Information

Difference between psychosis and schizophrenia

Difference between psychosis and schizophrenia

Can you please illustrate the difference between the psychosis and the schizophrenia?


Psychosis is part of schizophrenia, and it can be part of other psychiatric disorders, too. Psychosis is a concept that describes specific symptoms. Schizophrenia is a mental illness that has psychotic features. When broken down into symptoms, the notion of schizophrenia vs psychosis makes sense.

Psychosis isn't a mental disorder by itself. Instead, specific features define the experience psychologists call psychosis. Some of the psychotic symptoms include hallucinations, delusions, confusion, and confused speech.


Psychosis vs Schizophrenia

What is the difference between psychosis and schizophrenia?

Psychosis is of an episodic nature. Almost anyone can have psychotic episodes from time to time due, for example, to extreme tiredness or stress. If psychotic episodes are persistent, if they follow one after the other, and are consistent in their content (one hears the same commanding voices inside one’s head), that would most probably constitute schizophrenia, or disorders that are considered a precursor of schizophrenia, such as schizotypal personality disorder.

The other difference of psychosis in relation to schizophrenia is that the former may be a symptom not of the latter, but of some other disorder. Psychiatry is a notoriously imprecise discipline, and a patient may receive totally different diagnoses from different doctors. As psychosis accompanies a lot of other mental disorders, it would not be safe to assume it as a sign of schizophrenic disorder, and would be necessary to research the symptoms carefully, until a clearer picture emerges.


Acute schizophrenia

This article deals specifically with short lived episodes of schizophrenia. For wider consideration of Schizophrenia - see that page.


Acute schizophrenia is also known as Reactive Schizophrenia or Type I schizophrenia. It is usually manifested quite suddenly, often as a reaction to a significant stressor. Since the premorbid history is good, when it does manifest itself, it is in the early phases of the condition. It is often more amenable to treatment than the chronic form of schizophrenia, (also known as process schizophrenia). However, episodes of Type I schizophrenia may lead on to the development of Type II symptoms.

Acute schizophrenia resembles amphetamine psychosis. Ώ] Acute schizophrenia is usually restricted to the 'positive' symptoms (delusions, hallucinations and thought disorder) and these are the very characteristics that respond well to treatment with neuroleptins.

There are several studies that point to the existence of two, distinct syndromes that are currently termed schizophrenia:

Chronic schizophrenia can be resistant to treatment with amphetamine-like drugs which are effective in the treatment of acute schizophrenia ΐ]

Institutionalisation itself can lead to negative symptoms such as depressed affect and disorientation. Α]

Computer tomography has suggested a correlation between ventricular abnormality and the negative symptoms of schizophrenia. Β]


5. Duration

We must be cautious in this regard, since there are different disorders within the psychotic and within the dissociative, and each has its own characteristics. However, the truth is that we can say that duration is another difference between psychotic and dissociative disorders.

In general, psychotic disorders tend to last longer (Some are even chronic disorders), while dissociative disorders usually have a beginning and an end, that is, a shorter duration, limited in time (days, months . ). Furthermore, in the case of non-chronic psychotic disorders (eg, brief psychotic disorder), the duration of the disorders is usually longer than the duration of the dissociative disorders.

But let's give examples. In the case of psychotic disorders, Let's think about schizophrenia this is chronic. If we think, instead, of substance-induced psychotic disorders, they are temporary and therefore their duration is shorter (also schizophreniform disorder, which lasts between one month and six months).

In the case of dissociative disorders, consider dissociative fugue or dissociative (psychogenic) amnesia Both disorders usually last between hours and months (more hours than months).


ICD-10 and DSM-IV concepts of schizophrenia and related disorders

Although attempts have been made to bridge the gap between ICD-10 and DSM-IV and move them closer, significant differences still persist concerning the definition, duration and subtypes of schizophrenia and the nomenclature of various other psychotic disorders classified with schizophrenia. ICD-10 classifies schizotypal disorder, persistent delusional disorder, acute and transient psychotic disorders, induced delusional disorder and schizoaffective disorders together with schizophrenia (Table 1.1). DSM-IV does not include the category of schizotypal disorders with psychotic disorders but classifies it along with cluster A personality disorders.

Induced delusional disorder in ICD-10 is called shared psychotic disorder in DSM-IV persistent delusional disorder in ICD-10 is called delusional disorder in DSM-IV (Table 1.2). The major difference is in the category of acute and transient psychotic disorder of ICD-10, which overlaps with brief psychotic disorder and schizophreniform disorder of DSM-IV.

The other major difference is in the classification of psychotic illness secondary to substance misuse and to general medical conditions, which are classified together with schizophrenia in DSM-IV but are classified with disorder due to psychoactive substance misuse (F10–F19) and organic mental disorder (F00–F09), respectively, in ICD-10.

Table 1.1 Brief outline of ICD-10 classification of schizophrenia and other psychotic disorders.

F20 Schizophrenia
F21 Schizotypal disorder
F22 Persistent delusional disorder
F23 Acute and transient psychotic disorders
F24 Induced delusional disorders
F25 Schizoaffective disorder
F28 Other non-organic psychotic disorders
F29 Unspecified non-organic psychosis

ICD-10 avoids criteria based on social and occupational dysfunction for the diagnosis of schizophrenia on the basis that it is difficult to equate these criteria between different cultures.

This is a major inclusion criterion in DSM-IV that is essential for the diagnosis of schizophrenia.

Diagnostic criteria for schizophrenia
ICD-10 requires either one of the Schneiderian first-rank symptoms, or bizarre delusions, or two or more symptoms including persistent hallucinations, thought disorder, catatonic behaviour, negative symptoms or significant and persistent behavioural change. These features are required to be present for a 1-month duration or longer. ICD-10 recognizes that there may be a prodromal phase associated with schizophrenia, but as a prodrome typical of and specific to schizophrenia could not be described reliably it is not included in the diagnostic criteria. The 1-month duration of schizophrenia according to ICD-10 does not include the prodromal phase (Table 1.3).

ICD-10 requires exclusion of substance use or organic brain disease if they may be causing features of schizophrenia. As described earlier, the presence of the schizophrenia-like symptoms caused by either organic brain disease or substance use are classified along with organic mental disorder and substance misuse disorders, respectively, in ICD-10, not with schizophrenia.

DSM-IV requires, for the diagnosis of schizophrenia, 1 month’s duration of characteristic symptoms with at least two of the symptoms of delusions, hallucinations, disorganized speech, grossly disorganized catatonic behaviour or negative symptoms (Table 1.4). However, only one of these is required if delusions are bizarre or third-person auditory hallucination or running commentary are present. This criterion brings the DSM-IV diagnosis of schizophrenia closer to that of ICD-10.

Table 1.2 Brief outline of DSM-IV classification of schizophrenia and other psychotic disorders.
295.x Schizophrenia
295.4 Schizophreniform disorder
295.7 Schizoaffective disorder
297.1 Delusional disorder
298.8 Brief psychotic disorder
297.3 Shared psychotic disorder
293.x Psychotic disorder due to (specify medical condition):
.81 with delusions
.82 with hallucinations
293.x Substance-induced psychotic disorders:
.xx onset during intoxication
.xx onset during withdrawal
297.1 Delusional disorder
298.8 Brief psychotic disorder
297.3 Shared psychotic disorder
298.9 Psychotic disorder NOS

NOS, not otherwise specified.

In addition to this criterion, DSM-IV requires a total duration of at least 6 months, including 1 month of active symptoms and social and occupational disfunction during this time.

Table 1.3 ICD-10 diagnostic criteria for schizophrenia.
Characteristic symptoms

At least one of:
Thought echo, thought insertion/withdrawal/broadcast
Passivity, delusional perception
Third person auditory hallucination, running commentary
Persistent bizarre delusions

or two or more of:
Persistent hallucinations
Thought disorder
Catatonic behaviour
Negative symptoms
Significant behaviour change

Duration
More than 1 month

Exclusion criteria
Mood disorders, schizoaffective disorder
Overt brain disease
Drug intoxication or withdrawal


This criterion is significantly different from ICD-10 as the duration required is only 1 month in ICD-10 and social and occupational dysfunction is not required at all. DSM-IV recognizes the prodrome of schizophrenia and the duration of prodrome is included in the total 6-month duration required for its diagnosis. Specific exclusion criteria are similar to those of ICD-10, including those of schizoaffective and mood disorders and exclusion of disorders secondary to general medical condition and substance misuse. In the DSM-IV, schizophrenia-like illness secondary to a general medical condition or substance misuse is classified in the section on schizophrenia and related psychotic disorders. This is in contrast with ICD-10, as described above, and avoids hierarchical assumptions.

J.K. Wing and N. Agrawal

Edited by
Steven R. Hirsch
MD FRCP FRCPsych
Professor of Psychiatry Emeritus, Division of Neuroscience and Psychological Medicine Imperial College Faculty of Medicine and Director of Teaching Governance, West London Mental Health NHS Trust London, UK

Daniel R. Weinberger MD
Chief, Clinical Brain Disorders Branch Intramural Research Program National Institute of Mental Health Bethesda MD 20982, USA


Understanding Psychosis and Schizophrenia

The problems we think of as ‘psychosis’ – hearing voices, believing things that others find strange, or appearing out of touch with reality – can be understood in the same way as other psychological problems such as anxiety or shyness.

The manifestation of psychosis is often partly or wholly a reaction to the things – such as abuse, bullying, homelessness or racism - that can happen in our lives and over which we have no control.

People who experience these problems are rarely violent. However, unhelpful stereotypes can lead to people getting a poor deal from police and mental health services ( for example, mental health services detain nearly four times as many black people as white people every year).

No one can tell for sure what has caused a particular person’s problems. The only way is to sit down with them and try and work it out.

Accordingly, mental health workers should not insist that people see themselves as ill. Some prefer to think of their problems as, for example, an aspect of their personality which sometimes gets them into trouble but which they would not want to be without.

We need to invest much more in prevention by attending to the way we treat each other in our society, particularly in the areas of poverty, racism and homelessness as well as childhood abuse, neglect and bullying.

Understanding Psychosis and Schizophrenia: Why people sometimes hear voices, believe things that others find strange or appear out of touch with reality, and what can help is a report written by a group of eminent clinical psychologists drawn from eight universities and six NHS trusts, together with people who have themselves experienced psychosis.

Edited by Anne Cook of Canterbury Christ Church University, it provides an accessible overview of the current state of knowledge, and its conclusions have profound implications both for the way we understand ‘mental illness’ and for the future of mental health services.

The report can be downloaded free of charge and is the first Society document to be published under a Creative Commons licence. This means it can be freely distributed as long as a proper credit is given to the original publisher.

The authors of Understanding Psychosis and Schizophrenia have produced an edited version of the document, aimed at children and young people.

The guide, edited by BPS member Anne Cooke (Canterbury Christ Church University), was designed in partnership with The Bright Charity and explains in accessible language why some people hear voices when there is no one there, feel suspicious of others, or believe things that others find unusual.

These guidelines provide an overview of the current state of practice and knowledge regarding family interventions in psychosis and provide a guide for psychologists and other family work practitioners, regarding how to support and deliver these family interventions in services.

Providing family interventions and support for families is essential for good practice and good outcomes for service users and their families.

Faculty member Anna Solly and assistant psychologist Emily Currell have prepared slides and tutor notes for a one-day training event that anyone can use to communicate the main messages of 'Understanding Psychosis', for example within Trusts.

It is free for anyone to download and use, and by kind permission features the original beautiful images by artist Anita Klein.

Feel free to adapt the materials to suit your own context.

The suggested timings for the day are based on a 9:30am start but can of course be adapted to suit a differently timed session/s.


The most important differences between psychotic and dissociative disorders

In this article we have collected the 8 main differences between psychotic and dissociative disorders, although there are more.

1. Main symptoms

The first of the differences between psychotic and dissociative disorders are their symptoms As we have seen, these are two types of independent and differentiated disorders, each with its own characteristics.

In psychotic disorders, the main problem is one or more psychotic symptoms that involve a distorted perception of the present (hallucinations, delusions, disorganized thinking…) In contrast, in dissociative disorders, there are no psychotic symptoms, but their main symptom is a discontinuity (or interruption) between our identity, our memory, our behavior, etc.

So, as we see, the main symptoms in both disorders are totally different.

2. Nature of symptoms

The nature of the symptoms is also diverse. Thus, psychotic disorders involve the appearance of one or more symptoms (psychotic), establishing an incongruity between what the senses capture and what the consciousness perceives On the other hand, in dissociative disorders, there is a loss of a function (memory, identity …) that functions in a limited way.

3. Contact with reality / awareness of the disorder

Another difference between psychotic and dissociative disorders has to do with contact with reality.

In psychotic disorders (eg schizophrenia) there is usually a loss of contact with immediate reality in contrast, not in dissociative disorders.

Furthermore, in psychotic disorders it is more common for the person to be unaware of their involvement In contrast, in dissociative disorders, people are often aware of their “losses. For example, this is clearly seen in dissociative amnesia, where significant autobiographical memory loss occurs.

4. Presence of cognitive disorders

In psychotic disorders, cognitive disorders or alterations can appear (and they frequently appear), which usually affect attention, memory, decision-making, planning … These symptoms appear, especially, in advanced stages of the disorder (especially in schizophrenia).

In contrast, in dissociative disorders these symptoms are not characteristic (except for the memory loss that occurs in dissociative amnesia or dissociative fugue, although it would be of a different nature).

5. Duration

We must be cautious in this regard, since there are different disorders within the psychotic and within the dissociative, and each has its own characteristics. However, the truth is that we can say that duration is another difference between psychotic and dissociative disorders.

In general, psychotic disorders tend to last longer (some are even chronic disorders), while dissociative disorders tend to have a beginning and an end, that is, a shorter duration, limited in time (days, months …). Furthermore, in the case of non-chronic psychotic disorders (eg, brief psychotic disorder), the duration of the disorders is usually longer than the duration of the dissociative disorders.

But let’s give examples. In the case of psychotic disorders, let’s think of schizophrenia this is chronic. On the other hand, if we think about substance-induced psychotic disorders, these are temporary and therefore their duration is shorter (also schizophreniform disorder, which lasts between one month and six months).

In the case of dissociative disorders, consider dissociative fugue or dissociative (psychogenic) amnesia Both disorders usually last between hours and months (more hours than months).

6. Degree of incapacitation

Another difference between psychotic and dissociative disorders is their degree of interference in daily life or the disability it produces (remember that we always speak at a general level, and that each disorder should always be analyzed specifically). Typically, psychotic disorders are more disabling than dissociative ones.

7. Prevalence

The prevalence of psychotic disorders in general is not exactly known, but we do know its prevalence in the case of schizophrenia (0.3-0-7% of the population, according to DSM-5) or schizoaffective disorder (0 , 3% according to DSM-5).

For its part, it is estimated that dissociation occurs in 2-3% of the general population, while dissociative disorders themselves, according to some studies (Loewenstein, 1994) have a prevalence of 10% in the population.

8. Causes

Another difference between psychotic and dissociative disorders has to do with their causes.

The causes of psychotic disorders are usually multifactorial (less in those induced by substances or by other medical conditions). Thus, social, biological and environmental factors are combined in its etiology, although the hereditary factor in psychotic disorders should be highlighted (especially in schizophrenia, where it is known that monozygotic twins have a 48% probability of suffering from both).

In the case of dissociative disorders, we also find multifactorial causes, although it is true that psychological traumas are often at their base (sexual or physical abuse in childhood, witnessing or living an accident, events where death is witnessed, etc.).

Psychotic disorders usually appear, more than as a result of trauma, as a result of a highly stressful period, which is added other etiological factors (biological or personal vulnerability, biological inheritance …). Instead, dissociative disorders usually appear as a result of a trauma or a situation that the person feels as highly threatening or dangerous for them.


Difference between imagination and psychosis?

I was wondering what the difference is between schizophrenia/psychosis and an over-active imagination. I was wondering because I was diagnosed as schizophrenic, but it seems to me like all it is is that I'm imaginative and my imagination tends to spill over into my behaviour. and I guess if my fantasy starts blurring into my real behaviour then that would seem like a loss of reality, but I still can't comprehend what loss of reality means.

For example, I don't think I have delusions because a delusion is defined as a fixed false belief, but my beliefs are far from fixed. When I'm "psychotic" my beliefs are changing every day in a sense of "what if this is happening, or this?" and yeah, my speculations of what might be going on tend to be quite farfetched, but they're only what-ifs.

Plus, I don't have hallucinations apart from occassional hypnogogic halluciations and sometimes I actively imagine things in the environment around me but I don't ACTUALLY see them, and sometimes I imagine that my thoughts are coming from a different person but I don't ACTUALLY hear voices. (actually, hallucinations are not a symptom that has been identified by psychiatrists in me)

Then there's thought disorder, and I don't know what thought disorder is exactly, only that I supposedly show "disordered thinking". Well, ok, I don't know exactly what it means to have your thoughts in "order" but I do get flights of ideas, and fantasy-based thinking lacks order to it.

So I fantasise a lot usually, and this fantasising has stopped mostly now that I'm on anti-psychotics, so I can only assume that this is the symptom that medical professionals are trying to reduce in me, but honestly it's really unpleasant to not be my usual imaginative self when it comes to my thoughts. When I try to fantasise, it's like I can feel walls in my mind stopping me (oh, and if I said I feel walls in my mind to a psychiatrist, this is the sort of thing that would probably be seen as delusional). Plus there are many other negative side effects of the medication like akathisia, although I don't think I have dyskinesia.

Actually, the psychotic periods I have feel to me just like when I would be a child and play imaginative games with my friends where we would pretend to be pokemon trainers and I would "look, this (imaginary) person over here wants to have a battle, lets go!", except that now I am 25 and have few friends so the imagination tends to be done on my own, but it feels just the same.

A final note: based on me being psychotic, I have developed a definition of psychosis that it is "a prolonged, surreal experience". That's the main feature that I can point to - that often things feel very strange and this feeling might last for quite some time.

So yes. If anyone has any insight to share here, that would be helpful. I don't understand it.


RESULTS

Schizophrenia patients did not differ from schizoaffective patients on any of the hallucinations characteristics. The two diagnostic groups were combined for all subsequent analyses. Patients were divided into three groups based on the perceived location of their “worst past” auditory hallucinations. The external-only group was the largest (n = 48), followed by the group with both types (n = 31), followed by the internal-only group (n = 18). The groups did not differ significantly on gender, race, level of education, or parents’ level of education. Means and standard deviations for each group on the other PSYRATS hallucinations dimensions are presented in Table 2 . Group frequencies of the categorical SADS hallucinations variables are presented in Table 3 .

Table 2

Hallucination Characteristics, Symptom Severities, Age, and Duration of Illness in Patients with “Worst Past” Auditory Hallucinations that were Internal Only, Both Internal and External, or External Only, M (sd).

Internal Only (n = 18)Both Internal & External (n = 31)External Only (n = 48)
Auditory Hallucinations (PSYRATS):
𠀿requency of Occurrence3.17 (0.86)3.06 (1.26)2.71 (1.38)
𠀽uration of Each Occurrence3.39 (1.04)3.10 (1.01)2.58 (1.18)
 Loudness2.59 (1.37)2.45 (1.15)2.65 (1.02)
�liefs about Origins2.69 (1.45)3.31 (0.93)3.39 (1.02)
𠀺mount of Negative Content3.12 (1.32)2.83 (1.46)2.17 (1.63)
�gree of Negative Content3.41 (1.06)3.03 (1.56)2.28 (1.75)
𠀺mount of Distressing Content3.28 (1.41)3.42 (1.09)2.77 (1.59)
 Intensity of Distress3.33 (1.33)3.16 (1.29)2.68 (1.63)
𠀺mount of Life Disruption3.18 (1.19)3.16 (1.29)2.66 (1.43)
 Uncontrollability of Hallucinations3.50 (1.15)3.93 (0.25)3.30 (1.38)
Current Symptom Severity:
 PANSS Hallucinatory Behavior3.82 (1.38)3.30 (1.56)2.94 (1.74)
 PANSS Depression3.67 (1.28)3.53 (1.89)2.89 (1.37)
 PANSS Positive Total19.82 (5.56)17.76 (6.30)17.96 (6.12)
 PANSS Negative Total14.17 (3.85)14.90 (4.51)14.59 (5.11)
 PANSS General Total34.69 (7.22)35.63 (10.34)34.30 (9.55)
 PANSS Total68.47 (15.10)68.48 (17.09)67.05 (17.69)
Phase of Illness:
𠀼urrent Age, years43 (6)40 (7)39 (8)
𠀺ge 1st Psych Hospitalization24 (10)23 (8)19 (8)
𠀽uration of Illness, years19 (8)17 (10)20 (11)

PANSS = Positive and Negative Symptom Scales (Kay et al., 1987)

Table 3

Percentage of Patients in Each Group Experiencing Specific Auditory Hallucination Types: Patients Whose Hallucinations are Internal-Only, Internal and External, or External-Only.

Internal Only (n = 18)Internal & External (n = 31)External Only (n = 48)
Nonverbal Auditory Hallucinations44%74%59%
Voices Commenting88%84%68%
Voices Conversing59%53%26%
Voices Commanding94%81%66%
Commands to Harm/Kill Self27%32%34%
Commands to Harm/Kill Others36%32%13%
Positive/Helpful Voices20%11%18%
Persecutory Voices65%77%53%

Characteristics of the hallucinations of internal vs. external-only hallucinators

Patients with any internal hallucinations were compared to patients who had external-only, on characteristics of their hallucinations, see Tables 4 and ​ and5. 5 . Internal hallucinators reported more negative and distressing content, and more intensely negative content, with trends for more intense distress and greater life disruption associated with their hallucinations. They also reported longer duration of the average hallucination, and less perceived control over them. Internal hallucinators more frequently experienced voices commenting, voices conversing, voices commanding them to harm or kill others, and persecutory voices. The groups did not differ on occurrence of nonverbal auditory hallucinations or positive/helpful voices.

Table 4

Hallucinations Characteristics and Other Symptoms in Patients with Internal Auditory Hallucinations versus Patients with External Hallucinations Only, M (sd).

Internal (or both) (n = 49)External Only (n = 48)tpCohen’s d
Auditory Hallucinations (PSYRATS):
𠀿requency of Occurrence3.10 (1.12)2.71 (1.38)1.54.13.31
Duration of Each Occurrence3.20 (1.02)2.58 (1.18)2.77.01.57
 Loudness2.50 (1.22)2.65 (1.02)− 0.64.53.13
�liefs about Origins3.09 (1.16)3.39 (1.02)− 1.32.19.27
Amt of Negative Content2.94 (1.41)2.17 (1.63)2.41.02.49
Degree of Negative Content3.17 (1.40)2.28 (1.75)2.73.01.56
Amount of Distressing Content3.37 (1.20)2.77 (1.59)2.09.04.43
 Intensity of Distress3.22 (1.30)2.68 (1.63)1.81.07.37
𠀺mount of Life Disruption3.17 (1.24)2.66 (1.43)1.84.07.38
Uncontrollability of Hallus3.77 (0.75)3.30 (1.38)2.07.04.42
Symptom Severity:
 PANSS Hallucinatory Behavior3.49 (1.50)2.94 (1.74)1.65.10.34
PANSS Depression3.58 (1.67)2.89 (1.37)2.20.03.45
 PANSS Positive Total18.52 (6.06)17.96 (6.12)0.44.66.09
 PANSS Negative Total14.63 (4.25)14.59 (5.11)0.35.97.07
 PANSS General Total35.30 (9.31)34.30 (9.55)0.51.61.10
 PANSS Total68.48 (16.26)67.05 (17.69)0.40.70.08
Phase of Illness:
𠀼urrent Age, years41 (7)39 (8)1.36.18.28
Age at First Hospitalization23 (9)19 (8)2.14.04.44
𠀽uration of Illness, years18 (9)20 (11)− 1.09.28.22

PANSS = Positive and Negative Symptom Scales

Table 5

Percentage of Patients Experiencing Various Hallucination Types: Patients with Internal Auditory Hallucinations (or both) vs. External Only.

Internal (or both)External OnlyChi-sqp
Nonverbal Auditory Hallucinations63%59%0.21.68
Voices Commenting85%68%4.01.05
Voices Conversing55%26%8.66.01
Voices Commanding83%66%3.01.09
Commands to Harm/Kill Self30%37%0.40.53
Commands to Harm/Kill Others33%13%4.59.04
Affectively Positive and/or Helpful Voices32%46%1.67.20
Persecutory Voices73%53%3.97.05

Beliefs about the origins of the hallucinations

Patients with exclusively internal hallucinations were more likely than those with any external hallucinations to believe their hallucinations were self-generated, chi-square = 7.03, p < .01.

Severity of Illness in Internal vs. External-Only Hallucinators

“Worst past” internal hallucinators did not differ significantly from external-only hallucinators on PANSS-rated severity of current hallucinatory behavior, positive symptoms, negative symptoms, general symptoms, or total symptoms, but did endorse more severe depression ( Table 4 ).

Persistence of Hallucinations

In comparing “worst past” with current hallucinations, it emerged that 89% of patients with worst past internal-only hallucinations were also hallucinating at the time of assessment, compared with 77% of those with both internal and external, and 52% of those with external-only. Worst past internal hallucinators were significantly more likely than worst past external-only hallucinators to still (or again) be hallucinating currently, chi-square = 4.27, p < .04.

Phase of Illness

Patients with worst past internal hallucinations were numerically slightly older than those with external-only, but not significantly so, and the groups did not differ on duration of illness. These results are presented in Table 4 . Groups based on current hallucinations location were similar. This is inconsistent with the idea that internal hallucinations are associated with a later phase of the illness. Unexpectedly, worst past internal hallucinators had a significantly later onset of illness than external-only hallucinators, assessed as age at first psychiatric hospitalization, M (sd) = 23 (9) vs. 19 (8), t (95) = 2.14, p < .04.