What Are Psychotic Features?

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  • Written By: Tricia Ellis-Christensen
  • Edited By: Jessica Seminara
  • Last Modified Date: 06 August 2014
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Psychotic features are symptoms that can be present in certain mental illnesses. Such conditions, like schizophrenia or delusional disorders, are diagnosed solely on the presence of these symptoms. In other instances, illnesses like major depression or bipolar disorder may also have elements of psychosis, though not all people with these illnesses experience these additional symptoms. Generally, psychotic features are either hallucinations or delusions.

Hallucinations can be described as seeing, hearing, feeling, or experiencing things that are not there. Most commonly, people may suffer either auditory or visual hallucinations. Delusions are the belief in things that are not true. For example, a person might believe that aliens are trying to read his mind or he could believe that a famous person is trying to contact him. Both hallucinations and delusions are psychotic features or the main symptoms of some types of mental illnesses.

When psychotic features are present with no other symptoms this can lead to diagnosis of conditions like schizophrenia, schizophreniform, brief psychotic disorder, or one of the delusional disorders. The matter is complicated when a person also has a clear mood disorder like unipolar depression or bipolar illness. While not all people with depression or bipolar disorder have psychotic features, some individuals do. The diagnosing physician or mental health expert needs to account for these extra symptoms, as different kinds of medication could be more appropriate and a greater level of surveillance of the patient may be necessary.

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In the Diagnostic and Statistical Manual® (DSM®) the add-on phrase “with psychotic features” is an important part of accurately diagnosing bipolar and depressive illness. When practitioners note a patient is experiencing these extra symptoms, they must also reflect on and add an additional specifier as to whether these features are mood congruent or mood incongruent.

For example, a severely depressed person who feels psychotic levels of guilt has mood congruent, psychotic features. This means guilt and depressed mood are joined. In contrast, a person with bipolar disorder who is having delusions of persecution is suffering a mood incongruent addition to his illness. There is little connection between persecution and mood swings.

Psychotic symptoms in an illness are frequently treated with a variety of antipsychotic medications, which may be given in addition to mood stabilizing drugs if a mood disorder is also present. It can take a while to find the right combination of meds, but many people do respond well to treatment. It should be noted that some of the minor antipsychotic drugs like quetiapine and aripiprazole are sometimes prescribed for mood disorders even if an individual is not suffering from psychotic features.

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