Table 1.

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

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 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