Psychotic Symptoms

  • Questioning directed by patient's history, attempt to engage with nature

- “Colombo” method: do not agree with false beliefs but appear inquisitive to explore the patient’s subjective experience

- “I was wondering if you could tell me more about that...”


  • Closed questioning to confirm for more guarded patients directed towards their presentation,

- “Is anyone troubling you at the moment?”

- “Is anyone concerned about what’s happening?”

- “Is there anything happening at home?”

- “I understand you are having problems with your neighbour?”

- “Why do you think the police are involved?”


increasing this while exploring the patient’s experience rather than specific questioning on symptoms of mental disorder. That is

- “I understand that you are having difficulty with your neighbours, that must be very - distressing for you, can you tell me what’s happening?” rather than

- “Is your neighbour trying to harm you/reading your mind/speaking to you when they are not there” etc.


  • Delusions - fixed firm false beliefs not in keeping with cultural background, i.e believed 100% despite evidence to the contrary

- “Do you think anybody wishes you ill or wants to harm you?”

- “Do you ever think you can do things other people cannot?


  • Hallucinations - perception in the absence of external stimuli - sensation of sound, taste, touch, smell and/or vision despite not existing in external reality

- “Do you ever have experiences that distress you that you couldn’t explain?”

- “See, hear, taste, smell or feel anything that distresses you?”


- Frequency, duration, what makes it better or worse (frequency or intensity),

- Associated symptoms

- Who are people?

- Are they speaking to him (2nd person), about him (3rd person)?

- Your own thoughts spoken aloud, or commenting on what he does (running commentary)?

- Do they command you to do anything? Can you resist them? How do you explain then (association with delusions)?

- Specific occurrences - before going to sleep (hypnogogic) or when falling asleep (hypnopompic)


  • Illusions are a misinterpretation of a perceived external stimulus

For example: a cord is perceived as a snake in dim light or a shadow behind a curtain is perceived as a person at night after watching a horror film. The person has insight into this and the external stimulus (cord and shadow) existed in the external space, i.e. are real.


  • Thought disorder - abnormity in the way thoughts are formed when expressed as speech

- “Do you ever feel your thoughts are muddled?”


  • Passivity - the belief that the patient’s body or mood is being controlled by an external force 

- “Do you ever feel like you are being controlled, either your thoughts (insertion, withdrawal or broadcast), your feelings (emotion) or your movements (volition)?”


  • Delusional perception - appreciation of a real external change/stimulus but a delusional explanation

- “Does anything have a special meaning for you?”


  • Effect on functioning and risks associated with these effects - What did you do about this?

- “Did you try to protect yourself?”

- “Did you stay at home?”

- “Did you speak to him?”

- “Did you try to distract yourself?”

- etc


  • Negative symptoms, alogia, anhedonia, affective blunting and autism; changes in functioning, largely historical and collateral,

- “Have you had difficulty motivating yourself and getting around....?”


  • Insight

- “Do you think you have an illness?

- "Do you think you need treatment (medication, community team, admission etc.)?"

- "Would you take the treatment if it was offered to you?”


  • Emphasis on social stressors, compliance with treatment and drug misuse as included in rest of psychiatric history.

Copyright 2012 RevisePsych

Last updated March 2020

This site was designed with the
website builder. Create your website today.
Start Now