A number of disorders, including schizophrenia, are classified under “schizophrenia and psychotic disorders,” whereas bipolar disorder is classified under “bipolar and related disorders” (APA, 2013b). Psychotic symptoms are sometimes summarized as a person losing touch with reality. For instance, with some of the symptoms, such as hallucinations and delusions, a person may see, hear, smell or taste something that is not there and/or have a fixed, false belief about something, not consistent with the beliefs of their culture.
Belief in something untrue or not based on reality
Sensations that appear real, but are created by the mind
Speaking incoherently, responding to questions with unrelated answers, saying illogical things.
State close to unconsciousness, rigid body, waxy flexibility, lack of verbal response.
Diminished emotional expression, motivation, speech, ability to experience pleasure and/or interest in social interactions.
The rates of psychosis among first-generation immigrants are similar to that of the general population (Anderson et al., 2015). There are, however, inter-group differences among the immigrant population:
In comparison to immigrants, refugees have consistently higher rates of psychotic disorders regardless of the country of origin, except for refugee and non-refugee immigrants from sub-Saharan Africa, who have relatively the same high rates (Hollander et al, 2016).
Brief psychotic disorder, bipolar disorder, major depressive disorder (MDD) with psychotic features, and substance-related disorders may be confused with schizophrenia.
Symptoms of PTSD, such as flashbacks, numbness and detachment, may sometimes be misdiagnosed as psychosis. In PTSD, these perceptual abnormalities specifically relate to the trauma or its context.
Speaking incoherently, responding to questions with unrelated answers, saying illogical things.
Contextual factors should be considered when assessing symptoms such as not trusting the police or authority figures.
Some behaviours that appear bizarre or incongruent may be the result of cultural misunderstandings. For instance, hearing ancestors speak can be a culturally normal experience.
There are difficulties in distinguishing psychotic disorders from other mental health diagnoses in immigrant and refugee populations. For example, PTSD and adjustment disorders may be misdiagnosed as a psychotic disorder (Anderson et al., 2015).
Assessments for immigrants and refugees with regards to psychiatric categories like PTSD or psychosis can take a number of forms. I personally go by clinical assessment alone for any psychiatric condition. It's been quite complicated to find assessment tools and standardized tests that are suitable for this population, that are easily translated and easily filled out by our newcomer clients. So clinical assessment gives us a chance to get to know the person in depth as well as, if possible, to have a chance to obtain collateral history from family members or with permission of the patient, of course, settlement workers or other support people that they may have in the community. When it comes to PTSD, a clinical review of daily functioning, as well as screening for symptoms, gives us the information that we need to be able to make a diagnosis. In terms of psychosis, however, we may want to do a little bit more exploration of the meaning of various cultural-bound symptoms. For example, people may have different ways of expressing psychotic ideas in different cultures, and it's important also that we make sure that things that are spiritual beliefs or traditional or cultural beliefs are not misinterpreted as psychosis. Especially in terms of first episode psychosis in young people, I will also usually consult to make sure that nothing is being missed so making a referral to a first episode clinic.