ASSESSMENT CONTEXT

Hallucinations

Auditory hallucinations are the most common type of hallucination in primary mental illnesses. Clients typically hear voices that are demeaning, accusatory, or threatening. At times, they hear voices that give them commands. Clients may also hear multiple voices conversing or arguing. Other noises (including music, buzzing, and so forth) are not uncommon. Visual hallucinations also occur in psychosis. Tactile, olfactory, and gustatory hallucinations are more typical of organic brain pathology than primary mental illness.

Delusions

Delusions are false beliefs that are firmly held despite evidence to the contrary. Often, these beliefs have a paranoid or persecutory flavor to them. Clients might believe that they are being watched, followed, or talked about. Also common are grandiose beliefs-that they are of special importance, reincarnations of some significant historical figures, and so forth. Delusions may also concern a loss of control such that the clients fear that thoughts are being inserted into their minds, or that they are broadcasting thoughts, or that some outside forces are manipulating them.

Disorganized Thinking

Disorganized thinking involves individuals who display a disruption in thought processes. There may be tangential thought processes, where the clients respond to a question or statement by talking about something unrelated without realizing that they have changed the topic. Clients may show derailment or loose associations where they continually shift from unrelated topic to unrelated topic. At the extreme, thought process may be highly disorganized with the clients producing a word salad, that is, combining brief snippets of unrelated, incomplete thoughts.

Disorganized Behavior

Disorganized behavior is nonpurposeful. It could include aimless wandering, long periods of giggling at no particular stimulus, long periods of rocking and catatonic behavior, and so forth.

It is important to recognize that these symptoms represent psychosis but are not indicative of any particular disorder. While considered the hallmark of schizophrenia, psychosis can also occur in severe cases of major depressive disorder and bipolar disorder. When psychosis is observed, the evaluator must look for additional signs and symptoms that indicate a specific disorder, such as the course and negative symptoms of schizophrenia or evidence of depressive or manic symptoms that indicate a mood disorder.

Read the chapter on psychotic disorders in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), linked in the Resources under the Required Resources heading. In the Library and on the Internet, look for scholarly and professional resources on psychosis, schizophrenia, major depressive disorder, and bipolar disorder.

Psychosis can occur in a number of disorders, including in severe cases of major depressive disorder and bipolar disorder. With this in mind, write an assessment in which you address the following:

• What is psychosis? Do not simply list criteria from the DSM. Instead, analyze how the term is defined and used in the field of psychology.

• As a trained clinician, how would you recognize psychosis in a client?

• How could you, as a trained clinician, differentiate between psychotic and depressive disorders? Do not just list the criteria that differ, but explain what you would see that would be different.

• What elements in a client's history facilitate diagnosis of a psychotic disorder?

• What are the challenges of interviewing a psychotic client? How might a psychology professional deal with those challenges?

If you wish, you may use the APA Paper Template, linked in the Resources, to complete this assessment.