Understanding Psychosis: Delusions and Hallucinations

Psychosis, Delusions, and Hallucinations

Psychosis Defined

  • Psychosis is characterized as a break from reality.
  • It encompasses: delusions, perceptual disturbances, and disorganized thinking.

Delusions

  • Delusions are defined as fixed false beliefs that:
    • Cannot be altered by rational arguments.
    • Cannot be accounted for by the individual's cultural background.
  • Types of Delusions:
    • Paranoid Thinking: An irrational belief that one is being followed, tracked, or targeted.
      • Example: A patient believing the FBI is tracking and stalking their house.
    • Idea of Reference: A belief that some external event is uniquely related to the individual.
      • Example: A patient states, "newscasters are directly reporting about me," believing TV personalities are speaking directly to them without any words being exchanged.
    • Delusion of Grandeur: The belief that one possesses special powers or abilities far beyond those of a normal person.
      • Example: A person proclaiming, "I am the smartest person alive. I should be president and king of the world."
    • Delusions of Guilt: A false belief that one is guilty of something.
    • Persecutory Delusions: The belief that one is being followed or harassed by gangs or other individuals.
      • Example: A patient asserting, "my classmates are all ganging up on me because I have different opinions, and therefore, they want to hurt me."
    • Erotomanic Delusions: The conviction that a famous movie star or someone of higher social stature is in love with the individual.
      • Example: A patient stating, "I am convinced that some famous person loves me."
    • Somatic Delusions: The belief that one's body is somehow diseased, based on senses that are not rooted in reality.
  • Delusion vs. Illusion:
    • Delusion: A false belief not based on any real sensory input.
    • Illusion: A misinterpretation of an existing sensory stimulus.
      • Example of Illusion: Driving on a hot day and perceiving a body of water in front of you on the road (a mirage), as external reality creates the impression of water, though it's not truly there.

Hallucinations

  • Hallucinations are perceptual disturbances that are not based in reality.
  • Types of Hallucinations:
    • Auditory Hallucinations (Hearing Voices): These require deeper investigation into their nature.
      • Command Voices: Voices instructing the patient to hurt themselves or others. This is a critical screening point due to high risk.
      • Running Commentary: Voices that recount the patient's every move, motion, and thought in real-time. This is highly distressing to individuals.
      • Multiple Voices: Hearing one or several voices talking simultaneously. Patients hearing multiple voices are often more disturbed and distressed, potentially indicating a more severe form of psychotic disorder.
    • Visual Hallucinations: Seeing things that are not there. Mentioned in the context of differential diagnosis.
    • Olfactory Auras/Hallucinations (smelling things):
      • Context: Most commonly associated with temporal lobe epilepsy (TLE).
      • Characteristics: Rare but present with classic symptoms, typically described as smelling something burning.
      • Prevalence: Occur in approximately 1 to 6 percent (1-6\%) of TLE cases.
      • Localizing Value: Highly localizing, pointing to specific brain regions, particularly the amygdala and olfactory cortex.
      • Structural Causes to Consider: When olfactory auras occur, structural causes should be investigated.
        • Tumors: Low-grade gliomas or gangliogliomas are particularly likely causal factors.
        • Other Causes: Mesial temporal sclerosis, vascular malformations, trauma, and post-infectious scoliosis.
    • Tactile Hallucinations: An individual feeling something that isn't physically present.