Psychosis

Question 1

Qs to ask - thought disorder

Answer 1

Delusional thoughts:

• Do you think you may be someone particularly important? (grandiosity)
• Do you feel someone is out to get you? What makes you think this? How do you know?(paranoid)
• Have you noticed the TV or radio has messages of particular relevance for you? (Delusional reference and Delusional perception)

Thought interference:

• Do you think anyone is interfering with your thoughts/trying to put thoughts into your brain?
• Do you feel like people can hear your thoughts?

Delusions of control:
- Do you feel like your actions or feelings are being controlled by an outside force?

Question 2

Qs to ask - perceptions

Answer 2

Have you ever had experiences you couldn’t quite explain - such as people talking when no one else is around?

What do they say? Do you recognise the voice?

Do they talk about you or to you?

Have the voices ever given you commands? Have you ever acted on these?

Other unusual experiences - seeing something unusual, feeling strange things on your skin or inside you

Question 3

Structure to psychosis history

Answer 3

Structure it in the ABSEPTIC mental state exam format

• Dont need to comment on speech

Question 4

Appearance and behaviour

Answer 4

Comment and ask about anything unusual

• I notice you seem quite distressed/anxious - would you be happy to tell me what is bothering you?
• I notice you are wearing this? Why is that?

Question 5

Mood/emotions

Answer 5

How is your mood?

If low - how long, any suicidal thoughts/plans

If high - ever felt very low in the past

Have you ever had times when you felt the opposite - that your mood was very high?

Question 6

Insight

Answer 6

Your beliefs and/or experiences seem quite unusual.

Do you think it is possible that what’s happening to you is due to a mental health problem?