Talk on voices, delusions in psychosis

Psychologist and psychotherapist Laner Cassar recently delivered a talk entitled ‘Voices and delusions in psychosis’ as part of a series of psycho-educational lectures organised by the Psychology Department of the Gozo General Hospital at Barts Gozo Medical School (Queen Mary University, Malta Campus). 

Cassar highlighted the main signs and symptoms of psychosis and the causes of this condition which can be psychiatric, medical or drug-induced.

Psychologist and psychotherapist Laner Cassar

Psychosis refers to a loss of contact with reality, usually including false beliefs about what is taking place or who one is (delusions) and seeing or hearing things that are not there (hallucinations). Psychotic disorders are characterised by a failure of reality testing and creation of new realities such as delusions, hallucinations, thought disorders and lack of thought and insight.

While the word ‘psychosis’ can remind one of a more chronic condition as schizophrenia, it was not necessarily the case, Cassar said. One can experience psychosis for a short period of time, as is the case with brief psychotic disorder usually as a response to emotional stress, trauma or recreational drug-taking, where the possibilities of recovery are fairly good with the help of psychological and social interventions as well as medication.

Psychosis can also be the result of medical conditions or the side-effect of some medications.

One key symptom of psychosis is auditory hallucinations i.e. sensory perceptions of hearing in the absence of external stimuli. Some can be verbal, such is the case in voice-hearing. This is usually associated with psychiatric conditions but one can hear voices for several other reasons such as in the case of bereavement, sensory deprivation, trauma, etc. These were not always a sign of a mental health condition, Cassar said.

A person may perceive auditory hallucination as coming through their ears, in the mind or from anywhere in the space around them. They can occur frequently or as isolated episodes.

Another important symptom of psychosis is having a delusional belief, meaning a false and unshakeable belief. Delusions can be of different types, including paranoid, persecutory, referential, grandiose, somatic, related to jealousy and erotomaniac, among others.

Cassar also explained how to communicate when someone was presented with unshakeable beliefs, emphasising the need to validate their experiences but not to play along into what they think. He said it was also important not to criticise, minimise and dismiss their beliefs and not to act alarmed, horrified or embarrassed with what they present. It was also imperative to avoid a win-lose argument situation which could block the communication with the person having such delusional beliefs.

Acute psychosis is a treatable condition and is managed with anti-psychotic medication and psycho-social intervention managed by various caring professionals, he said.

While there have been significant improvements in the provision and accessibility of mental healthcare, Cassar said it was very important to continue to build a strong community mental health service in Gozo to minimise the number of admissions in psychiatric wards.