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

Hysterical

Irritable

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

Restless

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

Traumatized

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