Psychosis, Delusions and Hallucinations – Psychiatry | Lecturio


We’re going to talk about psychosis,
delusions, and hallucinations now. Otherwise known as the symptoms all
under the spectrum of disorders that are known as
psychotic disorders. Let’s start with psychosis
and let’s define it. Psychosis is a break from reality. It involves delusions, perceptual
disturbances and also disorganized thinking. What are delusions? Well, these are
fixed, false beliefs that cannot be altered
by rational arguments and cannot be accounted for by the
cultural background of the individual. There are several delusions. We’re going to go
through them one by one and I’m going to give
you some case examples from my own experiences
as a psychiatrist. So one delusion is
paranoid thinking. This is an irrational belief that one is being
followed, tracked, or somehow targeted. Here’s an example. A patient thinks, “The FBI is tracking
me and they’re stalking my house.” Another common type of delusion
is an idea of reference. This is a belief that some event is
uniquely related to an individual. So consider the patient who says, “Newscasters are directly
reporting about me.” This patient believes
when they watch TV that people are actually
talking about themselves. Another delusion is thought broadcasting. This is the belief that one’s thoughts
can be heard audibly by other people. So a patient may say, “I can hear everything you think
without you even saying a word.” Another delusion is a delusion of grandeur. This is the belief that one has special
powers beyond of those of a normal person. So consider the person who says,
“I am the smartest person alive. I should be president
and king of the world.” That would be a
delusion of grandeur. Delusions of guilt are also common. It’s a false belief that one is
guilty or responsible for something. So consider a patient who says, “I am solely responsible for
my aunt’s failing health.” When in fact we know it has
nothing to do with that patient. Persecutory delusions
are also quite common. This is the belief that one is being followed
or harassed by gangs or other people. So a patient may say, “My
classmates are all ganging up on me because I have different opinions and
therefore they want to hurt me.” Erotomanic delusions are the
belief that a famous movie star or someone with a higher stature
is in love with that individual. A patient may say, “I am convinced
that some famous person who loves me.” And somatic delusions are the belief
that the body is somehow diseased. So consider the case example
of a patient saying, “My scalp itches and therefore, I
must have incurable head lice.” When in fact there is no obvious
explanation for their scalp itching and the doctor has ruled
out that they have lice. Now, let’s consider hallucinations,
another type of a psychotic symptom. What exactly are hallucinations? These are perceived senses
that are not based in reality. It’s different from an illusion, which is a misinterpretation of
an existing sensory stimuli. So consider this, you’re driving
along in your car on a hot day and you perceive a body
of water in front of you. That would be an illusion. It’s not really there,
but external reality is giving you the impression
that it might be there. Hallucinations are different. There are actually a lot different
types of hallucinations. So let’s start with
auditory hallucinations. In other words, hearing voices. Auditory hallucinations are most commonly
seen in patients with schizophrenia. And there are a lot of different
types of auditory hallucinations. And it’s really important
that with your patient, you not only find out if
they’re hearing voices, but you dig deeper and
ask more about them. So there could be a command
voice that they’re hearing. This is extremely important because
that voice might be telling the patient to hurt themselves or others, something
that you need to screen for. They may be hearing a
running commentary. This is important because
running commentary voices are very distressing
to individuals. So this means that a person
is hearing something, basically recounting their every
move, motion and thought. It can be very distressing and
upsetting in real time for a patient. And then a person may hear one or maybe
several voices talking at one time. The person who’s hearing
several voices at once again is going to be more likely
to be disturbed and distressed and they may have a more severe
form of a psychotic disorder. Visual hallucinations, otherwise known
as seeing things, can also occur. Visual allocations are often seen in
an illness called Lewy body dementia and also in drug intoxication, something
very important to keep in mind when you’re making your
differential diagnosis of the patient presenting
with a visual hallucination. Olfactory hallucinations are
when people smell things. Can you think of a disorder which
often presents as an individual telling you that they smell something
funny, maybe something burning? Well, olfactory hallucinations are
often seen in seizure disorder or they’re otherwise known
as an aura during epilepsy, something very important
to keep in mind. And tactile hallucinations are when
an individual feels something. And when you have a patient
complaining of this, you really want to keep in mind
that this could be secondary to drug abuse or
alcohol withdrawal. That summarizes some of the psychotic
symptoms that you may be presented with. Things like delusions and hallucinations. It’s important to keep in mind the
different types of these disorders and always remember to
dig a little bit deeper to get more of a story from your patient
behind what they’re actually experiencing.

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