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we're going to talk about psychosis
delusions and hallucinations now
otherwise known as the symptoms that
fall 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
gonna 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 deluge or delusion of grandeur this
is the belief that one has special
powers beyond those of a normal person
so consider the person who says I am the
smartest person alive
I should be president in king of the
world that would be a delusion of
grandeur delusions of guilt are also
common it's the
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 patient may
say my classmates are all ganging up on
me because I have different opinions and
therefore they want to hurt me
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erato manic delusions are the belief
that a famous movie star or someone with
a higher stature is in love with that
individual patient may say I am
convinced that some famous person 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's 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 of 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 a
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
hallucinations 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 well factory 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 these
psychotic symptoms that you may be
presented with things like delusions
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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you