The Spectrum of Psychotic Disorders

Abstract

Summary of findings Introduction Psychosis is a term for a series of psychiatric symptoms that have in common clinical evidence of impairment in reality testing. Specific symptoms characteristic of psychotic disorders include hallucinations (sensory experience without sensory input, an impairment between internal sensory experience and external stimuli), illusions (distortions of sensory input at the level of perception), and delusions (fixed, false beliefs in the context of intact sensory processing, thus a disorder of attribution). In addition, “psychosis” also applies to deficits in cognitive organization (not just impairment in memory). Examples of cognitive disorganization include the inability to initiate and persevere on mental tasks, impaired language use (e.g., inappropriate rhyming or use of bizarre sentence constructions), and deficient affective modulation or control (e.g., affect that is discordant to the ongoing emotional status, or silly, labile, or odd). It is important to distinguish between isolated symptoms of psychosis (which can be classified among the symptom types above) that reflect a “primary” psychotic disorder versus those psychotic symptoms that may be best attributed to another psychiatric illness. Other psychiatric illnesses that may also feature psychotic symptoms include mood disorders (e.g., major depression with psychotic features and bipolar I disorder, manic episode with psychotic features), substance use disorders, delirium, and dementia. While the psychotic symptoms seen in these other psychiatric conditions may substantially overlap with the psychotic symptoms of “primary” psychotic disorder, the context will be different.