is not actually there)
- disorganized speech, thoughts or behaviour (e.g., switching rapidly between subjects in speaking; finding it hard to concentrate or follow a conversation; being unable to complete everyday tasks).
Negative symptoms involve normal functioning becoming lost or reduced. They may include:
- restricted emotional and facial expression
- restricted speech and verbal fluency
- difficulty with generating ideas or thoughts
- reduced ability to begin tasks
- reduced socialization and motivation.
- Other symptoms may include:
- cognitive symptoms, such as difficulties with attention, concentration and memory
- mood changes
- suicidal thoughts or behaviours
- substance abuse
- sleep disturbances.
Screening and Assessment
Quick screening questions for psychotic symptoms include:
- “Have you had any strange or odd experiences lately that you cannot explain?”
- “Do you ever hear things that other people cannot hear, such as noises, or the voices of other people whispering or talking?”
- “Do you ever have visions or see things that other people cannot see?”
- “Do you ever feel that people are bothering you or trying to harm you?”
- “Has it ever seemed like people were talking about you or taking special notice of you?”
- “Are you afraid of anything or anyone?”
Answering “yes” to any of these questions indicates the need for a more detailed assessment. It is also important to get corroborating information from caregivers or others who are close to the patient.