Assessment of psychotic disorders among prelingually deaf individuals

PURPOSE: This review discusses the assessment of psychotic disorders in prelingually deaf patients and the related challenges. VIEWS: Although prelingually deaf patients are often diagnosed with psychotic disorders, the clinical presentation of this group is complex and no clear guidelines regarding the assessment process can be formulated due to the lack of valid, reliable research. Sign language dynamics or language dysfluency may be falsely recognized as disorganized thinking. Some of the symptoms indicating disorganized thinking in the case of spoken languages may fulfill specific functions when used in sign language (for example object chaining). Furthermore, deaf individuals experience multiple stressors that may be considered as risk factors for developing delusions, especially for those growing up in hearing, non-signing families. Nevertheless, it is important to acknowledge that some seemingly delusional beliefs shared by prelingually deaf people may be associated with the lack of assisted learning, gullibility, low level of confidence in healthcare or deaf communities’ social norms. The question concerning the sensory modality of hallucinations experienced by deaf individuals remains unresolved. Patients’ accounts suggest that hallucinations described as auditory may be perceived as lip-reading without identifying the speaker’s face, among others. However, for those who provide help it is far more important to recognize the function of hallucinations and to differentiate them from normative experience. CONCLUSIONS: It is essential to expand our knowledge regarding the clinical presentation of psychotic disorders in deaf individuals in order to develop assessment guidelines and tools and, above all, increase the well-being of those suffering from psychotic disorders, as well as of those whose diagnosis remains unclear.