Psychosis includes a range of symptoms that affect an individual’s thoughts, feelings, and behaviours. Symptoms of psychosis are typically divided into two categories: “positive” and “negative” symptoms. “Positive’ symptoms are changes in thoughts and feelings that are “added on” to a person’s experiences (e.g., paranoia or hearing voices). “Negative” symptoms are things that are “taken away” or reduced (e.g., reduced motivation or reduced intensity of emotion).
Some of the positive symptoms include:
Delusions are very firmly held, false beliefs that are not consistent with one’s culture. These beliefs cannot be shaken despite reason or proof to the contrary. They are often very unique to the person. It is often very difficult for other people to understand why the person holds this belief.
Examples of delusions include:
- feeling they are being watched, followed or monitored in some way
- believing they are being plotted against
- believing they have special abilities or “powers”
- convinced that certain sights or sounds are specifically directed towards the young person or communicating a hidden message (e.g., the television announcer is personally criticizing them)
- believing they are being controlled by forces or other individuals
- convinced that their thoughts are being broadcasted so others can hear them
- belief that they are responsible for a negative event e.g., earthquake, plane crash)
Hallucinations involve seeing, hearing, feeling, smelling or tasting something that is not actually there. These experiences appear entirely real to the person who is experiencing them. The most common type of hallucination involves hearing things – such as voices or particular sounds – such as music.
A person hearing voices may respond out loud to what they are hearing. The content of the voices can range from friendly to critical, cruel and upsetting and may even tell the person what to do.
It is often the person’s behaviour in response to the hallucination that gets noticed by others. At times the person might be observed talking out loud when no one else is there or making gestures as if someone is in their presence.
Disorganized Speech or Behaviour
Examples of disorganized speech include:
- slipping off-topic
- going off on a tangent
- answering a question in a way that doesn’t make sense to the other person
- talking about things that seemed unrelated to the conversation
Disorganized behaviour refers to behaviours that don’t fit the situation; difficulty in completing tasks or reaching a goal; or catatonic behaviour (person becomes completely withdrawn).
Examples of disorganized behaviours include:
- wearing clothing that doesn’t fit the weather
- displaying an inappropriate emotional response to the situation (e.g., laughing in response to hearing about a person’s tragedy)
- difficulty performing activities of daily living such as cooking or self-care
- not responding or reacting to their environment
Negative symptoms reflect a decrease in, or loss of, normal functions. These symptoms are often less evident than positive symptoms and require careful assessment.
Some examples of negative symptoms include:
- inexpressive faces; little display of emotions
- monotone and one-syllable or general reduction in speech
- few gestures
- difficulties in thinking or coming up with ideas
- decreased ability to start initiate tasks
- lowered levels of motivation or drive
- lack of interest in other people
- inability to feel pleasure
- lack of spontaneity
It is also common for other symptoms or problems to occur along with the psychotic symptoms.
Some examples of other problems that may occur include:
- suicidal thoughts or behaviours
- alcohol and/or other drug use problems
- difficulties functioning
- sleep disturbance – for example staying up all night
- cognitive problems such as difficulties with memory, concentration, reasoning, etc.
Once treatment is initiated, acute, the psychotic symptoms should lessen and will usually fade away, often completely. However, some symptoms, especially negative symptoms may linger as they are less responsive to medication. Even with a good response to treatment, problems such as depression, decreased self-esteem, social problems and difficulties with work or school may require further support and treatment to help enable a full recovery.