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.