Symptoms of psychosis - or not

In this section, several symptom areas associated with psychosis are discussed - with the recognition that these phenomena are not experienced only by those diagnosed with a psychotic disorder.

Hearing voices

Introduction: Journal article from The Independent, "The enemy within: People who hear voices in their heads are being encouraged to talk back." see full text article



marius romme and sandra escher             Marius Romme and Sandra Escher discovered

             that hearing voices is far more

             prevalent in society then previously thought,

             and that many people can live with them 

             see you tube film

             Marius Romme and Sandra Escher, were the founders

             of hearing voices movement:  see Wikipedia

            and this interview with Marius and Sandra

             Most important publications recommendations

             The Maastricht Hearing voices Questionaire developed by Romme and Escher see website with Pdf’s

People with lived experience speak out:

Rachel Waddingham: "Can you sit beside me whilst the sky falls in?" see you tube

Irene van de Giessen: "The need for an odyssean construction with hearing voices" see you tube

"A Practical Guide to Coping with Voices" - online guide from Intervoice: the International Hearing Voices Network see website
Psychosis as a Personal Crisis: An Evidence Based-Approach an ISPS book by Romme and Escher, Routledge, 2012. see Routledge page

Spirituality and Hearing Voices: Considering the Relation" article by Simon McCarthy-Jones, Amanda Waegeli, and John Watkins in Psychosis: Psychological, Social and Integrative Approaches Volume 5, 2013 - Issue 3: Voices in a Positive Light, pp. 247-258. see article in Psychosis

"Emerging Perspectives From the Hearing Voices Movement: Implications for Research and Practice" article by Dirk Corstens, Eleanor Longden, Simon McCarthy-Jones, Rachel Waddingham and Neil Thomas in Schizophrenia Bulletin Volume 40, Issue Supplement 4, pp. S285-S294. see full text article

"Voices, Their Origin, and Ways to Address Them: Two Propositions and a Resolution" article by Berenice Royal in Psychosis: Psychological, Social and Integrative Approaches Volume 7, 2015 - Issue 2, pp. 186-191. see article in psychosis

"Beyond Beliefs: A Qualitative Study of People's Opinions About Their Changing Relations with Their Voices" article by Mark Hayward, Yvonne Awenat, Simon McCarthy-Jones, Georgie Paulik, and Katherine Berry in Psychosis: Psychological, Social and Integrative Approaches Volume 7, 2015 - Issue 2, pp. 97-107. see article in psychosis 

"'Lifting the Veil': A Qualitative Analysis of Experiences in Hearing Voices Network Groups" article by Lauren Oakland and Katherine Berry in Psychosis: Psychological, Social and Integrative Approaches Volume 7, 2015 - Issue 2, pp. 119-129. see article in psychosis


Intervoice,  the International Hearing Voices Network  see website

Hearing voices network see website

Delusions and paranoia

These phenomena have been well researched, most recently by researchers in the CBT (cognitive behavioral therapy) community. British psychologist Daniel Freeman discovered that paranoia is quite common in England, with the only difference between the people in psychiatric system and others being that the first group worries more about their paranoid thoughts!


Feel Paranoid? You Might Be, Says Daniel Freeman see website


How I Deal with Paranoia, Julie Fast, shares her ideas. See you tube


Paranoid Thoughts, A rich site from Maudsly institute see website


Daniel Freeman on paranoia, see you tube


From the Wellcome Trust, "Virtual Reality - Underground Ride Reveals Extent of Paranoid Thinking" An experiment by Daniel Freeman utilizing a virtual ride in the tube, revealing the extent of public paranoia. See you tube


"A Cognitive Model of Persecutory Delusions" article by Daniel Freeman, Philippa A. Garety, Elizabeth Kuipers , David Fowler and Paul E. Bebbington in the British Journal of Clinical Psychology, Volume 41, 2002, pp. 331–347. see full text Pdf 


Psychoanalysts have been interested in phenomena of paranoia and how to help since Sigmund Freud's early work The Schreber Case. See for example: Paranoia: New Psychoanalytic Perspectives edited by John Oldham and Stanley Bone. IUP 1994. See google book



Sometimes people with psychosis communicate in a way which is difficult to follow - this may be labeled a formal thought disorder by professionals. Mainstream psychiatry considers thought disorder as one of the criteria of schizophrenia, which may be why there is so little research on this symptom apart from general research on schizophrenia.

A description of formal thought disorder and a  wikipedia description 


Eugen Bleuler, a nineteenth to twentieth century Swiss psychiatrist was among the first to pay attention to the inner life of the people who stayed in his hospital. He coined the term schizophrenia, and considered thought disorder and loosening of associations as the essence of this disease. His book, Dementia Praecox or the Group of Schizophrenias (IUP, 1911/1964) is still available: see book on Amazon 


An article on his thoughts: “Eugen Bleuler's Dementia Praecox or the Group of Schizophrenias (1911): A Centenary Appreciation and Reconsideration,” by Andrew Moskowitz and Gerhard Heim in Schizophrenia Bulletin, Volume 37, Issue 3, pp. 471-479. see full text article 


See also the views of Parnas and Sass on disorganization, which they think it is a sign of incoherence of the self. “Schizophrenia, Consciousness, and Self” by Louis A. Sass and Josef Parnas in Schizophrenia Bulleting, Vol. 29, No. 3, 2003, pp. 427-444. see full text Pdf 


Some psychiatrists like L.Postmes consider incoherence as the result of incoherence of perception. “Schizophrenia as a Self-Disorder Due to Perceptual Incoherence” by Lot Postmes, Herman N. Sno, Saskia Goedhart, and L. deHaan in Schizophrenia Research, Volume 152, Issue 1 August 2013, pp.  See full text article 


This view has important therapeutic implications - people may profit from training which helps them to coordinate perception, for instance riding horses: “Non Conventional Psychiatric Rehabilitation in Schizophrenia Using Therapeutic Riding: the FISE Multicentre Pindar Project” by Stefania Cerino, Francesca Cirulli, Flavia Chiarotti, and Stefano Seripa in Annali dell'Istituto Superiore di Sanità, Volume 47, Number 4, December 2011. see full text article


In systems theory, disorganized speech (in mainstream psychiatry a sign of disordered thinking) is seen as a way of non-communicating when people are afraid to communicate clearly. This view is most clearly stated by R.D. Laing in his book The Divided Self (Penguin Books, 1965.) see book on Amazon 


Disorganized speech can also be provoked by the speaker’s perception that that the other is not interested in what a person has to say. In this interview, Dr. Marilyn Charles of Austen Riggs Center reports that people speak in a more disorganized fashion when not listened to. see vimeo



Negative symptoms

What are negative symptoms? 

You tube mental health advocate Miguel discusses the negative symptoms of schizophrenia. “Have you ever noticed a person that you know who has schizophrenia just seem to be in their own world, sitting staring into space or appear to be disinterested in the doing anything ‘constructive’ nor do they seem to be interested very much at all in the world around them? Also are you aware of what the symptoms of residual schizophrenia are? Please make sure that you watch this very informative video for some insight into these issues.” See you tube 


An overview of negative symptoms: “Negative Symptoms in Schizophrenia: An Update on Identification and Treatment” by By Dawn I. Velligan, PhD and Larry D. Alphs, PhD in Psychiatric Times, November 24, 2014. See website


What can you do to overcome negative symptoms?:

Bill MacPhee of explains what negative or deficit symptoms are and gives some tips on how to overcome them.  See You Tube 


“Effect of body-oriented psychological therapy on negative symptoms in schizophrenia: a randomized controlled trial” by Frank Rohricht and Stefan Priebe, Psychological Medicine, 2006, 36, pp. 669–678. see Pdf 


A less well known research outcome is that family treatment has a beneficial effect on negative symptoms in the long term: “Multiple-Family Groups and Psychoeducation in the Treatment of Schizophrenia” by William R. McFarlane, et al in Archives of General Psychiatry, Volume 52, 1995, pp. 679-687. See Pdf


A CBT (cognitive behavioral therapy) approach can restore hope and lessen anxiety. See article in  CBT section.


Latest developments David Fowler on early interventions for negative symptoms


Problems with concentration and other cognitive problems


Cognitive impairment, often preceding psychosis, is seen by mainstream psychiatry as typical of schizophrenia. Such problems don’t respond to, or are made even worse by, medication. There seems no causal relationship between cognitive impairment, and the severity and frequency of psychoses. So, although psychiatrists used to think that medicating psychosis rapidly could reduce cognitive impairment, it may be that a safe environment with support could reduce cognitive impairment more effectively than medication. On the medication page of learning resources  you can find studies indicating that programs with less medication and more psychological treatment result in better mean functioning of the group of treated clients, rather than TAU (treatment as usual). Possible differences in cognitive functions have not been researched. 

Could early intervention help to prevent cognitive impairment? And why does early intervention hold promise? In this you tube film (“Development of the Young Brain”) researcher Jay Giedd explains that the adolescent brain is changing rapidly - growing connections between neurons which are used and pruning the connections which are not used.

 This pruning is also influenced by genes: “Genetic study provides first-ever insight into biological origin of schizophrenia,”  press release from the Broad Institute of MIT and Harvard, January 26th, 2016. see article.

and by stress see 

In early psychosis research the emphasis has been on conversion to psychosis, but outcomes focused on functioning might be even more important. This study measures functional outcomes: “Clinical and Functional Outcomes After 2 Years in the Early Detection and Intervention for the Prevention of Psychosis Multisite Effectiveness Trial” by William R. McFarlane et al, Schizophrenia Bulletin, Volume 41, Issue 1, January 2015, pp. 30-43. see full text article.

What are the characteristics of the cognitive problems?

For a scientific review on this subject, see: “Cognitive Impairment in Schizophrenia,” by Richard S.E. Keefe and Philip D. Harvey from the European College of Neuropsychopharmacology. you tube

Cognitive impairment, rather than other symptoms like hallucinations or delusions is the main factor influencing functioning. See: “Work Rehabilitation in Schizophrenia: Does Cognitive Impairment Limit Improvement?” by Morris D. Bell and Qary Bryson in Schizophrenia Bulletin, Vol. 27, No. 2, 2001. see Pdf

What to do about it?

Is training for cognitive functioning useful? At the IEPA (The International Early Psychosis Association) conference in 2012, Sophia Vinogradov gave this lecture which inspired many: “Neuroscience-informed cognitive training in recent onset schizophrenia using laptop computer” see you tube, her website

The evidence

Although the ideas of Sophia Vinogradov were very stimulating, outcome research in cognitive training seems disappointing. There are brain changes:

“Brain Correlates of Cognitive Remediation in Schizophrenia: Activation Likelihood Analysis Shows Preliminary Evidence of Neural Target Engagement” by Ian S. Ramsay and Angus W. MacDonald in Schizophrenia Bulletin, Volume 41, Issue 6, pp. 1276-1284.see full text article

But there is no clear positive outcome in a multisite study, especially not transferring to real life functioning: Jesús J. Gomar, et al and the Cognitive Rehabilitation Study Group, “A Multisite, Randomized Controlled Clinical Trial of Computerized Cognitive Remediation Therapy for Schizophrenia” Schizophrenia Bulletin, Volume 41, Issue 6, pp. 1387-1396. see full text article

However, reviews can be tricky. Perhaps some trials researched this strategy as a single intervention. Rehabilitation specialists suggest that cognitive training must be in conjunction with real life activity, such as job support. See “An Overview of Cognitive Remediation Therapy for People with Severe Mental Illness” by Cherrie Galletly and Ashlee Rigby in ISRN Rehabilitation, Volume 2013. see full text article

And: “Cognitive Remediation Intervention for People with Schizophrenia and Schizoaffective disorder in the Cavan Rehabilitation Service” by Nnamdi Nkire, Aoife Moran, Attracta McGlinchey, Kiran Sarma, Kevin McEntee and Catherin McDonough. see full text

See also under Social skills training under the heading Rehabilitation methods








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