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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, these 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 these 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 symptoms, 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.
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 in 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 symptoms.
My mom has a friend whose daughter is bipolar, and when she goes manic, it's definitely with psychotic features. She has hallucinations and delusions.
The last time she had a bad episode, she was seeing angels and thought she was some kind of heavenly messenger. Unfortunately, medication has only been able to stabilize her temporarily and she is now in a long term care unit because she is dangerously unstable when off her meds, but will not stay on them unless compelled to do so.
And then there are the brief psychotic disorders, like hospital psychosis. That's a fun one.
My mom has been prone to hospital psychosis and has had it the majority of the times she has been in the hospital. Some uninformed nurses tried to say it was sundowner's syndrome, but that was just because they didn't know any better. One of her doctors, older and experienced, said her disorientation was due to hospital psychosis and she would get better as soon as she got home. He seemed very certain, and he was right. After mom had been home for just a few hours, she was much, much better. The confusion resolved and she was oriented.
Hospital psychosis is worth mentioning because it can come on fairly quickly, to someone who has previously been fine, mentally, and it can be scary. The good news is it almost always resolves once the person gets home and back in familiar surroundings.
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