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Table 1 Psychotic symptom/behavioral (PSB) clusters and specific symptoms/behaviors

From: Psychosis and help-seeking behavior in rural KwaZulu Natal: unearthing local insights

Symptom/behavioral clusters Specific symptoms and behaviors
Aggressive/agitated Aggressive in body language; aggressive verbally (threatens; insults others; calls out people’s names; shouts at others); extreme aggression
Anger: talks angrily; angry body language
Violence: throws objects (e.g. food); tears up objects; bangs wall with fists and head; fights; beats wife; murder
Causes trouble
Change in behavior: rude, talks disrespectfully, uses vulgar language
Induces fear in others
Screams; shouts throughout the night
Treatment noncompliance (traditional and Western-like)
Demands money; demands treatment
Uncooperative and needing supervision (e.g. refusing to eat; refusing to bathe)
Called “crazy” Acts “nuts”, mentally disturbed (temporary), mentally ill (chronic), very sick mentally, mentally affected, mentally confused, went “crazy”, looks like a “mad person”, “fully disturbed in such a way that everything went upside down during that day”
Driven “mad” by ancestral spirits; “lost his mind” after cultural ritual
Strange behavior Hoards rubbish
Picks up paper
Makes peculiar comments
Writes inappropriate things
Undresses in public; walks around naked or partially naked in public; walks barefoot; sleeps on grave of his murder victim; goes out in the rain; only wants to eat raw meat; sits outside people’s houses at night as if he wants to get inside; sings traditional songs never taught to him after cultural ritual; takes others’ washing from clothesline; takes children’s clothes and wears them; spits saliva, calls the name of the late radio announcer and then climbs up inside the house
Involved in repeated car accidents (smashed new cars)
Auditory hallucinations Hears voices (i.e. grandfather, etc.); hears voices after cultural ritual
Says things aloud as if he is talking to visible people
Talks to self; talks to self as if talking to others
Asks if you hear the people he/she hears
Hears voices to kill self by going into road or hanging self (COMMAND)
Confusion Shows signs of mental confusion (e.g. unable to recognize photos of wife and children)
Disappears from home/community
Gets lost
Disoriented (e.g. not knowing day’s date)
Poor hygiene General self-neglect
Not washing
Rotten teeth
Wears torn clothes
Wears dirty clothes
Talking nonsense Answers inappropriately
Talks in a way that shows he is “unwell”
Irrelevant talking; says nonsense; says incomprehensible things
Says untrue things
Sleep problems Not sleeping at night
Lack of sleep
Sleeps in street and outside in veld
Scared Appears frightened as if he sees something harmful
Looks around frightened as if someone will listen to conversation
Fears everything including a “bang” sound
Called “psychotic” Psychotic behavior
Appears to be in a psychotic state
Social/occupational dysfunction Stopped working
Left job
Stopped attending school
Wandering Wanders back and forth on road
Wanders from house to house
Visual hallucinations Appears to see something that is not there; says people who others do not see are passing by
Describes seeing invisible people from Bible
Says saw invisible people after cultural ritual
Says saw a snake entwining itself on bus steering wheel while driving
Psychomotor problems Reports blurred vision/being blind
Unable to walk
Feels physically sick; feels like vomiting
Weight change Not eating; does not eat when mentally sick
Social withdrawal Avoids social interaction
Avoids eye contact/looks down
Does not want to be touched
Paranoia Checks to see if people are listening
Looks around in a paranoid way
Says there are people who want to hurt him
Answers as if someone is attacking him and out to get him
Hypersexuality Asks women to move around in sexual way so he can get aroused
Tells women he yearns for them
Wants to rape women
Memory problems Concentration difficulty
Reports no memory of behavior during acute illness
Lack of insight Lacks insight about being mentally ill
Delusions of grandeur Says father is Nelson Mandela
Says whole earth belongs to him and all these other people pay him rent
Not communicating Does not answer questions