Types of Psychotic Disorders
Losing contact with reality is a major feature
Medically reviewed by Lindsay Cook, PharmDFact checked by Nick Blackmer
Psychotic disorders are severe mental health disorders that cause abnormal thinking and perceptions. Persons with a psychotic disorder often lose touch with reality and may experience symptoms like delusions and hallucinations. There are several different types of psychotic disorders, and they each have diagnostic criteria described in the fifth edition of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5).
Psychotic disorders can be highly distressing, impacting a person’s quality of life and ability to maintain self-care. However, most of these conditions can be managed with medication and therapy.
If you or a loved one is diagnosed with a psychotic disorder, it’s important to maintain consistent psychiatric care to help reduce the effects of your disorder on your life. This article lists the different types of psychotic disorders, as well as their associated symptoms and treatment options.
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Types of Psychotic Disorders
The different types of psychotic disorders include:
Schizophrenia: Schizophrenia is characterized by delusions, hallucinations, disorganized thoughts and speech, unusual behavior, and withdrawal.
Schizoaffective disorder: This disorder is defined as having symptoms of both schizophrenia and a mood disorder (such as depression or bipolar disorder).
Schizophreniform disorder: Persons with schizophreniform disorder present with symptoms of schizophrenia that last longer than one month and for less than six months.
Delusional disorder: Those with delusional disorder have false beliefs involving real-life situations. For example, a person with the disorder may falsely believe that someone is plotting against them or that a partner is being unfaithful.
Brief psychotic disorder: This condition is defined by an episode of psychotic behavior that lasts for less than one month.
Substance/medication-induced psychotic disorder: Certain drugs, including not only illicit drugs such as hallucinogens and stimulants but also prescribed medications such as steroids and antiepileptic drugs, can trigger short-term or long-term symptoms of psychosis.
Psychotic disorder due to another medical condition: Some medical conditions can cause hallucinations and/or delusions. This can result from conditions like traumatic brain injury or dementia.
Shared psychotic disorder: This is a rare disorder in which two or more people in a close relationship share a specific delusion. In such cases, a person without mental illness may start to believe the delusions of another person who has a psychotic disorder. In the most recent edition of DSM-5, DSM-5-TR, this disorder is called “delusional symptoms in the context of relationship with an individual with prominent delusions.”
Psychotic Disorder Symptoms
Psychotic disorders are characterized by a loss of touch with reality characterized by altered thinking, perceptions, and behavior.
Often, people who have psychotic disorders also manifest behavioral symptoms. Symptoms of psychotic disorders are often characterized as positive or negative.
Positive symptoms refer to additional behaviors that arise after an individual develops the condition, such as:
Hallucinations
Delusions
Disorganized thoughts and speech
Negative symptoms represent normal behaviors that are absent or reduced. They include:
Withdrawal from others
Diminished emotional expression
Many psychotic disorders are lifelong illnesses, often beginning during early adulthood. They may progress or stabilize over time. Some psychotic disorders are limited in their duration, however, and can resolve.
Hallucinations
Hallucinations are false sensory experiences. The most common are visual hallucinations (seeing things that aren’t real) or auditory hallucinations (hearing voices that aren’t real). Other false sensations, such as smell, taste, or touch, are less common with psychotic disorders, but they can occur.
Hallucinations can occur intermittently, and they may follow a theme, such as repeatedly hearing voices giving commands or seeing a specific type of animal or person that isn’t really there.
Delusions
Delusions are fixed false beliefs. In persons with psychotic disorders, the delusions often involve a sense of persecution and a belief that other people are sabotaging or harming them.
Sometimes delusions are grandiose, and a person might believe that they have special powers, mission, wealth, or identity.
Takeaway
It is not unusual for someone who has a psychotic disorder to experience grandiose delusions along with delusions about persecution.
A person who has a psychotic disorder might share some of the details of their delusions with a few trusted people, but could be worried that everyone is in on the conspiracy or may avoid telling loved ones about the beliefs in an effort to protect them.
Behavioral Symptoms
Some of the behavioral effects of psychotic disorders include:
Speaking incoherently
Erratic or odd behaviors
Agitation
Restlessness
Negative symptoms of psychotic disorders can include:
Apathy
Withdrawal
Lack of emotional expressions
Lack of self-care
Negative symptoms are not usually as disruptive as hallucinations and delusions, and they can go unnoticed by family and friends, and even by the person who is experiencing them.
A key characteristic of psychotic disorders is that a person may have a lack of insight into their symptoms—genuinely believing their hallucinations or delusions to be true. Additionally, they may not be aware of any abnormal behaviors.
Complications
Psychotic disorders can result in a number of complications, including:
Lack of self-care: This can cause a person to neglect things like eating, changing clothes, and/or bathing.
Inability or unwillingness to seek medical attention: If a person does not receive medical care for symptoms like pain or discomfort, this can allow physical problems to worsen. This can potentially lead to complications of infections, injuries, or medical illnesses. Medical problems can also exacerbate the symptoms of a psychotic condition.
Suicidal ideation: People who have a psychotic condition may think about or attempt suicide.
Takeaway
If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.
For more mental health resources, see our National Helpline Database.
Causes
Genetics
Psychotic conditions have a strong genetic component. They are more common among people who have one or more family members with a psychotic disorder. However, a person can develop one of these conditions without having a family history, and a person who has family members with psychotic disorders will not necessarily develop one.
The specific genes involved in psychotic disorders are not well established. Psychotic disorders are associated with brain and neurotransmitter dysfunction. Disruption of dopamine and serotonin, among others, is believed to play a role in these conditions.
Changes in Brain Structure
Certain psychotic disorders are associated with brain atrophy (shrinking) in certain parts of the brain, such as the frontal and/or temporal lobes. Sometimes the ventricles of the brain can be enlarged.
Other Causes
The presence of certain antibodies has also been associated with psychotic disorders, but the overall significance of immune dysfunction in psychotic disorders is not clear.
Diagnosis
The diagnosis of psychotic disorders is based on a set of criteria that is used for each of these conditions. The criteria generally include a list of thoughts, behaviors, and duration of symptoms. Usually, diagnosis of a psychotic disorder requires that a person has a certain number or combination of the clinical criteria, not necessarily all of them.
A medical evaluation for a possible psychotic disorder will likely include:
Obtaining a complete medical and psychiatric history
A neurological exam
Cognitive testing
Some of the symptoms of psychotic disorders occur due to other medical, neurological, and psychological conditions. If your assessment does not meet the criteria for a psychotic disorder and/or there is concern that you also might have another medical condition, you might have further diagnostic testing.
There are no blood tests or imaging tests that are considered indicative or that can confirm psychotic disorders. However, diagnostic tests may be used to rule out other potential causes of the symptoms.
Related: Different Types of Psychosis
Diagnostic tests you might need include:
Blood tests, such as complete blood count (CBC) for evidence of an infection or inflammation
Urine drug screening
Electroencephalogram (EEG)
These tests can help determine if there are other causes of your symptoms. For example, a brain tumor, which can be identified with brain imaging studies, might cause visual hallucinations.
Encephalitis (inflammation of the brain, often caused by an infection), which could be identified with brain imaging or LP, can cause changes in behavior. Some types of liver disease can cause mental status changes that can seem similar to psychotic disorders.
Treatment
The treatment of a psychotic disorder is tailored to the underlying condition and may include a combination of prescription medication and counseling. You may be prescribed one or more antipsychotic medications, and you might also be prescribed a medication for treatment of a mood disorder if present.
Your healthcare provider will likely also recommend that you have counseling or psychotherapy as part of your treatment plan for your psychotic disorder. Both of these therapies involve talking with a trained professional. Counseling can help address specific concerns, whereas psychotherapy can help you identify and change unhealthy emotions, thoughts, and behaviors.
Medications used to treat psychotic disorders include typical antipsychotics and atypical antipsychotics. Medications in both of these categories can control symptoms, and your healthcare provider will work with you to determine which might be best for managing your condition.
Some typical antipsychotics include:
Haldol (haloperidol)
Adasuve (loxapine)
Fluphenazine (generic)
Thiothixene (generic)
Thioridazine (generic)
Trifluoperazine (generic)
The most common side effect of these medications is sleepiness. Typical antipsychotics are associated with extrapyramidal side effects—tremors, spasms, muscle rigidity, and diminished control of movement. Side effects can diminish with medication adjustments, but sometimes extrapyramidal symptoms remain even after the medication is discontinued.
Some atypical antipsychotics include:
Clozaril (clozapine)
Abilify (aripiprazole)
Risperdal (risperidone)
Zyprexa (olanzapine)
Seroquel (quetiapine)
Atypical antipsychotics are not as likely to cause extrapyramidal side effects as typical antipsychotics. They can cause side effects, including constipation, sleepiness, weight gain, high cholesterol, and decreased sex drive.
You might have episodes during which the effects of your psychotic condition worsen substantially, necessitating in-patient treatment. During this time, you will be kept safe, and your medication may be adjusted. Any other medical problems that you have (like an infection) would be managed as well.
Coping
Living with a psychotic disorder can be challenging. You might have fluctuations in your symptoms, and you can experience side effects from your medications.
It can be difficult for you to keep up with employment, and your relationships and social life can be affected as well. The social stigma can affect your life and the lives of your family members.
As you are coping with your condition, it’s important that you know that your psychotic disorder is not something that you or anyone else is to blame for. It is an illness, just like any other medical condition. You might consider some approaches that could help you cope with your condition to optimize your quality of life.
Counseling/Therapy
Managing your psychotic illness doesn’t have to stop with controlling the symptoms. You might have concerns or apprehensions about your condition. Speaking with a professional therapist or with your psychiatrist about any feelings you have about your condition can help.
Join a Support Group
Sometimes, interacting with others who are going through the same things you are going through can help you feel less alone. Some support groups are moderated by a professional, and you might find a professionally moderated group to be a good type of group for you. Give yourself time to find a group that makes you feel comfortable.
When you feel that the time is right, you can also be a valuable source of support for others who are searching for hope and camaraderie.
Family/Community
How much you want to share about your condition is up to you. However, since psychotic illnesses are characterized by altered perceptions of reality, it would be beneficial if you could talk about your condition with one or more people whom you trust. They can be resources for help if your symptoms worsen or if you need urgent medical attention.
Caregiver Support
Psychiatric disorders affect the quality of life of the people who are experiencing them, as well as the lives of family, friends, and loved ones. If someone who is a part of your life is showing the symptoms of a psychotic disorder or has been diagnosed with a psychotic illness, the condition can cause distress for you as well.
Even though you want to maintain a relationship with your parent, sibling, spouse, child, or friend suffering from psychosis, you might not know how best to do so when they have a psychotic disorder.
Talking with someone who you care about when they are not in touch with reality can be overwhelming and you might not know how much you should engage in a discussion about their delusions or hallucinations.
It may be important that you seek professional guidance as you navigate the challenges that your loved one’s illness can pose in your own life, rather than trying to learn how to do it on your own.
Consider seeking professional counseling or therapy and/or joining a support group so you can learn how to manage your relationship and how to participate in their care in the way that works best for you.
You and the person you care about might also decide that you can accompany them to their healthcare appointments and/or help them as they manage their medical and psychiatric care.
You should also make sure that you or another trusted friend, family member, or caregiver understand the signs of an emergency that might necessitate urgent medical attention. Make sure to have a plan in place for getting urgent medical help if needed.
Takeaway
If you or a loved one are struggling with a psychotic disorder, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.
For more mental health resources, see our National Helpline Database.
Outlook for Psychotic Disorders
The prognosis for psychotic disorders can vary. It largely depends on the underlying cause and whether someone is receiving appropriate treatment. Some mental illnesses like schizophrenia can be difficult to treat and may often present with chronic symptoms.
That said, you can have an emotionally and physically healthy life if you are living with a psychotic disorder. This involves maintaining consistent psychiatric and medical care. A community support structure from family, friends, and a healthcare team can help optimize the quality of life for a person who is living with a psychotic illness.
Summary
Psychotic disorders are mental health disorders in which a person loses touch with reality. People with these types of disorders may experience symptoms like delusions or hallucinations. Treatment varies depending on the cause, but it often includes a combination of prescription medication and counseling.
Because insight may be impaired in psychotic illness, it can be difficult to know when symptoms are recurring or when medication adjustments are needed. Therefore, having a routine for taking medications and going to medical appointments can help with this process.
Read the original article on Verywell Health.
