Psychosis: Wikis


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Classification and external resources
ICD-9 290-299
OMIM 603342 608923 603175 192430
MedlinePlus 001553
MeSH F03.700.675

Psychosis (from the Greek ψυχή "psyche", for mind/soul, and -ωσις "-osis", for abnormal condition) means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality". People suffering from psychosis are said to be psychotic.

People experiencing psychosis may report hallucinations or delusional beliefs, and may exhibit personality changes and thought disorder. This may be accompanied by unusual or bizarre behavior, as well as difficulty with social interaction and impairment in carrying out the daily life activities.

A wide variety of central nervous system diseases, from both external poisons and internal physiologic illness, can produce symptoms of psychosis.

However, many people have unusual and unshared (distinct) experiences of what they perceive to be different realities without fitting the clinical definition of psychosis. For example, many people in the general population have experienced hallucinations related to religious or paranormal experience.[1][2] As a result, it has been argued that psychosis is simply an extreme state of consciousness that falls beyond the norms experienced by most.[3] In this view, people who are clinically found to be psychotic may simply be having particularly intense or distressing experiences (see schizotypy).


Signs and symptoms

People with psychosis may have one or more of the following: hallucinations, delusions, or thought disorder, as described below.


A hallucination is defined as sensory perception in the absence of external stimuli. They are different from illusions, or perceptual distortions, which are the misperception of external stimuli.[4] Hallucinations may occur in any of the five senses and take on almost any form, which may include simple sensations (such as lights, colors, tastes, and smells) to more meaningful experiences such as seeing and interacting with fully formed animals and people, hearing voices, and having complex tactile sensations.

Auditory hallucinations, particularly experiences of hearing voices, are a common and often prominent feature of psychosis. Hallucinated voices may talk about, or to, the person, and may involve several speakers with distinct personas. Auditory hallucinations tend to be particularly distressing when they are derogatory, commanding or preoccupying. However, the experience of hearing voices need not always be a negative one. One research study has shown that the majority of people who hear voices are not in need of psychiatric help.[5] The Hearing Voices Movement has subsequently been created to support voice hearers, regardless of whether they are considered to have a mental illness or not.


Psychosis may involve delusional beliefs, some of which are paranoid in nature. Karl Jaspers has classified psychotic delusions into primary and secondary types. Primary delusions are defined as arising suddenly and not being comprehensible in terms of normal mental processes, whereas secondary delusions may be understood as being influenced by the person's background or current situation (e.g., ethnic or sexual orientation, religious beliefs, superstitious belief).[6]

Thought disorder

Thought disorder describes an underlying disturbance to conscious thought and is classified largely by its effects on speech and writing. Affected persons show loosening of associations, that is, a disconnection and disorganization of the semantic content of speech and writing. In the severe form speech becomes incomprehensible and it is known as "word-salad".

Clinical Scales

The Brief Psychiatric Rating Scale (BPRS) [7] assesses the level of 18 symptom constructs of psychosis such as hostility, suspicion, hallucination, and grandiosity. It is based on the clinician's interview with the patient and observations of the patient's behavior over the previous 2–3 days. The patient's family can also provide the behavior report.


Causes of symptoms of mental illness were customarily classified as "organic" or "functional". Organic conditions are primarily medical or pathophysiological, whereas, functional conditions are primarily psychiatric or psychological. The DSM-IV-TR no longer classifies psychotic disorders as functional or organic. Rather it lists traditional psychotic illnesses, psychosis due to General Medical conditions, and Substance induced psychosis.


Functional causes of psychosis include the following:

A psychotic episode can be significantly affected by mood. For example, people experiencing a psychotic episode in the context of depression may experience persecutory or self-blaming delusions or hallucinations, while people experiencing a psychotic episode in the context of mania may form grandiose delusions.

Stress is known to contribute to and trigger psychotic states. A history of psychologically traumatic events, and the recent experience of a stressful event, can both contribute to the development of psychosis. Short-lived psychosis triggered by stress is known as brief reactive psychosis, and patients may spontaneously recover normal functioning within two weeks.[9] In some rare cases, individuals may remain in a state of full-blown psychosis for many years, or perhaps have attenuated psychotic symptoms (such as low intensity hallucinations) present at most times.

Sleep deprivation has been linked to psychosis.[10][11][12] However, this is not a risk for most people, who merely experience hypnagogic or hypnopompic hallucinations, i.e. unusual sensory experiences or thoughts that appear during waking or drifting off to sleep. These are normal sleep phenomena and are not considered signs of psychosis.[13]

Vitamin B12 deficiency can also cause symptoms of mania and psychosis.[14][15]

Vitamin D deficiency can cause altered thinking and psychosis.[16]

Genetics may also have a role in psychosis. The Genain quadruplets were identical quadruplets who were all diagnosed with schizophrenia.

General medical

Psychosis arising from "organic" (non-psychological) conditions is sometimes known as secondary psychosis. It can be associated with the following pathologies:

Psychosis can even be caused by apparently innocuous ailments such as flu[51][52] or mumps.[53]

Psychoactive drug use

Some studies indicate that certain cannabis strains containing large proportions of THC and low proportions of CBD [54][55], may lower the threshold for psychosis, and thus help to trigger full-blown psychosis in some people.[56] Early studies have been criticized for failing to consider other drugs (such as LSD) that the participants may have used before or during the study, as well as other factors such as pre-existing ("comorbid") mental illness. However, more recent studies with better controls have still found an increase in risk for psychosis in cannabis users.[57]

It is not clear whether this is a causal link, and it is possible that cannabis use only increases the chance of psychosis in people already predisposed to it; or that people with developing psychosis use cannabis to provide temporary relief of their mental discomfort. Cannabis use has increased over past few decades but declined in the last decade, whereas the rate of psychosis has not increased. This suggests that a direct causal link is unlikely for all users.[58] Alcohol is also a common risk of causing psychotic disorders or episodes. Research has shown that alcohol abuse causes an 8-fold increase in psychotic disorders in men and a 3 fold increased risk of psychotic disorders in women.[8][59] Alcoholic psychosis is sometimes misdiagnosed as a mental illness such as schizophrenia.[60]

It is also important to this topic to understand the paradoxical effects of some sedative drugs.[61] Serious complications can occur in conjunction with the use of sedatives creating the opposite effect as to that intended. Malcolm Lader at the Institute of Psychiatry in London estimates the incidence of these adverse reactions at about 5%, even in short-term use of the drugs.[62] The paradoxical reactions may consist of depression, with or without suicidal tendencies, phobias, aggressiveness, violent behavior and symptoms sometimes misdiagnosed as psychosis.[63][64] However, psychosis is more commonly related to the benzodiazepine withdrawal syndrome.[65]

Psychotic states may occur after ingesting a variety of substances both legal and illegal and both prescription and non-prescription. Drugs whose use, abuse or withdrawal are implicated include:

Prescription medication

Some medications such as bromocriptine and phenylpropanolamine may also cause or worsen psychotic symptoms.[97][98][99]


The first brain image of an individual with psychosis was completed as far back as 1935 using a technique called pneumoencephalography[100] (a painful and now obsolete procedure where cerebrospinal fluid is drained from around the brain and replaced with air to allow the structure of the brain to show up more clearly on an X-ray picture).

The purpose of the brain is to collect information from the body (pain, hunger, etc), and from the outside world, interpret it to a coherent world view, and produce a meaningful response. The information from the senses enter the brain in the primary sensory areas. They process the information and send it to the secondary areas where the information is interpreted. Spontaneous activity in the primary sensory areas may produce hallucinations which are misinterpreted by the secondary areas as information from the real world.

For example, a PET or fMRI scan of a person who claims to be hearing voices may show activation in the primary auditory cortex, or parts of the brain involved in the perception and understanding of speech.[101]

Tertiary brain cortex collects the interpretations from the secondary cortexes and creates a coherent world view of it. A study investigating structural changes in the brains of people with psychosis showed there was significant grey matter reduction in the right medial temporal, lateral temporal, and inferior frontal gyrus, and in the cingulate cortex bilaterally of people before and after they became psychotic.[102] Findings such as these have led to debate about whether psychosis itself causes excitotoxic brain damage and whether potentially damaging changes to the brain are related to the length of psychotic episode. Recent research has suggested that this is not the case[103] although further investigation is still ongoing.

Studies with sensory deprivation have shown that the brain is dependent on signals from the outer world to function properly. If the spontaneous activity in the brain is not counterbalanced with information from the senses, loss from reality and psychosis may occur already after some hours. A similar phenomenon is paranoia in the elderly when poor eyesight, hearing and memory causes the person to be abnormally suspicious to the environment.

On the other hand, loss from reality may also occur if the spontaneous cortical activity is increased so that it is not longer counterbalanced with information from the senses. The 5-HT2A receptor seems to be important for this, since drugs which activate them produce hallucinations.

However, the main feature of psychosis is not hallucinations, but the inability to distinguish between internal and external stimuli. Close relatives to psychotic patients may hear voices, but since they are aware that they are unreal they can ignore them, so that the hallucinations do not affect their reality perception. Hence they are not considered to be psychotic.

Psychosis has been traditionally linked to the neurotransmitter dopamine. In particular, the dopamine hypothesis of psychosis has been influential and states that psychosis results from an overactivity of dopamine function in the brain, particularly in the mesolimbic pathway. The two major sources of evidence given to support this theory are that dopamine receptor D2 blocking drugs (i.e., antipsychotics) tend to reduce the intensity of psychotic symptoms, and that drugs which boost dopamine activity (such as amphetamines and cocaine) can trigger psychosis in some people (see amphetamine psychosis).[104] However, increasing evidence in recent times has pointed to a possible dysfunction of the excitory neurotransmitter glutamate, in particular, with the activity of the NMDA receptor. This theory is reinforced by the fact that dissociative NMDA receptor antagonists such as ketamine, PCP and dextromethorphan/detrorphan (at large overdoses) induce a psychotic state more readily than dopinergic stimulants, even at "normal" recreational doses. The symptoms of dissociative intoxication are also considered to mirror the symptoms of schizophrenia, including negative psychotic symptoms, more closely than amphetamine psychosis. Dissociative induced psychosis happens on a more reliable and predictable basis than amphetamine psychosis, which usually only occurs in cases of overdose, prolonged use or with sleep deprivation, which can independently produce psychosis. New antipsychotic drugs which act on glutamate and its receptors are currently undergoing clinical trials.

The connection between dopamine and psychosis is generally believed to be complex. While dopamine receptor D2 suppresses adenylate cyclase activity, the D1 receptor increases it. If D2-blocking drugs are administered the blocked dopamine spills over to the D1 receptors. The increased adenylate cyclase activity affects genetic expression in the nerve cell, a process which takes time. Hence antipsychotic drugs take a week or two to reduce the symptoms of psychosis. Moreover, newer and equally effective antipsychotic drugs actually block slightly less dopamine in the brain than older drugs whilst also blocking 5-HT2A receptors, suggesting the 'dopamine hypothesis' may be oversimplified.[105] Soyka and colleagues found no evidence of dopaminergic dysfunction in people with alcohol-induced psychosis[106] and Zoldan et al. reported moderately successful use of ondansetron, a 5-HT3 receptor antagonist, in the treatment of levodopa psychosis in Parkinson's disease patients.[107]

Psychiatrist David Healy has criticised pharmaceutical companies for promoting simplified biological theories of mental illness that seem to imply the primacy of pharmaceutical treatments while ignoring social and developmental factors which are known to be important influences in the aetiology of psychosis.[108]

Some theories regard many psychotic symptoms to be a problem with the perception of ownership of internally generated thoughts and experiences.[109] For example, the experience of hearing voices may arise from internally generated speech that is mislabeled by the psychotic person as coming from an external source.

One clear finding is that persons with bipolar disorder seem to have increased activity of the left hemisphere compared to the right hemisphere of the brain, while persons with schizophrenia have increased activity in the right hemisphere.[110]

Increased level of right hemisphere activation has also been found in healthy people who have high levels of paranormal beliefs[111] and in people who report mystical experiences.[112] It also seems to be the case that people who are more creative are also more likely to show a similar pattern of brain activation.[113] Some researchers have been quick to point out that this in no way suggests that paranormal, mystical or creative experiences are in any way by themselves a symptom of mental illness, as it is still not clear what makes some such experiences beneficial and others distressing. People who have profoundly different experiences of reality or hold unusual views or opinions have traditionally held a complex role in society, with some being ostracized and viewed as deviants, whilst others are lauded as prophets or visionaries.


The treatment of psychosis depends on the cause or diagnosis or diagnoses (such as schizophrenia, bipolar disorder and/ or substance intoxication). The first line treatment for many psychotic disorders is antipsychotic medication (oral or intramuscular injection), and sometimes hospitalisation is needed. There is growing evidence that cognitive behavior therapy[114] and family therapy[115] can be effective in managing psychotic symptoms. When other treatments for psychosis are ineffective, electroconvulsive therapy (ECT) (aka shock treatment) is sometimes applied to relieve the underlying symptoms of psychosis due to depression. There is also increasing research suggesting that Animal-Assisted Therapy can contribute to the improvement in general well-being of people with schizophrenia.[116]

Early intervention

Early intervention in psychosis is a relatively new concept based on the observation that identifying and treating someone in the early stages of a psychosis can significantly improve their longer term outcome.[117] This approach advocates the use of an intensive multi-disciplinary approach during what is known as the critical period, where intervention is the most effective, and prevents the long term morbidity associated with chronic psychotic illness.

Newer research into the effectiveness of cognitive behavioural therapy during the early pre-cursory stages of psychosis (also known as the "prodrome" or "at risk mental state") suggests that such input can prevent or delay the onset of psychosis.[118]


The word psychosis was first used by Ernst von Feuchtersleben in 1845[119] as an alternative to insanity and mania and stems from the Greek ψύχωσις (psychosis), "a giving soul or life to, animating, quickening" and that from ψυχή (psyche), "soul" and the suffix -ωσις (-osis), in this case "abnormal condition".[120][121] The word was used to distinguish disorders which were thought to be disorders of the mind, as opposed to "neurosis", which was thought to stem from a disorder of the nervous system.[122] The psychoses thus became the modern equivalent of the old notion of madness, and hence there was much debate on whether there was only one (unitary) or many forms of the new disease.[123]

The division of the major psychoses into manic depressive illness (now called bipolar disorder) and dementia praecox (now called schizophrenia) was made by Emil Kraepelin, who attempted to create a synthesis of the various mental disorders identified by 19th century psychiatrists, by grouping diseases together based on classification of common symptoms. Kraepelin used the term 'manic depressive insanity' to describe the whole spectrum of mood disorders, in a far wider sense than it is usually used today. In Kraepelin's classification this would include 'unipolar' clinical depression, as well as bipolar disorder and other mood disorders such as cyclothymia. These are characterised by problems with mood control and the psychotic episodes appear associated with disturbances in mood, and patients will often have periods of normal functioning between psychotic episodes even without medication. Schizophrenia is characterized by psychotic episodes which appear to be unrelated to disturbances in mood, and most non-medicated patients will show signs of disturbance between psychotic episodes.

During the 1960s and 1970s, psychosis was of particular interest to counterculture critics of mainstream psychiatric practice, who argued that it may simply be another way of constructing reality and is not necessarily a sign of illness. For example, R. D. Laing argued that psychosis is a symbolic way of expressing concerns in situations where such views may be unwelcome or uncomfortable to the recipients. He went on to say that psychosis could be also seen as a transcendental experience with healing and spiritual aspects. Arthur J. Deikman suggested use of the term "mystical psychosis" to characterize first-person accounts of psychotic experiences that are similar to reports of mystical experiences. Thomas Szasz focused on the social implications of labeling people as psychotic, a label he argues unjustly medicalises different views of reality so such unorthodox people can be controlled by society. Psychoanalysis has a detailed account of psychosis which differs markedly from that of psychiatry. Freud and Lacan outlined their perspective on the structure of psychosis in a number of works.

Since the 1970s, the introduction of a recovery approach to mental health, which has been driven mainly by people who have experienced psychosis (or whatever name is used to describe their experiences), has led to a greater awareness that mental illness is not a lifelong disability, and that there is an expectation that recovery is possible, and probable with effective support.[citation needed]

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Further reading

  • Sims, A. (2002) Symptoms in the mind: An introduction to descriptive psychopathology (3rd edition). Edinburgh: Elsevier Science Ltd. ISBN 0-7020-2627-1

Personal accounts

  • Dick, P.K. (1981) VALIS. London: Gollancz. [Semi-autobiographical] ISBN 0-679-73446-5
  • Hinshaw, S.P. (2002) The Years of Silence are Past: My Father's Life with Bipolar Disorder. Cambridge: Cambridge University Press.
  • Jamison, K.R. (1995) An Unquiet Mind: A Memoir of Moods and Madness. London: Picador.
    ISBN 0-679-76330-9
  • Schreber, Daniel Paul (2000) Memoirs of My Nervous Illness. New York: New York Review of Books. ISBN 0-940322-20-X
  • McLean, R (2003) Recovered Not Cured: A Journey Through Schizophrenia. Allen & Unwin. Australia. ISBN 1-86508-974-5
  • The Eden Express by Mark Vonnegut
  • James Tilly Matthews
  • Saks, Elyn R. (2007) The Center Cannot Hold—My Journey Through Madness. New York: Hyperion. ISBN 978-1-4013-0138-5

External links


Up to date as of January 23, 2010

From Wikibooks, the open-content textbooks collection

< Psychiatric Disorders

Psychotic disorders include the following disorders: Schizophrenia, Schizoaffective Disorder, Schizophreniform Disorder, Delusional Disorder, Brief Psychotic Disorder, and the Secondary Psychotic Disorders (Psychotic Disorder that are due to medical conditions or to substances). The central feature of these disorders is that they cause psychosis. Psychosis can be thought of as a loss of contact with reality. A person with a psychotic disorder is unable to evaluate properly what is or is not real.

In addition to the primary psychotic disorders, a number of other psychiatric disorders can cause a person to become psychotic. These include the mood disorders, such as psychotic depression, or mania with psychosis.


Thought Disorders

Psychotic disorders represent the failure of normal thought and, hence, they can be categorized as thought disorders. Thought disorders can be divided into different types. Most commonly, they are divided into disorders of process and disorders of content.

Disorders of Thought Process

Disorders of thought process involve a disturbance in the way one formulates thought. Thought disorders are inferred from speech, and often referred to as "disorganized speech." Historically, thought disorders have included associative loosening, illogical thinking, over inclusive thinking, and loss of the ability to engage in abstract thinking. Associative loosening includes circumstantial thought and tangential thought.

Other types of formal thought disorder include:

  • Perseveration: the patient gets stuck on one idea or one thing and cannot move on from there)
  • Clanging: the connections between thoughts may be tenuous, and the patient uses rhyming and punning
  • Neologisms: words that patients make up; often a condensation of several words that are unintelligible to another person
  • Echolalia: the patient repeats back the words of other people, “parrots” people’s speech
  • Thought blocking: stopping mid-thought and being unable to continue with the thought
  • Word salad: an incomprehensible mixing of meaningless words and phrases.
  • For a larger list of thought disorders, see this article

Disorders of Thought Content

Disorders of thought content include hallucinations and delusions.

Hallucinations are perceptions without external stimuli. They are most commonly auditory, but may be any type. Auditory hallucinations are often voices, mumbled or distinct. Visual hallucinations can be simple or complex, in or outside the field of vision (ex. "in head") and are usually of normal color rather than black and white. Olfactory and gustatory hallucinations generally occur together as unpleasant tastes and smells. Tactile or haptic hallucinations may include any sensation—for example, an electrical sensation or the feeling of bugs on skin (formication).

Delusions are fixed, false beliefs, not amendable by logic or experience. There are a variety of types. Delusions are most commonly persecutory, but may be somatic, grandiose, religious or nihilistic. No one type of delusion is specific to any particular disorder (such as schizophrenia). Hallucinations and delusions are common across all cultures and backgrounds; however, culture may influence their content. Culture and religion must be considered when evaluating whether an event is a delusion or hallucination. In this context, a good rule of thumb is that if other people endorse it, it may not be a delusion or hallucination.

Lack of Insight

Truly psychotic persons have a breakdown in the ability to analyze their own thoughts rationally. This may best distinguish psychotic disorders (like schizophrenia) from "normal" misperceptions. Most psychotic patients thus have poor insight into their own illness, which can make compliance with treatment difficult.


Up to date as of February 01, 2010

From Wikia Gaming, your source for walkthroughs, games, guides, and more!


Developer(s) Naxat Soft
Publisher(s) NEC
Release date PC-Engine:
March 1, 1990 (JP)
TurboGrafx 16:
1990 (NA)
Virtual Console:
February 25, 2008 (NA)
February 29, 2008 (EU)
June 24, 2008 (JP)
Genre Scrolling Shoot 'em up
Mode(s) Single player
Age rating(s) N/A
TurboGrafx 16
Virtual Console
Platform(s) PC-Engine
TurboGrafx 16
Virtual Console
Media HuCard
TurboGrafx 16
Input Turbo Pad
Gamecube Controller
Wii Remote
Classic Controller
Credits | Soundtrack | Codes | Walkthrough


This article is a stub. You can help by adding to it.

Stubs are articles that writers have begun work on, but are not yet complete enough to be considered finished articles.

This article uses material from the "Psychosis" article on the Gaming wiki at Wikia and is licensed under the Creative Commons Attribution-Share Alike License.

Simple English

Psychosis is the name used in psychiatry for a number of conditions. People who suffer from psychosis are said to be psychotic. Usually, psychotic people lose touch with reality, they have trouble telling what is real and what is not.

The word psychosis has two parts. The first part comes from psyche, which means soul in Ancient Greek. The second part is the ending '-osis', which means illness or unnatural condition. So literally, psychosis means unnatural condition of the soul.

People with psychosis may have hallucinations, which means they can experience things that are not really there. They may also have delusions, which are fixed beliefs and ideas that are usually false. Sometimes their personality changes, and they cannot think straight. Some of these thoughts may be paranoid. Not every psychotic person has all of these problems.

Because of these, psychotics often act in strange ways, which also makes it difficult for them to live a normal life as part of society. They often have trouble with making friends, as most people do not understand them.

Psychosis can affect people to different levels. Some people can continue with mostly normal lives, while other people will need medical help.

About 1 percent of people suffer from psychosis during their lives.[needs proof]

There are many things that can make someone seem psychotic. These include poisons, drugs, diseases of the nervous system, and other illnesses. For this reason, some people use the image of a fever of the central nervous system to talk about psychosis - a serious illness that may not have a very detailed explanation.[1][2]

Many people have gone through unusual experiences that they believe are real. Hallucinations connected to religion or paranormal experiences seem to be quite common.[3][4] Very often, these experiences cannot be called psychosis in a medical sense of the word. For this reason, some people have said that psychosis may simply be an extreme case of something that is experienced by most.[5] People who have suffered from what could be called psychosis may simply have had experiences that were very strong or distressing.

In movies and the media in general, certain people who are shown as violent and antisocial are sometimes labelled psychotic. This image of psychosis is wrong, the people shown are usually psychopaths or sociopaths, they usually do not have hallucinations or delusions.

Psychosis is most associated with schizophrenia, bipolar disorder, depression, drug addiction and brain damage but it can be caused by a wide range of conditions.


Psychosis is not a disease but rather a name for a number of symptoms, that can be caused by different diseases and conditions. Very broadly speaking there are two types of causes for psychosis:

  1. In some cases, psychosis can be directly linked to a cause. Some of the causes are:
  2. There are certain cases of people who suffer from psychosis, where no cause for the psychosis is clear. In these cases, the causes are usually not known. Current research suggests that some of these psychoses may be linked to genetic factors, or due to certain events during the pregnancy of the mother, or the early childhood of the person suffering from psychosis. The first episode of psychosis may be triggered by stress.


Most psychoses can be treated, so that those suffering from them can lead a normal life. The treatment depends on the cause of the psychosis. In general, there are two different forms of treatment available:


  1. Tsuang, Ming T.; William S. Stone, Stephen V. Faraone (July 2000). [Expression error: Unexpected < operator "Toward Reformulating the Diagnosis of Schizophrenia"]. American Journal of Psychiatry 157 (7): 1041–1050. doi:10.1176/appi.ajp.157.7.1041. PMID 10873908. 
  2. DeLage, J. (February 1955). [Expression error: Unexpected < operator "[Moderate psychosis caused by mumps in a child of nine years.]"]. Laval Médical 20 (2): 175–183. PMID 14382616. 
  3. Tien AY (December 1991). [Expression error: Unexpected < operator "Distributions of hallucinations in the population"]. Soc Psychiatry Psychiatr Epidemiol 26 (6): 287–92. PMID 1792560. 
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  5. Johns, Louise C.; Jim van Os (2001). "The continuity of psychotic experiences in the general population". Clinical Psychology Review 21 (8): 1125–41. doi:10.1016/S0272-7358(01)00103-9. PMID 11702510. Retrieved 2006-08-19. 
  6. Tien AY, Anthony JC (August 1990). [Expression error: Unexpected < operator "Epidemiological analysis of alcohol and drug use as risk factors for psychotic experiences"]. J. Nerv. Ment. Dis. 178 (8): 473–80. PMID 2380692. 
  7. Sharma, Verinder; Dwight Mazmanian (April 2003). "Sleep loss and postpartum psychosis". Bipolar Disorders 5 (2): 98–105. doi:10.1034/j.1399-5618.2003.00015.x. PMID 12680898. Retrieved 2006-09-27. 
  8. Chan-Ob, T.; V. Boonyanaruthee (September 1999). [Expression error: Unexpected < operator "Meditation in association with psychosis"]. Journal of the Medical Association of Thailand 82 (9): 925–930. PMID 10561951. 
  9. Devillieres, P.; M. Opitz, P. Clervoy, and J. Stephany (May-June 1996). [Expression error: Unexpected < operator "[Delusion and sleep deprivation]"]. L'Encéphale 22 (3): 229–31. 
  10. Ohayon, M. M.; R. G. Priest, M. Caulet, and C. Guilleminault (October 1996). "Hypnagogic and hypnopompic hallucinations: pathological phenomena?". British Journal of Psychiatry 169 (4): 459–67. doi:10.1192/bjp.169.4.459. PMID 8894197. Retrieved 2006-10-21. 

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