Child and Adolescent Psychiatry

194 Chapter 24

Box 24.1Some symptoms that can occur in a psychotic episode

Perplexity (typically at the onset of a psychotic episode)

Andrew went through a period of a week or so when he was very upset because

he was sure something had gone seriously wrong, but he wasn’t sure what. He

felt confused for all of this time and nothing seemed right – it was like being

trapped in a bad dream for day after day.

Auditory hallucination

Beth hears voices when there is definitely no one around. Sometimes the

voices are speaking directly to her (‘second person’ auditory hallucinations)

and sometimes they talk to one another about her (‘third person’ auditory

hallucinations). What they say is mostly critical of her.

Thought insertion

Craig feels strange thoughts being inserted directly into his head. These thoughts

are definitely not his own thoughts. Sometimes it seems as if the thoughts are

put into his head by laser beams, mobile phone masts, or other special methods.

Thought withdrawal

Daniel sometimes experiences his own thoughts being taken out of his mind or

stolen by some strange force.

Delusions of control (passivity phenomena)

At times, Erin feels that her mind has been taken over by a strange force that

makes her do things that she did not choose to do – rather as if she had become

someone else’s robot.

Delusions of reference

Frank experiences a strange force that communicates directly with him by sending

special signs or signals that only he can understand. This sometimes happens

through the radio or television.

Persecutory delusion

Although her family and friends disagree, Gabrielle is convinced that there is a

serious plot against her, involving people who are following her around or who

are out to harm or poison her.

Grandiose delusion

Hugh has times when he is sure that he has special powers that make him far

better than other people and unbeatable. (Outside these episodes, he realises

that he is not very different from most other people of his age.)

Motor abnormalities

Isabel will suddenly bend her trunk forward in a rather uncomfortable way and

stay like that for several minutes (posturing). Sometimes she looks upwards and

says ‘Cancel, cancel’ (a mannerism). At other times she repeatedly moves her neck

to the right (a stereotypy). Occasionally she freezes (immobility).