Psychotic Disorder

What’s a Psychotic Disorder?

A psychotic disorder is a disorder which is characterized by psychotic episodes; episodes during which a patient loses their ability to discern what is real and what is imagined.

Learn about how to spot and treat a psychotic disorder, as well as what causes one.

Psychotic Disorder Overview

Psychotic disorders are disorders which impede and disrupt an individual’s ability to understand reality. A psychotic disorder often affects various facets of a person’s mental state: their mood, thought processes, and outward behaviors.

A psychotic disorder may affect how someone communicates with others, their ability to make intelligent decisions, behave appropriately in social situations, take care of their well-being and hygiene, and go about daily routines and tasks. There is no singular psychotic disorder; rather, there are many different disorders which may, at any given point in time, display symptoms of psychosis. Some of these disorders are lifelong and require long-term treatment and maintenance; others will resolve themselves within a relatively short period of time.

Although a psychotic disorder is a serious mental health concern which should be quickly addressed, in many cases, patients can recover and return to good health.

The various types of psychotic disorders are as follows:

Schizophrenia

Individuals with schizophrenia will experience a number of psychotic symptoms. Most commonly, they will experience hallucinations and delusions. Symptoms will last longer than six months. Symptoms will almost always affect their ability to function in daily life. Schizophrenia is a lifelong disorder which requires long-term treatment.

Schizoaffective disorder

Symptoms are a combination of schizophrenia and another mood disorder.

Schizophreniform disorder

When a patient with schizophrenia has symptoms that last less than six months, they are diagnosed with schizophreniform disorder.

Brief psychotic disorder

A patient suffering from short and sudden episodes of brief psychotic behavior will be diagnosed with brief psychotic disorder. Typically, brief psychotic disorder is triggered by an extremely stressful event, like the death of a loved one. It is more common in persons susceptible to psychosis.

Delusional disorder

When someone has delusional disorder, they will experience delusions for at least one month, but no other symptoms of psychosis. It is a disorder characterized by delusions.

Bipolar disorder

In this disorder, the symptoms and nature of the psychosis will closely align with the patient’s mood. For example, if an individual with bipolar disorder is experiencing a severely depressive episode, they may believe that voices are telling them negative thoughts.

If the individual is experiencing very high mania, they may have distorted beliefs and perceptions about their abilities. Their beliefs may be grandiose or exceptionally unrealistic – for example, that they are capable of flight or mind-reading, or that they are destined to become the the next president of the United States.

Major depressive disorder

Although psychosis is not a common feature of major depressive disorder, those suffering from severe depressive disorder may experience or exhibit symptoms of psychosis. These symptoms will generally manifest as negative delusions.

Substance-induced psychotic disorder

Certain substances may provoke psychosis in individuals predisposed to a psychotic disorder (with genetic vulnerabilities).

Paraphrenia

Schizophrenia in elderly patients is referred to as paraphrenia.

Psychotic disorder caused by another (underlying) medical condition

Psychosis may be caused by an underlying medical problem, such as Parkinson’s or dementia.

Trauma to the brain

Serious physical trauma to the brain has the potential to induce a psychotic episode.

Although an individual may suffer from one of the above conditions or psychotic disorders, the individual may not always display symptoms of psychosis.

Psychotic Disorder Symptoms

Symptoms of psychotic disorders can sometimes be challenging to identify, especially in the early stages of a psychotic episode. Many times, symptoms will not become very apparent until a psychotic episode has reached a critical point at which he or she requires hospitalization.

Symptoms can also vary from person to person, disorder to disorder, and may change over the course of a person’s lifetime or even in a single psychotic episode. Additionally, because of the nature of the disorders and psychotic episodes, a patient may have difficulty effectively communicating the severity of their mental state. They may be in denial about their mental state, or may believe that it will resolve itself. Above all, the psychotic disorder will hinder the individual’s ability to separate what is real from what isn’t.

Hallucinations and delusions are the most obvious and most common symptoms of a psychotic disorder. They are hallmark symptoms of a psychotic disorder. Delusions are false or distorted beliefs – for example, an individual may believe that they are being tracked by the government or that they have the ability to read minds.

Hallucinations are false or distorted sensory perceptions; an individual may see, feel, taste, or touch things that are not there. For example, someone may feel that their arm is being grabbed although nobody is touching them, or they may see someone standing before them although nobody is in the room with them.

Symptoms will vary from person to person and disorder to disorder. Symptoms may change throughout a person’s lifetime or even a single psychotic episode.

An individual with a psychotic disorder may experience the following symptoms:

  • Paranoia: a pervasive and persistent suspiciousness of those around them
  • Hallucinations: feeling, seeing, or hearing things which are imagined and not present in the individual’s immediate environment
  • Bizarre and often dramatic behavioral and personality changes
  • Delusions: ideas and beliefs which are false or grossly distorted
  • Inability to focus: difficulty with focusing, concentration, or following a logical train-of-thought
  • Social isolation: withdrawing from friends, family members, and loved ones
  • Dangerous behavior: behavior which is harmful and injurious to the individual’s self or others
  • Limited ability to care for self and participate in daily routines
  • No emotional response; inappropriate displays of apathy and indifference
  • Confused, incoherent speech and a limited ability to communicate with others
  • Dramatic fluctuations in mood
  • Changes in sleep patterns

It is important to note that one symptom is not necessarily indicative of a psychotic disorder. However, if several of the symptoms listed are present in an individual, a mental health professional should be consulted in order to evaluate and make a diagnosis.

Psychotic Disorder Causes

There are numerous possible causes of psychotic disorders, and even more possible causes of psychosis. A psychiatric evaluation along with medical tests can determine whether a patient is suffering from a psychotic disorder. Psychosis can be induced by certain external factors.

Extreme sleep deprivation has been known to cause psychosis, even in people who are not predisposed to psychosis. Certain substances and drugs are known to cause psychosis. In people who are predisposed to psychotic episodes, traumatic events – such as a sexual assault or the death of a loved one – provoke a psychotic episode. Traumatic brain injuries, Parkinson’s Disease, strokes, and brain tumors can also provoke psychosis.

Psychosis is a common feature of several mental health disorders, such as schizophrenia and bipolar disorder. In rare cases, chromosomal disorders can cause psychosis. Certain infectious diseases, such as HIV and syphilis, have been known to cause psychosis. Regardless of the causes of psychosis, it is definitively known that genetics do play some sort of role in determining who suffers from a psychotic episode.

Individuals with relatives that suffer from a psychotic disorder are more likely to develop one themselves. Additionally, individuals with the genetic mutation known as 22q11.2 deletion syndrome are more likely to develop a psychotic disorder of some kind.

Psychotic Disorder Treatment

Treatment options are numerous and almost all psychotic disorders will require various forms of treatment, including psychotherapy and regular medication as prescribed by a doctor. Other forms of treatment include brain stimulation therapy and tranquilization.

Medication

Certain drugs known as antipsychotics are the most popular medication used to treat psychotic disorders. These drugs work by reducing a patient’s delusions and hallucinations and allowing their mind to think more clearly. Some patients will only need to remain on medications for a brief period of time, until their symptoms of psychosis subside.

Other psychotic disorders will require that a patient remains on their medication for the rest of their life.

Antipsychotic drugs which are commonly prescribed are as follows:

Older antipsychotics:

  • Chlorpromazine (Thorazine)
  • Thioridazine (Mellaril)
  • Loxapine (Loxitane)
  • Haloperidol (Haldol)
  • Perphenazine (Trilafon)
  • Fluphenazine (Prolixin)

Newer antipsychotics:

  • Ziprasidone (Geodon)
  • Olanzapine (Zyprexa)
  • Risperidone (Risperdal)
  • Quetiapine (Seroquel)
  • Paliperidone palmitate (Invega Sustenna, Invega Trinza)
  • Paliperidone (Invega)
  • Lurasidone (Latuda)
  • Iloperidone (Fanapt)
  • Clozapine (Clozaril)
  • Cariprazine (Vraylar)
  • Brexpiprazole (Rexulti)
  • Asenapine (Saphris)
  • Aripiprazole (Abilify)

Tranquilization

Certain psychotic episodes may cause a patient’s mental state to escalate quickly. When this happens, an individual may become a danger to their self or those around them.

In these situations, rapid tranquilization is administered by a medical professional in order quickly sedate the individual. The effects of tranquilization are short-term, and thus tranquilization is not a suitable form of long-term treatment.

Psychotherapy and Cognitive Behavioral Therapy

Psychotherapy is another important element of treatment for persons with psychotic disorders. For many of these individuals, medication is not enough. Psychotherapy has proven to be effective in treatment and recovery and can play a powerful role in those with a psychotic disorder. Therapy may be in a group setting or individual setting. The most popular form of therapy for patients is CBT, which stands for cognitive behavioral therapy. CBT helps patients to change their thought patterns and thought processes in permanent and lasting ways.

Brain Stimulation Therapy

Another method of treating certain psychotic disorders, brain stimulation therapy is a procedure which works by activating and engaging the brain through the use of implants, electricity and magnets. It is a less common form of treatment than medication and psychotherapy, and tends to be used for those experiencing psychosis caused by an underlying medical condition, such as Parkinson’s.

Although it can be used for those suffering from mood or mental disorders, brain stimulation therapy is typically only used when other forms of treatment fail to work for the patient.

For many individuals with a psychotic disorder, treatment will be an issue of regular maintenance to avoid the return of a psychotic episode.

Psychotic Disorder Prevention

Many times, a psychotic episode is not capable of being prevented; however, in some cases it can be prevented. For those with certain disorders, sticking to the medications and advice of their doctors and mental health professionals will help to prevent future relapses.

Plenty of patients that are diagnosed with psychotic disorders are able to live happy, healthy, and fully functional lives. Psychotic episodes can be mitigated and monitored when treated appropriately, and when treatment is monitored by a doctor. Various factors play into what a patient needs from and for treatment, and what they will get out of treatment. For example, gender and age will play important roles in how a patient responds to treatment and what works for them.

For certain psychotic disorders, lifelong treatment will be necessary in order to avoid further episodes of psychosis. Other patients, however, will not require lifelong treatment but treatment only for as long as their doctor deems necessary.

Unfortunately, there is no way to prevent a psychotic disorder. However, when properly managed, symptoms of psychotic disorders can be prevented. The sooner that a psychotic disorder is addressed and treated, the more likely that a patient will quickly recover.