Psychotic disorders are severe mental disorders that cause abnormal thinking and perceptions. People with psychoses lose touch with reality. Two of the main symptoms are delusions and hallucinations. Delusions are false beliefs, such as thinking that someone is plotting against you or that the TV is sending you secret messages. Hallucinations are false perceptions, such as hearing, seeing, or feeling something that is not there.
They make it hard for someone to think clearly, make good judgments, respond emotionally, communicate effectively, understand reality, and behave appropriately.
When symptoms are severe, people with psychotic disorders have trouble staying in touch with reality and often are unable to handle daily life. But even severe psychotic disorders usually can be treated.
The percentage of people who suffer from any psychotic symptom at any one time (prevalence) varies greatly from country to country, from as little as 0.66% in Vietnam to 45.84% in Nepal. While the figure of one out of 100 people who qualify for the diagnosis of schizophrenia may sound low, that translates into about 3 million people in the United States alone who have schizophrenia. Except for the usually middle-aged onset of delusional disorder (around 48 years of age), the first time a person has psychotic symptoms is usually between the ages of 18-24 years, with related but less severe (prodromal) symptoms often start during the teenage years. Statistics for postpartum psychosis include that it occurs in one or two out of 1,000 births but increases greatly, up to one in seven mothers, in women who had postpartum psychosis in the past. Men are thought to develop psychotic illnesses more often and at younger ages than women.
Hallucinations means seeing, hearing, or feeling things 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.
Delusions are false beliefs that don’t go away after even after they’ve been shown to be false. For example, a person who is certain his or her food is poisoned, even if someone has shown them that the food is fine, has a delusion.
Other possible symptoms of psychotic illnesses include:
- Disorganized or incoherent speech
- Confused thinking
- Strange, possibly dangerous behavior
- Slowed or unusual movements
- Loss of interest in personal hygiene
- Loss of interest in activities
- Problems at school or work and with relationships
- Cold, detached manner with the inability to express emotion
- Mood swings or other mood symptoms, such as depression or mania
- People don’t always have the same symptoms, and they can change over time in the same person.
There are different types of psychotic disorders, including:
Schizophrenia: People with this illness have changes in behavior and other symptoms — such as delusions and hallucinations — that last longer than 6 months. It usually affects them at work or school, as well as their relationships.
Schizoaffective disorder: People have symptoms of both schizophrenia and a mood disorder, such as depression or bipolar disorder.
Schizophreniform disorder: This includes symptoms of schizophrenia, but the symptoms last for a shorter time: between 1 and 6 months.
Brief psychotic disorder: People with this illness have a sudden, short period of psychotic behavior, often in response to a very stressful event, such as a death in the family. Recovery is often quick — usually less than a month.
Delusional disorder : The key symptom is having a delusion (a false, fixed belief) involving a real-life situation that could be true but isn’t, such as being followed, being plotted against, or having a disease. The delusion lasts for at least 1 month.
Shared psychotic disorder (also called folie à deux): This illness happens when one person in a relationship has a delusion and the other person in the relationship adopts it, too.
Substance-induced psychotic disorder: This condition is caused by the use of or withdrawal from drugs, such as hallucinogens and crack cocaine, that cause hallucinations, delusions, or confused speech.
Psychotic disorder due to another medical condition: Hallucinations, delusions, or other symptoms may happen because of another illness that affects brain function, such as a head injury or brain tumor.
Paraphrenia: This condition has symptoms similar to schizophrenia. It starts late in life, when people are elderly.
Psychotic disorder facts
Psychotic disorders include schizophrenia and a number of lesser-known disorders.
The number of people who develop a psychotic disorder tends to vary depending on the country, age, and gender of the sufferer, as well as on the specific kind of illness.
There are genetic, biological, environmental, and psychological risk factors for developing a psychotic disorder.
Usually, with any psychotic disorder, the person’s thoughts and behavior have notably deteriorated.
When assessing a person suffering from psychotic symptoms, health care professionals will take a careful history of the symptoms from the person and loved ones as well as conduct a medical evaluation, including necessary laboratory tests and a mental health assessment.
Most effective treatments for psychotic disorders are comprehensive, involving appropriate medication, mental health education, and psychotherapy for the sufferer of psychosis and his or her loved ones. It will also include the involvement of community support services, which patients often need.
Prevention of psychosis primarily involves preventing or decreasing the impact of factors that put the person at risk for developing a psychotic disorder.
Behavior changes that might occur during a psychotic break include the following:
- Social withdrawal/social isolation or loneliness
- Agitation, restlessness, hyperactivity, or excessive excitement
- Anxiety, nervousness, fear, or hypervigilance
- Hostility, anger, aggression
- Depersonalization (a combination of intense anxiety and a feeling of being unreal, detached from oneself, or that one’s thoughts are not one’s own)
- Loss of appetite
- Worsened hygiene and a lack of self-care
- Disorganized speech like rapid and frenzied speaking, incoherent speech, and excessive wordiness
- Disorganized behaviors, like a lack of discretion or restraint
- Catatonic behavior, in which the affected person’s body may be rigid and the person may exhibit persistent repetition of words, a deficiency of speech, or be physically and/or verbally unresponsive. The catatonic individual might also engage in repetitive movements, slowness in activity, and thought or nonsense word repetition.
- Changes/problems with thinking that may occur in a psychotic disorder include delusions (beliefs with no basis in reality),hallucinations (for example, hearing, seeing, or perceiving things not actually present),the sense of being controlled by outside forces, and disorganized thoughts.
A person with a psychotic disorder may not have any outward characteristics of being ill. In other cases, the illness may be more apparent, causing bizarre behaviors. For example, a person suffering from psychosis may stop bathing in the belief that it will protect against malicious individuals from attacking them.
People with psychosis vary widely in their behavior as they struggle with an illness beyond their control. Some may ramble in illogical sentences or react with uncontrolled anger or violence to a perceived threat. Characteristics of a psychotic illness may also include phases in which the affected individuals seem to lack personality, movement, and emotion (also called a flat affect). People with a psychotic disorder may alternate between these extremes. Their behavior may or may not be predictable.
In order to better understand psychotic diseases, the concept of clusters of symptoms is often used. Thus, people with psychosis can experience symptoms grouped under the following categories:
Positive symptoms: hearing voices that are not actually present (auditory hallucinations) or other hallucinations (seeing things: visual hallucinations; feeling things: tactile hallucinations; smelling things: olfactory hallucinations, or tasting things: gustatory hallucinations); suspiciousness to the point of paranoia, feeling that one is under frequent or constant surveillance or pursuit (persecutory delusions), religious delusions like feeling one is a deity or other false belief of superiority; or making up words without a meaning (neologisms)
Negative symptoms (deficit symptoms): social isolation, limited range of emotions, difficulty in expressing emotions (in extreme cases called blunted affect), difficulty in taking care of themselves, inability to feel pleasure, general discontent (These symptoms cause severe impairment.)
Cognitive symptoms: difficulties thinking and understanding information, remembering simple tasks, attending to and processing information, and understanding their environment confusion
Affective (or mood) symptoms: often manifested by depression, accounting for a very high rate of having thoughts and attempts at suicide in people suffering from schizophrenia and other types of psychotic disorders
Postpartum psychosis, now described as brief psychotic disorder with postpartum onset, usually develops within the first three months after childbirth, often within three to 14 days. Symptoms may include auditory or visual hallucinations, delusions, or rapid mood swings. The hallucinations may have themes of violence toward herself or her baby. This condition may be associated with significant problems in thinking, ranging from disorientation and other symptoms of mental confusion and indecision to intrusive and bizarre thoughts. Also, symptoms can arise and disappear suddenly, with the mother appearing lucid one moment and exhibiting psychotic behavior the next.
Most psychotic disorders are treated with a combination of medications and psychotherapy, which is a type of counseling.
Medication: The main type of drug that doctors prescribe to treat psychotic disorders are “antipsychotics.” Although these medicines aren’t a cure, they are effective in managing the most troubling symptoms of psychotic disorders, such as delusions, hallucinations, and thinking problems.
Older antipsychotics include:
Newer “atypical antipsychotics” include:
Paliperidone palmitate (Invega Sustenna, Invega Trinza)
Because the risk of relapse of illness is higher when antipsychotic medications are taken irregularly or discontinued, it is important that people with a psychotic disorder follow a treatment plan developed in collaboration with their doctors and with their families. The treatment plan will involve taking the prescribed medication in the correct amount and at the times recommended, attending follow-up appointments, and following other treatment recommendations.
People with psychosis often do not believe that they are ill or that they need treatment. Other possible things that may interfere with the treatment plan include side effects from medications, substance abuse, negative attitudes toward treatment from families and friends, societal stigma about mental illness, or even unrealistic expectations about treatment. When present, these issues need to be acknowledged and addressed for the treatment to be successful.
causes and risk factors
Some medical diseases or the use of certain substances may cause psychotic disorders. For most psychotic disorders, specific causes are unknown. However, physicians believe the interplay of inherited (familial), biological, environmental, and psychological factors is involved. We do not yet understand all of the causes and other issues involved, but current research is making steady progress toward elucidating and defining causes of psychosis. For example, schizophrenia and bipolar disorder have many risk factors in common.
In biological models of psychotic disorders, researchers have investigated genetic predisposition, infectious agents, toxins, allergies, and disturbances in metabolism. Psychotic disorders run in families. For example, the risk of the disease in an identical twin of a person with schizophrenia is 40%-60% and in other siblings is 5%-15%. A child of a parent suffering from schizophrenia has about a 10% chance of developing the illness, in contrast to the risk of schizophrenia in the general population being about 1%. Toxins like ketamine or marijuana increase the risk of developing acute (rapid onset) psychosis.
The current concept is that multiple genes are involved in the development of schizophrenia and that risk factors such as prenatal (intrauterine), perinatal (around the time of birth), and nonspecific stressors are involved in creating a disposition or vulnerability to develop the illness. Neurotransmitters (chemicals involved in the communication among nerve cells) have also been implicated in the development of psychotic disorders. The list of neurotransmitters under scrutiny is long, but researchers give special attention to dopamine, serotonin, and glutamate.
Also, recent research studies have identified subtle changes in brain structure and function, indicating that, at least in part, schizophrenia could be a disease of the development of the brain. The fact that autism is a risk factor for developing psychosis during childhood seems to support that theory. Psychosis is more likely to occur in people who have poor medical health in a general sense or who suffer from another mental illness.
Environmental risk factors, like a history of problem drinking, using tobacco, marijuana, or other drugs, have been associated with the development of a psychotic disorder.
There are a number of medical risk factors for psychotic disorders. Steroid-induced psychosis is one example of the risk of certain medications causing this illness. Women who have recently delivered a baby (in the postpartum state) are at risk for a number of mental health problems, including postpartum psychosis. More than 25% of mothers with bipolar I disorder (those who have ever suffered from a full-blown manic episode, with possible symptoms of racing or other unwanted thoughts, pressured speech, and decreased need for sleep) may develop postpartum psychosis, and more than half of those who have both a personal history of bipolar disorder and a family history of postpartum psychosis tend to develop the condition. Children of mothers with a psychotic disorder may experience more than the genetic risk of developing a psychotic illness if their birth mother’s pregnancy with them was characterized by problems like malnutrition, infections, high blood pressure, or problems with the placenta.
Psychological risks for developing a psychotic disorder include a history of mood problems, like an anxiety disorder, major depression, or bipolar disorder and trouble functioning socially or generally. People who are at risk for developing a psychotic disorder as the result of having a close relative with such symptoms are also more likely to have symptoms of attention deficit hyperactivity disorder (ADHD). Individuals who have frequent nightmares, tend to be suspicious of others or who have unusual thoughts (for example feeling paranoid, believing that an ordinary event has special and personal meaning, having somatic symptom disorder) are also more likely to develop a psychotic disorder. Studies show that women with postpartum psychosis are frequently victims of domestic violence or abusive childhoods and often have histories of abandonment or substance abuse.
Conditions classified as neurocognitive disorders, like delirium and major neurocognitive disorders, formerly called dementia, can include psychotic symptoms. Delirium, a condition characterized by disruptions in attention and thinking (cognition), usually develops quickly, over a period of hours to days, and can include psychotic symptoms like hallucinations. Major neurocognitive disorder, formerly called dementia, can have identifiable or unidentifiable causes and is characterized by a marked decline in cognitive functioning that results in the sufferer’s having trouble doing things (like cooking or driving) independently; the symptoms do not only occur in the context of delirium and are not better described by another mental disorder.
Children, teens, or adults who have endured more negative life events, have poor housing, are more ethnically isolated where they live, or otherwise have little in terms of a support group are at higher risk for developing a psychotic disorder.