Indicators of Psychosis

Abstract

This chapter introduces the concept of psychosis, pivotal for psychopathology and nosology. Psychosis implies a loss of rationality, but the recognition of psychosis is not just a matter of identifying explicit, “psychotic” symptoms but requires a global appraisal of rationality. Even in the absence of circumscribed, productive symptoms of psychosis, certain clinical states are characterized by a loss of implicit rationality as seen in, e.g., disorganized (hebephrenic) schizophrenia. Most space in this chapter is devoted to schizophrenia, the quintessence of psychosis, and the schizophrenia spectrum, a broad range of clinical and subclinical states, many of which escape the diagnostic criteria. What distinguishes the schizophrenia spectrum disorders from nonschizophrenic disorders is its generative disorder, autism and disordered self-awareness, which contribute the specific, fundamental structure and coloring to all its psychopathological phenomena, e.g., the autistic-solipsistic quality of delusions. Transition sequences from nonpsychotic self-disorder to first-rank symptoms have been demonstrated. Failing to identify this fundamental structure, the clinician may be tempted to make diagnoses guided by single symptoms or characteristics (e.g., anxiety or personality disorder). Changing and multiple diagnoses should raise the suspicion of underlying schizophrenia spectrum. Acute, affective, and organic psychoses are treated elsewhere in this book.