Whenever people think about psychosis, they only think it involves hearing voices and paranoia. Yet psychosis involves so much more than hearing voices, in fact it involves 4 categories of symptoms. Therefore, in this clinical psychology podcast episode, you’ll learn about what are the positive, negative, disorganised and catatonic symptoms of psychosis. If you enjoy learning about psychosis, mental health and clinical psychology then this is a great episode for you.
Today’s psychology podcast episode has been sponsored by Clinical Psychology: Second Edition. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it. Also available as an AI-narrated audiobook from selected audiobook platforms and library systems. For example, Kobo, Spotify, Barnes and Noble, Google Play, Overdrive, Baker and Taylor and Bibliotheca.
What Are The Four Categories Of Psychotic Symptoms?
What Are The Positive Symptoms Of Psychosis?
I certainly think that the term “positive” is one of the weirdest terms in psychology because there is nothing “good”, “exciting” or “happy” about psychotic symptoms and they can be extremely distressing to individuals with the condition. Yet what positive actually means in this context is “additional experience”. Therefore, when we talk about positive symptoms, what we actually mean is symptoms that add an extra experience to the client’s life and perceptions.
Two examples of this include hallucinations as well as delusions.
Hallucinations are internally generated sensory experiences because there is nothing in the person’s environment that is generating these voices, visions, smells, noises or tactile experiences that are very real to the person. Interestingly, smells, taste and tactile experiences are very rare hallucinations to experience in psychosis without there being an underlying medical condition or the effects of a substance.
If a client is experiencing these three symptoms then they should be referred for a medical evaluation.
On the other hand, delusions are fixed, false beliefs that people with psychosis hold with great conviction because they are convinced these beliefs are true even without any supporting evidence. At times, these delusions are believable or plausible in nature and these are known as non-bizarre delusions. For instance, if someone with psychosis believes they might be cheated on, they might be pregnant, have a disease or someone is plotting against them.
Personally, I wasn’t sure if I was going to include this in today’s episode but the reason why I wanted to research psychosis more is because of persecutory delusions. This is where someone strongly believes someone or a group of people is out to harm them, and a woman I know verbally attacked me because of these delusions. It led to a whole thing in our social group and it was messy. Thankfully, everyone in our friendship group knows this woman has a few mental health conditions and that I would never hurt her, so even though I avoid her like the plague now. I really hope she’s okay.
In addition, you can have bizarre delusions where these are highly unlikely or just impossible in nature. Such as, people with psychosis believing that other people can hear their thoughts or aliens have implanted thoughts inside their head. And some of the most bizarre delusions are nihilistic in nature, like a person believing they don’t exist.
Finally for this section, it’s useful to note that delusions and hallucinations are not exclusive of each other. Often people with psychosis have both of these examples of positive symptoms.
What Are The Negative Symptoms Of Psychosis?
Whilst the positive psychotic symptoms are probably the most well-known, the negative symptoms are very common too. These symptoms include an absence of experiences and other things that should be present in a “healthy” client. For instance:
· Cognitive impairment- including an inability to focus and have a slow cognitive processing speed.
· Avolition- an inability to do the things someone wants to do.
· Poverty of speech content- when the person speaks their words lack any substance.
· Poverty of speech or mutism- typically this involves one-word or simple verbalisations or a complete lack of speech.
· Inappropriate or flat facial or emotional expressions- a lack of expression or an expression that is incongruent to the content. Such as, talking about being scared whilst grinning.
· Thought blocking- this is when the person with psychosis clearly has something they want to say or they’re in the process of saying and then they fall silent. Interestingly, they still appear to have something to say and on their mind but they just can’t get it out.
· Social withdrawal- they’re disengaged from others and people with psychosis often report this is because they often don’t feel like they fit in because of their mental health condition or paranoia.
What Are the Catatonic Symptoms of Psychosis?
When a lot of people think about people in catatonic states, they often believe the person is in an unmovable, withdrawn and silent state. However, in reality, a person in a catatonic state can be excited or withdrawn so this means we need to split catatonic symptoms into two different categories.
Firstly, when someone is in an excited catatonic state, they can act impulsively, seem agitated, perform meaningless and repetitive movements, mirror other people’s movements and echo other people’s noises or verbalisations.
Secondly, when someone is in a withdrawn catatonic state, they tend to hold strange postures for hours and they can be placed in a posture by others as well. Or they might remain rigid for hours so they’re resistant to being moved by other people. Also, people in a withdrawn catatonic state don’t tend to have facial expressions or speak at all, even though at times they might grimace and have no response to an external stimuli.
What Are Disorganised Psychotic Symptoms?
It means there are a few weird terms when it comes to mental health because yet again, this is a term that doesn’t mean what we typically associate with it. Instead of being a mess and clutter, “disorganised” symptoms mean people with psychosis experience severe thought disorganisation. There are six different examples of this thought disorganisation.
Firstly, “clanging” involves a person with psychosis using a “singsong” or rhyming speech pattern so the person is more interested in how they’re saying sounds to themselves compared to what they’re actually saying.
Secondly, you can experience circumstantial thought processes where a person with psychosis doesn’t get to the point of what they’re saying linearly. Since there are a lot of extra, unneeded details that make the listener lose sight of the topic of the conversation but the person eventually ties it all together. And this example is a good reminder about why diagnosis needs multiple symptoms for a range of time and these symptoms have to cause clinically significant levels of distress in multiple domains of functioning. Due to everyone does this thought process every so often and I’ve had conversations with people who do this naturally without psychosis, so it is the combination of other symptoms that means someone has psychosis.
Thirdly, loose associations involve a person with psychosis drawing parallels between two related items. As well as flights of ideas or thought derailment include clients jumping between topics without fully completing their thoughts. Then if the derailment is severe, then a client might be talking about their favourite car and then start talking about an unrelated topic without a transition or warning.
Moreover, word salad involves a gross inability for the person with psychosis to form any sort of verbal cohesion so the words just pour out in a massive jumbled mess.
Finally, neologism means “new words” so someone with psychosis can say words that don’t make much (or any) sense except to the client. Then the client tries to use these new words to describe some experience they’ve had but don’t have the words to describe it.
Clinical Psychology Conclusion
Whilst this was definitely one of the more information-heavy podcast episodes that we’ve done in recent months, and I wasn’t able to add in too many of my own thoughts and feelings on the topic (besides from being attacked and berated by someone with persecutory delusions, my experience of psychosis is just academic), I still enjoyed it. Since psychosis is a popular mental health condition to have in books, films and TV programmes and whilst I always prefer positive depictions of mental health conditions, this doesn’t happen with psychosis. This leads people to believe psychosis is only hallucinations and delusions, but psychosis is so much more than that as shown in today’s episode.
And I hope you found it as interesting, thought-provoking and eye-opening as I did.
I really hope you enjoyed today’s clinical psychology podcast episode.
If you want to learn more, please check out:
Clinical Psychology: Second Edition. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it. Also available as an AI-narrated audiobook from selected audiobook platforms and library systems. For example, Kobo, Spotify, Barnes and Noble, Google Play, Overdrive, Baker and Taylor and Bibliotheca.
Have a great day.
Clinical Psychology References and Further Reading
Best, M. W., Law, H., Pyle, M., & Morrison, A. P. (2020). Relationships between psychiatric symptoms, functioning and personal recovery in psychosis. Schizophrenia research, 223, 112-118.
Davey, G. C. (2021). Psychopathology: Research, assessment and treatment in clinical psychology. John Wiley & Sons.
Davey, G., Lake, N., & Whittington, A. (Eds.). (2015). Clinical psychology. Routledge.
Davies, C., Radua, J., Cipriani, A., Stahl, D., Provenzani, U., McGuire, P., & Fusar-Poli, P. (2018). Efficacy and acceptability of interventions for attenuated positive psychotic symptoms in individuals at clinical high risk of psychosis: a network meta-analysis. Frontiers in Psychiatry, 9, 187.
Geekie, J., Randal, P., Lampshire, D., & Read, J. (2012). Experiencing psychosis. Personal and professional perspectives.
Longden, E., Branitsky, A., Moskowitz, A., Berry, K., Bucci, S., & Varese, F. (2020). The relationship between dissociation and symptoms of psychosis: a meta-analysis. Schizophrenia bulletin, 46(5), 1104-1113.
Parra, A., Juanes, A., Losada, C. P., Álvarez-Sesmero, S., Santana, V. D., Martí, I., ... & Rentero, D. (2020). Psychotic symptoms in COVID-19 patients. A retrospective descriptive study. Psychiatry research, 291, 113254.
Read, J., Bentall, R., Mosher, L., & Dillon, J. (Eds.). (2013). Models of madness: Psychological, social and biological approaches to psychosis. Routledge.
Swora, E., Boberska, M., Kulis, E., Knoll, N., Keller, J., & Luszczynska, A. (2022). Physical activity, positive and negative symptoms of psychosis, and general psychopathology among people with psychotic disorders: A meta-analysis. Journal of Clinical Medicine, 11(10), 2719.
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