4. Positive and Negative Symptoms of Psychosis

Psychosis manifests itself in a variety of ways and affects an individual's thoughts, feelings, and behaviours. In addition, the symptoms of psychosis are frequently separated into "positive" or thoughts and feelings that are "added on" to how a person ususally thinks and feels and "negative" categories, or things that are "taken away" such as motivation.

I. Confused Thinking

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Thoughts become confused and seem to either speed up or slow down.
-may have difficulties concentrating, following instructions or conversations, and remembering things.

II. Changed Feelings
Individuals with psychosis may feel strange and cut-off from the rest of the world. They may experience mood swings and feel unusually excited or depressed. Their emotions frequently appear dampened and it is difficult for other others to tell if they are feeling - or simply showing - less emotion.

III. "Positive" Symptoms
These symptoms are referred to as "positive" because they are viewed as an excess or distortion of the individual's normal functioning. They include:

A. Delusions
Delusions are false beliefs that are firmly held. They are distinguished from strongly held beliefs by the degree of conviction with which the belief is held despite contradictory evidence. They are generally organized around one or more of the following themes:

1. Persecutory. Most common. Belief that one is being followed, tormented, or subjected to ridicule.




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2. Referential. Also common. Belief that certain gestures, comments, songs, or other environmental cues are specifically directed toward oneself. Grandiose. Belief that one has special abilities or "powers."
3. Religious. Delusions have religious themes (e.g., receiving orders from God)
4. Somatic. Belief that something unusual is occurring in or on one's body, despite medical evidence to the contrary.



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5. Loss of Control over Mind or Body. Belief that one's thoughts or body are being controlled by forces or by other individuals. Belief that thoughts are broadcast so others can hear them. A belief that thoughts are being taken out of one's head or are somehow inserted into one's brain.

Delusions are considered "bizarre" if they are clearly implausible and are not derived from ordinary life experiences. For example, believing that one's internal organs have been replaced by someone else's without surgery would be considered a bizarre delusion while the belief that one is being followed by the police would be considered non-bizarre.

B. Hallucinations

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Hallucinations involve seeing, hearing, feeling, smelling, or tasting something that is not actually there. Auditory hallucinations are the most common. They are usually experienced as voices that are perceived as distinct from the individual's own thoughts.

C. Disorganized Speech
The speech of individuals with psychosis may be disorganized in a variety of ways: Loose Associations. The person frequently moves from one topic to the next with minimal connection between topics.

1. Tangentiality. The person frequently moves from one topic to the next with no apparent connection between topics.
2. Incoherence. The person's speech is so disorganized as to not be understandable. Since mildly disorganized speech is common and nonspecific, the symptom must be severe enough to substantially impair effective communication to be considered indicative of psychosis.

D. Disorganized Behaviour
The behaviour of individuals with psychosis also may be disorganized, often due to difficulties with goal-oriented behaviour:

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1. Difficulties performing activities of daily living (e.g., cooking, maintaining hygiene).
2. Marked dishevelment or unusual or inappropriate dress.
3. Inappropriate sexual behaviour.
4. Unpredictable and untriggered agitation.
5. Inappropriate affect (e.g., laughing while describing a personal tragedy).



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6. Catatonic behaviour -characterized by muscular rigidity and mental stupor, sometimes alternating with great excitement and confusion.
    

I. "Negative" Symptoms.

Negative symptoms appear to reflect a decrease in or loss of normal functions. They are difficult to evaluate because they occur on a continuum with normality, are nonspecific, and may be due to a variety of other factors (e.g., medication side-effects, mood disorder). They include:

 



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1. Restrictions in the range and intensity of emotional expression.

2. Restrictions in the fluency and productivity of thought and speech.

3. Restrictions in the initiation of goal-directed behaviour.