Psychotic Disorders

Psychotic disorders are a group of serious illnesses that affect the mind. These illnesses alter a person’s ability to think clearly, make good judgments, respond emotionally, communicate effectively, understand reality and behave appropriately. When symptoms are severe, people with psychotic disorders have difficulty staying in touch with reality and often are unable to meet the ordinary demands of daily life. However, even the most severe psychotic disorders usually are treatable.

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 six months, usually with a decline in work, school and social functioning.
• Schizoaffective disorder: People with this illness have symptoms of both schizophrenia and a mood disorder, such as depression or bipolar disorder.
• Schizophreniform disorder: People with this illness have symptoms of schizophrenia, but the symptoms last more than one month but less than six months.
• Brief psychotic disorder: People with this illness have sudden, short periods 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: People with this illness have delusions involving real-life situations that could be true, such as being followed, being conspired against or having a disease. These delusions persist for at least one month.
• Shared psychotic disorder: This illness occurs when a person develops delusions in the context of a relationship with another person who already has his or her own delusion(s).
• Substance-induced psychotic disorder: This condition is caused by the use of or withdrawal from some substances, such as alcohol and crack cocaine, that may cause hallucinations, delusions or confused speech.
• Psychotic disorder due to a medical condition: Hallucinations, delusions or other symptoms may be the result of another illness that affects brain function, such as a head injury or brain tumor.
• Paraphrenia: This is a type of schizophrenia that starts late in life and occurs in the elderly population.

Symptoms vary from person to person and may change over time. The major symptoms of psychotic disorders are hallucinations and delusions.

Hallucinations are unusual sensory experiences or perceptions of things that aren’t actually present, such as seeing things that aren’t there, hearing voices, smelling odors, having a "funny" taste in your mouth and feeling sensations on your skin even though nothing is touching your body.

Delusions are false beliefs that are persistent and organized, and that do not go away after receiving logical or accurate information. For example, a person who is certain his or her food is poisoned, even if it has been proven that the food is fine, is suffering from 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

The exact cause of psychotic disorders is not known, but researchers believe that many factors may play a role. Some psychotic disorders tend to run in families, suggesting that the tendency, or likelihood, to develop the disorder may be inherited. Environmental factors may also play a role in their development, including stress, drug abuse and major life changes.

In addition, people with certain psychotic disorders may have an imbalance of certain chemicals in the brain. They may be either very sensitive to or produce too much of a chemical called dopamine. Dopamine is a neurotransmitter, a substance that helps nerve cells in the brain send messages to each other. An imbalance of dopamine affects the way the brain reacts to certain stimuli, such as sounds, smells and sights and can lead to hallucinations and delusions.



About 1% of the population worldwide suffers from psychotic disorders. These disorders most often first appear when a person is in his or her late teens, 20s or 30s. They tend to affect men and women about equally.



If symptoms are present, the doctor will perform a complete medical history and physical examination to determine the cause of the symptoms. Although there are no laboratory tests to specifically diagnose psychotic disorders except those that accompany a physical illness, such as a brain tumor the doctor may use various tests, such as blood tests and X-rays, to rule out physical illness as the cause of the symptoms.

If the doctor finds no physical reason for the symptoms, he or she may refer the person to a psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists use specially designed interview and assessment tools to evaluate a person for a psychotic disorder.



Most psychotic disorders are treated with a combination of medications and psychotherapy (a type of counseling).

• Medication: The main medications used to treat psychotic disorders are called antipsychotics. These medicines do not cure the illnesses, but are very effective in managing the most troubling symptoms of psychotic disorders, such as delusions, hallucinations and thinking problems. Antipsychotics include older medications such as Haldol, Thorazine, and Mellaril and newer medications (often called atypicals) such as Clozaril, Risperdal, Zyprexa, Seroquel, Abilify, and Geodon. The newer medications sometimes referred to as atypical antipsychotics are considered first-line treatments because they have fewer and more tolerable side effects.
• Psychotherapy: Various types of psychotherapy, including individual, group and family therapy, may be used to help support the person with a psychotic disorder.

Most patients with psychotic disorders are treated as outpatients. However, people with particularly severe symptoms, those in danger of hurting themselves or others, or those unable to care for themselves because of their illness may require hospitalization to stabilize their condition.



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 period of time, and some, such as those who have suffered 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 control side effects.



The outlook varies depending on the type of psychotic disorder and the individual. However, these disorders are treatable and most people will have a good recovery with treatment and close follow-up care.



In general, there is no known way to prevent most psychotic disorders, but many of the related symptoms can be prevented with early detection and treatment. Seeking help as soon as symptoms appear can help decrease the disruption to the person’s life, family and friendships. Avoiding drugs and alcohol can prevent psychotic disorders associated with these substances.