Schizophrenia and Psychosis

Symptoms, responding to hallucinations and delusions, and treatment

Mental Health

Positive (added): hallucinations (usually voices), delusions, disorganized speech and behavior.
Negative (taken away): flat affect, little speech (alogia), low motivation (avolition), no pleasure (anhedonia), social withdrawal.
Cognitive: poor attention, memory and planning.
Duration ≥6 months (with ≥1 month of active symptoms).

Loose associations, word salad, clang associations (rhyming), neologisms (made-up words), echolalia (repeating), concrete thinking.

Persecutory	"They're poisoning me." (offer sealed or packaged food)
Grandiose	"I'm the president's advisor."
Referential	"The TV is sending me messages."
Somatic	"My organs are rotting."

Don't argue or try to prove it wrong, and don't pretend to agree. Respond to the feeling, focus on reality and present activities, build trust.

Watch for cues: looking around, talking or laughing to no one, tilting the head as if listening.
Ask what the voices are saying: command hallucinations telling the person to harm themselves or others are an emergency for safety.
Present reality without arguing: "I don't hear the voices, but I can see they're upsetting you."

Focus on what's real right now; engage in a simple activity; distraction (music, conversation).
Reduce noise and stimulation.
Teach coping: humming, talking back to voices in a firm way, telling staff.

Antipsychotics (see Part 1): adherence is key; long-acting injections help.
Clozapine for treatment-resistant illness and suicidal behavior (ANC monitoring).
Metabolic monitoring (weight, glucose, lipids).
Family psychoeducation, social skills training, supported employment, case management.

Schizoaffective: psychosis + major mood episodes.
Delusional disorder: fixed delusions, otherwise functioning.
Brief psychotic disorder: ≥1 day but <1 month, with full return to baseline.
Catatonia: immobility, mutism, posturing → lorazepam, ECT; watch nutrition and skin.