Psychotic Disorder

Psychotic disorders are serious mental illnesses where people lose touch with reality, experiencing false beliefs or perceiving things that aren’t there. These conditions affect how a person thinks, feels, and behaves, but with proper treatment, many people can recover and live full lives.

Table of contents

• What is a psychotic disorder?
• Signs and symptoms
• Types of psychotic disorders
• What causes psychotic disorders?
• How are psychotic disorders diagnosed?
• Treatment options
• Living with psychotic disorders

What is a psychotic disorder?

Psychotic disorders are a group of serious mental illnesses that cause unusual thinking and perceptions. When someone has a psychotic disorder, they experience psychosis, which means losing some contact with reality. This happens when a person has disruptions in their thoughts that make it hard for them to recognize what is real and what isn’t.^[1][2]

Psychotic disorders are severe mental conditions that cause abnormal thinking and perceptions. People with these disorders lose touch with reality in ways that can be frightening and confusing. The experience affects the most basic functions that give a person a feeling of individuality, uniqueness, and self-direction.^[1]

These conditions are more common than many people realize. Around three percent of all people will experience psychosis in their lifetime. That’s over 11 million Americans. Studies have estimated that as many as three in every 100 people will have an episode at some point in their lives.^[11][18]

Signs and symptoms

The main symptoms of psychotic disorders include delusions and hallucinations. Delusions are false beliefs that a person strongly holds onto, even when others don’t believe them or there’s plenty of evidence that the belief isn’t true. For example, someone might think that the TV is sending them secret messages or that someone is plotting against them.^[1][4]

Hallucinations are false sensory experiences, such as hearing, seeing, or feeling something that is not there. The most common type is hearing voices that aren’t there. A person might also see things that others cannot see, feel someone touching them when no one is there, smell something that others don’t, or taste something despite not having food in the mouth.^[1][5][6]

Beyond delusions and hallucinations, psychotic disorders can cause several other symptoms. These include disorganized thinking or speech, which are patterns of thought that aren’t logical or goal-directed. A person might speak very quickly or slowly, change topics frequently, speak in muddled-up sentences, use the wrong words to describe things, or make up words.^[2][6]

Disorganized behavior involves patterns of behavior that are unpredictable or inappropriate. People might withdraw from family and friends, experience changes in sleep patterns, have decreased attention to personal hygiene, or show behaviors that seem strange or out of character.^[2][6]

Negative symptoms refer to a decrease or loss of normal functioning. For instance, a person may stop expressing emotions, show diminished emotional expression, speak only certain phrases or stop speaking altogether, or lack motivation to start and keep doing activities. These symptoms can continue even after the more obvious symptoms disappear, causing ongoing difficulties in daily life.^[2][15]

Types of psychotic disorders

According to medical classification systems, psychotic disorders include several specific conditions. Schizophrenia is one of the most common types of psychotic disorder. It is a severe condition that typically begins in late adolescence or early adulthood and is found approximately equally in men and women, though the onset tends to be later in women. To be diagnosed with schizophrenia, a person must have two or more active-phase symptoms for at least one month, and continuous signs for at least six months.^[2][4][15]

Schizophreniform disorder is a condition where someone has the same active-phase symptoms as schizophrenia, but the symptoms don’t last as long. Brief psychotic disorder is another type where symptoms appear suddenly but last for a shorter period.^[2][4]

Schizoaffective disorder combines symptoms of psychosis with mood disorder symptoms. Delusional disorder primarily involves strong false beliefs without other major psychotic symptoms. There are also substance or medication-induced psychotic disorders, where psychosis is triggered by drugs, alcohol, or medications, and psychotic disorders due to another medical condition.^[1][4]

Psychosis can also happen with certain types of mood disorders, including bipolar disorder and major depression. People with bipolar disorder may have psychotic symptoms during severe mood episodes.^[1][4]

What causes psychotic disorders?

Psychotic disorders can result from various causes. Many are primary psychiatric disorders, meaning they are mental health conditions in their own right. However, psychosis can also result from medical disorders affecting the brain and body, including Alzheimer’s disease and other types of dementia, hormone-related conditions like Addison’s disease and Cushing’s disease, thyroid problems, infections of the brain or spinal cord, lupus, Lyme disease, multiple sclerosis, stroke, and vitamin B1 and B12 deficiencies.^[1][4]

Other problems that can cause psychosis include alcohol and drug misuse, brain tumors, brain infections, and physical trauma. Severe head injuries, traumatic experiences, and unusually high levels of stress or anxiety can also trigger psychotic symptoms.^[1][4]

Some people may be more likely to develop psychosis if they have a family member with the condition. Studies have shown that childhood trauma, especially sexual and physical abuse and emotional neglect, increases the risk for later development of psychotic symptoms.^[6][19]

In some cases, psychosis follows a specific trigger. A psychotic episode can develop quickly after misuse of alcohol or recreational drugs, particularly amphetamines and hallucinogens. Stopping drug or alcohol use suddenly after long-term consumption can also lead to psychosis. A traumatic experience, extreme stress, or bereavement may trigger symptoms in vulnerable individuals.^[1][5][6]

How are psychotic disorders diagnosed?

Diagnosis of psychotic disorders involves ruling out other mental health conditions and making sure that symptoms aren’t due to substance misuse, medication, or another medical condition. Finding a diagnosis may include a physical exam to rule out other problems that could cause similar symptoms and check for any related complications.^[1][14]

Tests and screenings may include laboratory tests that help rule out conditions with similar symptoms, screening for alcohol and drug use, and imaging studies such as an MRI or CT scan. A healthcare professional or mental health professional checks mental status by noting how a person looks and behaves, and asking about thoughts, moods, delusions, hallucinations, substance use, and potential for violence or suicide. This evaluation includes family and personal history.^[1][14]

Psychiatrists use diagnostic manuals to help them decide if a patient has psychosis. They look for specific symptoms including delusions, hallucinations, disorganized speech, disorganized behavior, and negative symptoms. The timing and duration of symptoms are important for determining which specific psychotic disorder a person has.^[2]

Treatment options

Treatment for psychotic disorders usually involves a combination of medication, talking therapies, and social support. The treatment depends on the cause of the psychosis, but generally aims to control symptoms and help people return to normal functioning.^[1][8]

Antipsychotic medicines are the most common type of medication used to treat psychosis. These drugs work by blocking the effect of brain chemicals called neurotransmitters, such as dopamine, which transmit messages in the brain. Antipsychotic medicines can usually reduce feelings of anxiety within a few hours of use, but they may take several days or weeks to reduce psychotic symptoms such as hallucinations or delusional thoughts.^[1][8]

Antipsychotics can be taken by mouth or given as an injection. There are several slow-release antipsychotics where a person only needs an injection every one to four weeks. These medications can have side effects, including drowsiness, shaking and trembling, weight gain, restlessness, muscle twitches and spasms, blurred vision, dizziness, constipation, loss of sex drive, and dry mouth. If side effects become troublesome, there may be alternative medications available that cause fewer problems.^[8][20]

Other medications may also be helpful, including antidepressants or lithium for certain conditions. In some cases, treating an underlying medical cause is the only treatment needed.^[4][9]

Talking therapies can help reduce the intensity and anxiety caused by psychosis. Cognitive behavioral therapy (CBT) for psychosis helps people make sense of their experiences and understand why some experiences cause distress. A CBT therapist may encourage a person to consider different ways of understanding what’s happening to them, with the aim of reducing distress and helping them return to work, education, or training.^[8][20]

Family intervention is known to be an effective form of therapy for people with psychosis. It’s a way of helping both the person and their family cope with the condition. Family therapy involves a series of meetings over several months and may include discussing the condition, exploring ways of supporting someone with psychosis, and deciding how to solve practical problems caused by psychotic episodes.^[8][20]

For severe cases of psychosis, especially when a person may be dangerous to themselves or others, hospitalization may be necessary. Brief seclusion or restraint may be required if a patient becomes aggressive and combative. If symptoms are only minimally impairing function and a specific stressor is identified, removing the stressor may be sufficient for treatment.^[1][12]

Treatment is likely to involve a team of mental health professionals working together. If this is a person’s first psychotic episode, they may be referred to an early intervention team specifically set up to work with people experiencing their first episode of psychosis. These teams provide a full assessment of needs, medication, talking therapies, and social, occupational, and educational interventions.^[8]

Living with psychotic disorders

The outlook for people with psychotic disorders varies widely. Schizophrenia follows a variable course, with complete symptomatic and social recovery in about one-third of cases. Almost half the individuals initially developing schizophrenia can expect a full and lasting recovery with modern advances in drug therapy and psychosocial care. It has been repeatedly demonstrated that schizophrenia follows a less severe course in developing countries.^[15]

Some people may experience only a few episodes of psychosis or a brief episode that lasts for a few days or weeks. Others will experience symptoms more frequently in association with a longer-term illness. The period of time where people experience psychotic symptoms is known as an episode of psychosis. Symptoms may last a day, weeks, months, or longer.^[5][11]

Even after the more obvious symptoms have disappeared, some residual symptoms may remain. These include lack of interest and initiative in daily activities and work, social difficulties, and inability to take interest in pleasurable activities. These can cause continued disability and place a considerable burden on families.^[15]

People with a history of psychosis are more likely than others to have drug or alcohol misuse problems. Some people use these substances as a way of managing psychotic symptoms, but substance use can make psychotic symptoms worse or cause other problems. People with psychosis also have a higher than average risk of self-harm and suicide.^[5]

Getting immediate medical help for a psychotic episode is vital. It’s important that psychosis is treated as soon as possible, as early treatment can be more effective. With proper treatment including medication and community support, psychotic symptoms can be relieved or even eliminated. Early diagnosis and treatment can make a significant difference in outcomes.^[5][6][11]