Psychotic Disorders: Types, Symptoms, Diagnosis, Treatment

Know the early warning signs of schizophrenia.

Schizophreniform disorder

This is a psychiatric condition where you have the same active-phase symptoms as schizophrenia, but your symptoms only last 1-6 months.

Find out more on schizophreniform disorder symptoms to look for.

Schizoaffective disorder

This is when you have active-phase symptoms of schizophrenia and at the same time as those symptoms, you have symptoms of a mood disorder, such as depressive or manic episodes.

Learn more about the symptoms of schizoaffective disorder.

Delusional disorder

This is when you have one or more delusional thoughts for at least 1 month that can't be explained by another condition.

Read more on the types of delusions.

Brief psychotic disorder

This is a psychiatric condition where you have sudden onset of psychosis that lasts less than 1 month and then goes completely into remission when you take an antipsychotic. Sometimes this may be triggered by a stressful event or trauma.

Get more information about the different forms of brief psychotic disorder.

Psychotic Disorder Symptoms

People with psychoses don’t always have the same symptoms, and they may change over time in the same person. There are five symptoms that characterize psychotic symptoms, including:

Delusions

These are false beliefs that don’t go away even after you have evidence that the belief is wrong. For example, a person who is certain their food is poisoned, even if someone has shown them that the food is not poisoned, may have a delusion. There are several types of delusions, such as:

• Persecutory (most common), where you may believe someone is "out to get you."
• Referential, where you think that things in your external environment are directed at you. For instance, you may think the people on the TV are talking directly to you.
• Grandiose, where you may have an over-the-top view of your own abilities.
• Erotomaniac, where you believe other people who you may not know well are in love with you.
• Nihilistic, where you believe a major catastrophe is just about to happen.
• Somatic, where you believe you have something medically or biologically wrong with you.

Delusions can be bizarre, where they are outside the realm of possibility or beyond the physical laws of the universe. They can also be non-bizarre, where they are plausible but nevertheless not true. 

Hallucinations

These are things you think you see, hear, smell, touch, or taste, but that don’t exist. For instance, someone might see things that aren't there, hear voices, smell odors, have a "funny" taste in their mouth, or feel sensations on their skin even though nothing is touching their body. 

People with schizophrenia spectrum disorders seem to have auditory hallucinations most commonly. People with severe alcohol withdrawal may have visual and tactile hallucinations most often. People with Lewy body dementia most often have visual hallucinations.

Disordered thought or speech

This is when you struggle to organize your thoughts while speaking. You may:

• Be unable to give a direct answer to a question without giving excessive, unnecessary, or unrelated detail. 

• Go off on tangents or become incoherent. People may describe your speech as "word salad," which is speech that is unintelligible or a jumble of incoherent words. 

• Create and use new words or phrases that don't mean anything to other people.

• Repeat words or statements over and over.

Causes of Psychotic Disorders

Doctors don't know the exact cause of psychotic disorders. Researchers believe that psychotic symptoms are caused by a combination of different factors, such as:

• Your genes
• The way your brain develops over time
• Exposure to stressors and trauma
• In older adults, physical or mental illnesses

Researchers think that the "positive" symptoms of psychosis (delusions, hallucinations, disordered thoughts and speech, and disorganized movement) may be related to a change in the balance of at least some of your brain chemicals called neurotransmitters. For instance, you may have too much dopamine and glutamate in a particular area of your brain called the mesolimbic tract. The mesolimbic tract is sometimes called your brain's "reward pathway" since it helps move dopamine (the reward chemical) from your midbrain to your forebrain (where you make decisions).

Some studies also show that people with schizophrenia may have problems with the neurotransmitters gamma-amino-butyric acid (GABA) and acetylcholine.

What can trigger a psychotic episode?

Psychosis can be caused by many different conditions, including:

• Psychiatric and neuropsychiatric conditions, especially schizophrenia spectrum disorders
• Neurological conditions, such as epilepsy
• Medical conditions, such as Parkinson's disease or Alzheimer's disease
• Mood disorders, such as major depressive disorder or bipolar disorder
• Substance use disorders or withdrawal

Psychotic Disorder Diagnosis

Your doctor will need to do an extensive medical workup on you because your symptoms could be caused by a lot of different conditions or substances. You may get tests, such as:

Imaging tests, such as CT and MRI to check for medical conditions such as stroke, brain injury, and tumors.

Laboratory tests on your blood, pee, and cerebrospinal fluid. These tests can help rule out heavy metal toxicity, poisoning, and infections that may be causing your symptoms.

Brain activity testing with an electroencephalogram (EEG) to help rule out conditions like epilepsy.

If your doctor can't find a physical reason for your symptoms, they may refer you to a psychiatrist or psychologist. These mental health professionals will use specially designed interview and assessment tools to help them decide whether you have a psychotic disorder.

Psychotic Disorder Treatment

Your treatment will depend on what is causing your psychotic symptoms. In general, the earlier you get treatment, the better your chance of recovery. Any person with psychotic symptoms should see a psychiatrist for an evaluation.

You will usually need to see a team of doctors that includes a psychologist, psychiatrist, or social worker who can develop a treatment plan. Most people with a psychotic disorder do better if they have coordinated specialty care that focuses on recovery and includes shared decision-making between your doctors, you, and your family members or caregivers. 

Coordinated specialty care includes multiple phases, such as:

• Individual or group psychotherapy. This is personalized to your recovery goals. For instance, cognitive and behavioral therapies can help you develop the knowledge and skills you need to cope with challenging aspects of your condition and achieve your personal goals.
• Family support and education programs. This helps your family members or caregivers learn about your condition and effective ways to help you cope, communicate, and problem-solve.
• Medication management. This includes individualizing the types and doses of all your medicines to meet your recovery goals.
• Employment and education services. This may include coaching to support your return to school or work and help you meet your professional goals.
• Case management. This gives you access to a case manager who can help you address practical problems with your treatment and help you get access to any support services you may need.

Medication for psychotic disorders

Most people with a psychotic disorder or having a psychotic episode will need a prescription for an antipsychotic. Although these medicines aren’t a cure, they are effective in managing the "positive" symptoms of psychotic disorders, such as delusions, hallucinations, and disorganized thoughts and behavior. They work by changing how your brain uses your neurotransmitters.

First-generation antipsychotics include:

• Chlorpromazine
• Fluphenazine
• Haloperidol (Haldol)
• Loxapine
• Perphenazine
• Thioridazine

You may also need other medications to help you manage your negative symptoms, such as benzodiazepines for catatonic symptoms. You may also need medicines to address some of the side effects of your antipsychotic medicines. It's important that you work with your doctor to find the right combination of medicines for you. And be patient because it can take several weeks or months for you to see improvement.

People who are particularly agitated or aggressive or who are at risk of harming themselves or others may need to be hospitalized until their symptoms are stabilized. However, most people with psychotic disorders are treated as outpatients, meaning they don’t live in an institution. 

Recovering From Psychotic Disorders

Each person being treated for a psychotic disorder may respond to therapy differently. Some will show improvement quickly. For others, it may take weeks or months to get symptom relief.

Some people may need to continue treatment for an extended time. Some, such as those who have had several severe episodes, may need to take medication indefinitely. In these cases, the medication usually is given in as low a dose as possible to minimize side effects.

Can psychotic disorders be cured?

In general, no, a psychotic disorder cannot be cured, but this depends on the kind of disorder you have. Individual psychotic episodes are usually treatable. About 25% of people who have a psychotic episode never have another. 

About 50% of people will have more than one psychotic episode, but they are still able to live relatively normal lives with treatment. Some people need ongoing support throughout their lives.

What Is the Outlook for People With Psychotic Disorders?

The depends on the type of psychotic disorder and the person who has it. But these disorders are treatable, and most people will have a good recovery with treatment and close follow-up care.

Can Psychotic Disorders Be Prevented?

No. But the sooner treatment starts, the better. It helps to prevent symptoms. Seeking help as soon as possible can help the person's life, family, and relationships.

For people who are at high risk for psychotic disorders, such as those who have a family history of schizophrenia, avoiding drugs such as marijuana and alcohol may help to prevent or delay these conditions.

Takeaways

Psychotic disorders are a group of serious mental illnesses that have a cluster of symptoms called psychosis. These symptoms include hallucinations, delusions, disorganized thoughts, speech, and actions, and negative symptoms, such as lack of motivation. Schizophrenia spectrum disorders, such as schizophrenia, schizophreniform disorder, and schizoaffective disorder, are probably the most well-known psychotic disorders. This is because psychosis is the defining characteristic of these conditions. To diagnose you with a psychotic disorder, your doctor will need to do an extensive workup because they need to rule out other causes of your psychotic episode, such as substance withdrawal or an underlying medical condition. Treatment will usually take a multi-faceted approach including an antipsychotic medicine, other medicines necessary to manage your symptoms, cognitive or behavioral therapy, and other support services you need to meet your treatment goals.

Psychotic Disorders FAQs

Is bipolar disorder a psychotic disorder?

Not generally; however, some people with bipolar I disorder may have delusions and hallucinations during a manic episode. This can make it challenging for your doctor to distinguish between bipolar disorder and a schizophrenia spectrum disorder. People who have any symptoms of psychosis should always be evaluated by a psychiatrist to help ensure they get the correct diagnosis.