Clinical presentation

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Acute psychosis represents one of the most severe and complex presentations, and one of the most intrusive when attempting to treat AOD use [520]. During an acute episode of psychosis a person’s behaviour is likely to be disruptive and/or peculiar. Psychotic symptoms include [521]:

  • Delusions – false beliefs that usually involve a misinterpretation of perceptions or experiences (e.g., thinking that someone is out to get you, that you have special powers, or that passages from the newspaper have special meaning for you).
  • Hallucinations – false perceptions such as seeing, hearing, smelling, sensing, or tasting things that others cannot.
  • Disorganised speech – illogical, disconnected, or incoherent speech.
  • Disorganised thought – difficulties in goal direction such that daily life is impaired.
  • Catatonic behaviour – decrease in reactivity to environment (e.g., immobility, peculiar posturing, motiveless resistance to all instructions, absence of speech, flattened affect).
  • Rapid or extreme mood swings or behaviour that is unpredictable or erratic (often in response todelusions or hallucinations; e.g., shouting in response to voices, whispering).

It is important to note that mood swings, agitation, and irritability without the presence of hallucinations or delusions does not mean that the person is not psychotic. Workers should respond to these clients in the usual way for such behaviour (described in this chapter), such as providing a calming environment so their needs can be met [123].

Individuals in AOD settings commonly present with sub-acute psychosis, particularly as a result of methamphetamine use. These clients may display a range of low-grade psychotic symptoms such as [123]:

  • Increased agitation, severe sleep disturbance.
  • Mood swings.
  • A distorted sense of self, others, or the world.
  • Suspiciousness, guardedness, fear, or paranoia.
  • Odd or overvalued ideas.
  • Illusions and/or fleeting, low-level hallucinations.
  • Erratic behaviour.