From the Guidelines
The psychosis spectrum refers to a range of mental health conditions characterized by delusions, hallucinations, disorganized speech or thought, and negative symptoms such as diminished expression of emotions 1.
Key Features of Psychosis Spectrum
- Primary psychosis: related to an underlying psychiatric disorder, such as schizophrenia, bipolar disorder, schizoaffective disorder, or depression with psychotic features 1
- Secondary psychosis: directly related to drug/alcohol use, withdrawal, or an underlying medical cause 1
- Awareness and level of consciousness: frequently intact in patients with psychosis, unlike other presentations of altered mental status 1
Diagnosis and Treatment
- Validated assessment scales: such as the Richmond Agitation Sedation Scale and Glasgow Coma Scale, may be employed to objectively quantify the severity of symptoms 1
- Treatment: aimed at the underlying medical cause and control of psychotic symptoms, with antipsychotic medications, psychological therapy, and psychosocial interventions 1
Classification
- ICD-11: introduces dimensional expansions regarding severity, course, and specific symptoms for some diagnoses, including schizophrenia or other primary psychotic disorders 1
- Dimensional symptom specifiers: describe the current severity of symptoms in six domains, including positive symptoms, negative symptoms, depressive symptoms, manic symptoms, psychomotor symptoms, and cognitive symptoms 1
From the Research
Definition of Psychosis Spectrum
The psychosis spectrum refers to a range of conditions characterized by disruptions in thought, perception, and behavior, including delusions, hallucinations, and thought disorders 2. This spectrum encompasses various psychiatric, neurodevelopmental, neurologic, and medical conditions, with psychosis being a common and functionally disruptive symptom 3.
Characteristics of Psychosis Spectrum
The psychosis spectrum is marked by:
- A continuum of psychotic symptoms, ranging from mild to severe 4
- A dimensional approach, recognizing that psychosis is one of several dimensions of neuropsychiatric disturbance, including abnormal psychomotor behaviors, negative symptoms, cognitive impairments, and emotional disturbances 3
- The presence of hallucinations and delusions, which arise from neural systems subserving perception and information processing 3
Psychosis Spectrum Disorders
The psychosis spectrum includes:
- Schizophrenia spectrum disorders, which define the severe end of the spectrum 3
- Psychotic experiences, which are common in community and clinical samples of children and adolescents 5
- Psychosis risk syndromes, which are characterized by early warning signs indicative of heightened risk for developing a psychotic disorder 4
- Early-onset psychotic disorders, which are rare but can have a significant impact on individuals and families 5
Diagnosis and Assessment
Diagnosing and assessing conditions within the psychosis spectrum can be complex, as clinical presentations are heterogeneous and psychotic symptoms exist on a continuum 4. Accurate diagnosis is important to guide treatment and avoid inaccurate labeling, as most youth reporting psychotic-like experiences do not have a true psychotic disorder 6. Assessment tools and differential diagnosis are essential in guiding identification and diagnosis of early psychosis within the presenting clinic or via referral to a specialty clinic 4.