Guide
Guide | Reference

33  Predominant Psychosis Prototypes

33.1 Summary

  • Prototypes dominated by reality distortion, hallucinations, and reduced insight that drive functional impairment or risk.

33.2 Included Prototypes (Guide exemplars)

  • First Episode Psychosis Prototype (exemplar).
  • Schizophrenia-Spectrum Prototype (exemplar).
  • Full catalog appears in the Clean Reference.

33.3 How to Use This Cluster

  • Start with the Atlas entry for reality distortion and psychosis-spectrum experiences.
  • Rate the Psychosis and Reality Testing domain.
  • Apply a prototype label only when it improves communication or documentation.

33.4 Boundary Markers

  • What it is: persistent or recurrent reality distortion beyond transient causes.
  • What it is not: delirium, substance-induced states, or culturally normative beliefs.

33.5 Common Overlap

  • Mood and drive dysregulation.
  • Cognitive control and executive function difficulties.
  • Sleep and circadian disruption.

33.6 First Episode Psychosis Prototype (Exemplar)

33.6.1 Summary

  • A first clear presentation of reality distortion or psychosis-spectrum symptoms with functional change or risk.

33.6.2 Prototype Features

  • New onset hallucinations or unusual beliefs.
  • Reduced insight or disorganized thinking.
  • Noticeable functional change or behavioral disruption.

33.6.3 Threshold Guidance

  • Use when psychosis-spectrum symptoms are new and clinically significant.

33.6.4 Expected Domain Profile

  • Psychosis and Reality Testing: moderate to high.
  • Mood and Drive Dysregulation: variable.
  • Cognitive Control and Executive Function: variable.

33.6.5 Time-Course and Trajectory

  • Acute or subacute onset.
  • High variability early in course.

33.6.6 Differential and Red Flags

  • Delirium or acute confusional states.
  • Substance intoxication or withdrawal.
  • Medication or iatrogenic effects.
  • Seizure, autoimmune, infectious, or neurodegenerative mimics.

33.6.7 Specifiers

Specifiers: course + contributors + risk, as relevant; see Reference for full.

33.7 Schizophrenia-Spectrum Prototype (Exemplar)

33.7.1 Summary

  • A persistent pattern of reality distortion with functional impairment and disorganization that is not limited to a single episode.

33.7.2 Prototype Features

  • Ongoing hallucinations or delusional beliefs.
  • Disorganized thought or behavior.
  • Functional decline or reduced engagement.

33.7.3 Threshold Guidance

  • Use when psychosis-spectrum symptoms are persistent and impairing over time.

33.7.4 Expected Domain Profile

  • Psychosis and Reality Testing: moderate to high.
  • Cognitive Control and Executive Function: variable, often affected.
  • Social Communication and Relatedness: variable strain.

33.7.5 Time-Course and Trajectory

  • Chronic persistence with episodic exacerbations.

33.7.6 Differential and Red Flags

  • Mood-psychosis pattern with mood-congruent episodes.
  • Substance or medication effects.
  • Neurocognitive or neurologic contributors.

33.7.7 Specifiers

Specifiers: course + contributors + risk, as relevant; see Reference for full.