1.01 - Approaches to Positive Psychotic Symptoms

Summary

In community settings, the most common barriers to independent living, employment, and stable interpersonal relationships for patients suffering from schizophrenia-spectrum disorders or other psychotic disorders are negative symptoms and cognitive deficits [1]. In contrast, severely mentally ill individuals, often incarcerated or chronically institutionalized, more frequently experience substantial barriers related to positive psychotic symptoms leading to problematic behaviors such as aggression or violence [2]. This is not to say that among the chronically institutionalized severely mentally ill population that positive psychotic symptoms are the only, or even majority, source of problematic behaviors. A survey conducted within the California Department of State Hospitals, a circa 7000-bed system dedicated to the treatment of conserved and forensically committed patients, reviewed 839 episodes of aggression or violence by 88 persistently aggressive inpatients and found that 54% of such episodes were impulsive, 39% were predatory or instrumental, and 17% were psychotically driven [3]. Nevertheless, amelioration or control of positive psychotic symptoms commonly forms the initial treatment focus among the severely mentally ill [4].