Psychotic symptoms, which can occur in severe mood episodes, as well as in many other medical and psychiatric conditions, involve a person losing touch with some aspect(s) of reality.
This can take a number of forms:
• Hallucinations. This is perceiving things that don’t exist through one of the five senses.
• Auditory, hearing voices, typically outside of the person’s head.
• Command auditory hallucinations, voices that instruct the person to do something. These can range from benign instructions like ‘brush your teeth’ to very scary orders to commit suicide or to harm someone else. The voice can be someone the person recognizes, such as an entity like God or the devil, a family member, or a celebrity, or an anonymous male or female voice. People may have a single voice or multiple different ones.
• Visual, seeing things that aren’t there.
• Gustatory, tasting things that aren’t there. These are often quite unpleasant.
• Tactile, such as believing that there is something crawling on one’s skin.
• Olfactory, smelling things that aren’t there. Examples include smoke, feces, urine, and other foul odors.
• Delusions. These are fixed false beliefs that take many forms. Often these match the prevailing emotional state, and are termed mood-congruent. For example, a person who is depressed and psychotic may well have paranoid and persecutory delusions, while someone who is manic might be more on the grandiose side of things.
• Persecutory or paranoid
• Being pursued by the CIA
• Being secretly filmed
• Being conspired against by a secret society
• A belief that one’s food or water is being poisoned
• Having special powers
• Being the president (if in fact you’re not) or some other important world figure or business leader
• Having vast quantities of money and/or property (when in fact you don’t)
• Having dozens of children
• Being the messiah, a prophet, or some other religious or historical figure, often accompanied by having a special mission, such as rewriting the Bible, or needing to spread a message
• Somatic, the false belief that there is something going on
with your body that is not reality-based
• Delusional pregnancies
• Aliens growing inside your body
• Thought disorganization, while not always included as a psychotic symptom (some experts include only delusions and hallucinations), when people became severely manic, their pattern of thought can reach a point where they stop making sense. Sentences and phrases no longer fit together, and the ability to think straight and to communicate through language is significantly impaired.