Definition and Use in the Field of Psychology
Psychosis is a functionally disruptive of reality due to the neurologic, neurodevelopmental and other medical conditions leading to mood disorders, delusions and hallucinations, and impairments in reality. The definition of psychosis, as well as the criteria for the classification of psychotic disorders, has changed over the years. The main presenting symptom for psychosis is an impairment in reality. Therefore a variety of conditions including schizophrenia, delusional disorder, bipolar disorder among others (Louter, 2010; Van Os, 2010). The updated definition includes schizophrenia spectrum disorders and its related disorders such as neurologic disorders (Louter, 2010). Psychotic disorders are either developmental that they develop as the child grows, acquired or degenerative in nature.
Diagnosis
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) provides a guide for clinical practice for identifying psychotic disorders (APA, 2013). Thus, a combination of informal assessment and application of the structured guide can effectively identify the condition. The presenting symptoms for assisting in the identification of psychosis include hallucinations, delusions and delusional misidentification syndromes (Louter, 2010). Hallucination is perceptions often in the senses without corresponding external stimuli such that the person responds to the stimuli without their actual presence. Often the hallucinations occur without the individual’s insight. Reality testing, in this case, reveals an impaired condition which is typical of psychotic disorders. Delusions, on the other hand, are strong beliefs about the external environment or an individual self-such that the person maintains the same belief even when presented with evidence that contradicts the belief. Patients will often misinterpret occurrences to suit these beliefs hence enabling the identification of psychotic symptoms. Delusional misinterpretation symptoms are also an indicator of psychosis. They occur where the patient tends to duplicate objects or occurrences in their immediate environment or thoughts. Therefore a close observation or testing of these three symptoms is sufficient in recognizing psychosis in patients.
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Differentiating Between Psychotic and Depressive Disorders
Often the symptoms presented by both psychotic and depressive disorders lead to misdiagnosis where the practitioners fail to assess the details of the two disorders. However, the differences in symptoms make it possible to easily differentiate the two. From the updated definition of psychotic disorders, psychosis is majorly characterized by a disconnection from reality through hallucinations and delusions. Comparatively, depressive disorders mainly affect the moods of the patients due to imbalances in mood regulation (Kupfer, Frank & Phillips, 2012). Individuals affected by depressive disorders often show disinterest in activities that they initially enjoyed or had a great interest in before the onset of the condition. Depressive conditions are also characterized by an overwhelming feeling of sadness which can result into suicidal ideations. Additionally, patients may report cravings for extreme sleep or lack of sleep altogether. Psychotic, on the other hand, are mainly characterized by disconnections with reality which are uncommon in depressive disorders (Kupfer, Frank & Phillips, 2012). Although patients with psychotic disorders are likely to have difficulties in concentration, they do not portray any forms of disinterest in activities that they enjoy.
Patient History in Psychotic Disorders
Elements of a patient’s history are influential in the diagnosis of psychotic disorder at its onset. For instance, a family history of mania, a period of heightened energy level and mood, is an indicator of bipolar disorder (Grande, Berk, Birmaher, & Vieta, 2016). Additionally, an individual portraying maniac behavior is at a high risk of developing bipolar disorder. A history of substance abuse is another relevant indicator of psychotic disorders. The link between drug abuse and psychosis has been studied for years with results showing some illegal as well as prescribed drugs can mimic the effects portrayed by psychotic individuals. A psychiatric history of depressive disorders is another possible indicator of psychosis. Some depressive disorders if not properly diagnose and treated can develop to psychotic disorders.
Challenges Interviewing Psychotic Clients
Interviewing psychotic clients may offer a challenge owing to issues such as incoherent speech, bizarre behaviors or detachment from reality. These clinical interviews are conducted purposely to make the right diagnosis before the commencement of treatment. Since the patient is required to have informed consent, often a third party should be available to make a clarification on issues that the patients have a faint or no recollection at all. Incoherent speech can significantly alter the effectiveness of communication between the client and the patient. Thus, providing a calm environment where the client feels at ease helps in adding coherence to speech. A third party who is more familiar to the client may also provide assistance.
Bizarre behavior by the client is also a challenge and can possibly place the doctor at risk. It is crucial to first understand the patient’s history of violent behavior before effectively setting up an environment where the client can stay calm while at the same time averting danger to those around. Mood disorders and anxiety may lead to forms of mistrust and concealing of information. Thus, establishing rapport improves the relationship with the patient and helps to build trust. Rapport facilitates the obtaining of vital information during the interview process. Some patients have the capability to interpret nonverbal cues or signs in their communication. Thus, proper utilization of these cues becomes vital in activating the patient’s memory when discussing certain issues or establishing a relationship that leads to trust. Overall, the doctor has to understand the patients' preferred form of communication and utilize it in the interview process.
References
APA. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). American Psychiatric Publishing.
Grande, I., Berk, M., Birmaher, B., & Vieta, E. (2016 ). Bipolar Disorder. Lancet, 387 , 1561–1572.
Kupfer, D. J., Frank, E., & Phillips, M. L. (2012). Major depressive disorder: New clinical, neurobiological, and treatment perspectives. The Lancet , 379 (9820), 1045-1055.
Louter, M. (2010). Schizophrenia: what's in a name? Mental Health Practice , 13 (7), 28-31
Van Os, J. (2010). Are psychiatric diagnoses of psychosis scientific and useful? The case of schizophrenia. Journal of Mental Health , 19 (4), 305-317.
