Psychotic Symptoms
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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...”
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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.
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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?”
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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)
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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.
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Thought disorder - abnormity in the way thoughts are formed when expressed as speech
- “Do you ever feel your thoughts are muddled?”
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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)?”
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Delusional perception - appreciation of a real external change/stimulus but a delusional explanation
- “Does anything have a special meaning for you?”
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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
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Negative symptoms, alogia, anhedonia, affective blunting and autism; changes in functioning, largely historical and collateral,
- “Have you had difficulty motivating yourself and getting around....?”
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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?”
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Emphasis on social stressors, compliance with treatment and drug misuse as included in rest of psychiatric history.
Assessment > Psychiatric Interview > History of Presenting Complaint > Psychotic Symptoms