Psychotic disorders are not as common as compared to other mental health illnesses such as anxiety and mood disorders. Approximately one percent of the population have a psychotic disorder. The age range in which psychotic disorders tend to develop is early teens to thirties, and it occurs equally in men as with women, and it occurs with same prevalence across all races. Although schizophrenia is a serious illness and psychosis has serious effects on functioning, many schizophrenics respond to treatment and live normal lives. Although violence and suicide are not associated with schizophrenia, it is usually incurable and medications are needed to stabilize its symptoms. Statistics on people ten years after their initial psychotic break indicate: 25% of people have experienced recovery, 25% are much improved and living independently, 25% are improved but require constant support, 15% are hospitalized and 10% die, usually from suicide. (Tracy, n.d.).
Many people get confused between schizophrenia and psychosis, thinking they are the same. However, psychosis is different from schizophrenia. Schizophrenia is a mental health illness while psychosis is the cause that contributes to certain symptoms of schizophrenia (Canadian Mental Health Association, 2015). Clients who have psychosis have thoughts, perceptions, and/or sensory experiences that are not real, and are subsequently diagnosed with a psychotic disorder. Symptoms of psychosis are delusions (having thoughts that are not real) and hallucinations (seeing or hearing things that are not there). Other symptoms include: suspiciousness, difficulty concentrating, anxiety, depressed mood, sleeping too much or too little, and withdrawal from family (Psychosis, n.d.). Early signs of psychosis may also include uneasiness with others, spending more time alone, strong inappropriate emotions or no feelings at all, disorganized speech, switching topics erratically, decline in personal hygiene and self-care, and impairment in functioning or job performance (NAMI, n.d.).
Psychotic disorders are severe mental health disorders that cause abnormal thinking. Along with schizophrenia, there are eight other psychotic disorders. They are: Schizophreniform Disorder, Brief Psychotic Disorder, Delusional Disorder, Schizoaffective Disorder, Psychotic Depression, Bipolar Illness, Drug-induced Psychosis, and Organic Psychosis (DSM 5, n.d.; Different Types of Psychosis, n.d.). Other mental health disorders that may have symptoms of psychosis are depression, dementia, and borderline personality disorder. Along with schizophrenia, these mental health conditions have symptoms that distinguish them differently from other psychotic disorders and mental illnesses (Psychotic Disorders, n.d.)
Types of Psychotic Disorders
- Schizophrenia: My clients with this type of psychosis have symptoms that include hallucinations and delusions for at least six months. However, symptoms may not affect the client’s overall functioning. Not all schizophrenics have all symptoms, and the duration of symptoms vary from person to person. Schizophrenia is the most common of the nine psychotic disorders and psychosis is only one aspect among other symptoms of schizophrenia. A symptom of schizophrenia could be disorganized thinking or thinking, speaking, or behaving in a way that is not understood by others. Another symptom may be flat affect or having a dull voice without facial movement. Other symptoms may be social withdrawal, loss of pleasure in usual activities, trouble processing information, inability to focus, and learning difficulties. Most of the time, schizophrenia does not start until adulthood. Due to the increasing awareness of childhood onset, I can usually see some signs of schizophrenia early as the disorder develops into full blown symptoms in adulthood. Symptoms of delusions and hallucinations usually start between the ages of 16 and age 30, and almost all symptoms are evident after age 45. I have noticed that the onset of symptoms occurs a bit later for men than women (Schizophrenia, n.d.).
- Schizophreniform Disorder: My clients with schizophreniform disorder only have psychotic symptoms for less than six months, whereas schizophrenia is not diagnosed until 6 months of psychotic symptoms. The symptoms of delusions and/or hallucinations may stay the same and persist into schizophrenia or they may progress into another psychiatric diagnosis with additional symptoms of bipolar disorder or schizoaffective disorder.
- Brief Psychotic Disorder: My clients with this psychotic disorder typically are triggered by a sudden response to a major stressor such as the death of a family member. With this psychotic disorder, delusions and/or hallucinations of psychosis usually lasts less than a month.
- Delusional Disorder: My clients with this psychosis have strong thoughts of things and/or situations that are unreal, and very fixed beliefs that are irrational. Changes in visual, auditory, and tactile perception (hallucinations) are not symptoms of this disorder. A delusional disorder does not always affect the ability to function.
- Bipolar Illness: My clients with this type of illness have thought disturbances of delusions and hallucinations, but the psychosis is more descriptive of mood disturbance than thought disturbance; the mood is consistent with the corresponding thoughts as they arise. The client may feel mania or depression. For example, my clients with this psychotic disorder who have mania and elevated mood may also think that they are special and have superior abilities to others. Clients with this psychotic disorder who think they are hearing voices criticizing them and telling them they are a failure may feel depression and hopelessness.
- Schizoaffective Disorder: My clients with this disorder experience delusions or hallucinations, or both, and the symptoms of a mood disturbance. The symptoms of psychosis and mood disturbance may alternate or co-exist for varying frequency and durations of time.
- Psychotic Depression: My clients with this disorder have no symptoms of mania related to Bipolar Disorder. This psychotic disorder is also called depression with psychotic features. Symptoms include delusions and hallucinations of psychosis and severe depression.
- Drug-induced Psychosis: My clients with drug-induced psychosis have symptoms of delusions and hallucinations resulting from alcohol and drugs. Illicit use of hallucinogens such as LSD, acid, mushrooms, and even marijuana can cause clients to see, hear, or feel things that are not there. One incident, frequent use, or extended use of substances (i.e., amphetamines) can cause psychotic symptoms.
- Organic Psychosis: This psychotic disorder is caused by another physical illness or medical condition such as a head injury or brain tumor. A physical exam and medical tests (brain scan/MRI) are needed to confirm or rule out this psychotic disorder. Paraphrenia is a psychosis that occurs in old age and results from changes in the brain. (What are Psychotic Disorders? n.d.). Psychosis can also be secondary to other disorders and disease such as Dementia, Alzheimer’s Disease, and neurological illnesses such as Parkinson’s Disease and Huntington’s disease. (Psychosis, n.d.).
Causes of Psychotic Disorder
Psychosis can be caused by internal biological factors as well as external environmental factors. Biologically, it can be related to genetics and family history, as those with a family history of psychosis are more likely to have symptoms than those clients who have no family history. It can also be related to developmental issues. Those with a brain injury in fetal development or in childhood are at a higher risk to have the disorder. Psychosis can result from brain abnormalities that include the hyperactivity of brain chemicals and, specifically, those involving the chemical messenger systems of dopamine and serotonin. (Psychosis, 2013). Brain abnormalities that occur in old age cause paraphrenia; head injuries, tumors, strokes, HIV, and other medical conditions and illnesses can result in psychosis.
Environmental factors like childhood trauma have been associated with psychosis; research indicates a connection between childhood trauma and psychosis. In 2003, Read, et.al., published that more than half of the patients diagnosed with psychotic disorders have experienced child sexual abuse (48% females, 28% males), incest (29% females, 7% males), and child physical abuse (48% females, 50% males). This data is from 51 studies of psychiatric inpatients and outpatients (Environment and Schizophrenia, n.d.)
Treatment of Psychotic Disorders
Treatment of psychosis includes medical examinations, medications, counseling, and self-help groups. Examination includes obtaining a family history, and completing medical tests to rule out other physical problems that could result in psychotic symptoms. Antipsychotics are medications used to treat psychosis. These medications help manage and reduce hallucinations, delusions, and other symptoms of the disease. Some antipsychotics names are: pimozide, haloperidol, chlorpromazine, and amisulpride. Depending on the effectiveness of the medications, it may be necessary to be prescribe more than one medication consecutively to manage symptoms. I have clients with psychotic symptoms who only need to stay on medication for a short time, while others may be on medication for the rest of their life.
Treatment of psychotic disorders includes individual, family, and group counseling. Sometimes clients with hallucinations and delusions of psychosis will become dangerous to themselves or others and, thus, need to be hospitalized until they are stabilized on medications (rapid tranquilization). Emergency response personnel or a medical doctor administers a tranquillizer of a fast-acting shot or liquid medicine to quickly relax the patient. Clients with psychotic disorders can a reside in psychiatric residential/inpatient program and then attend an Intensive Outpatient program until they learn how to manage their symptoms.
I have found that cognitive behavioral therapy is an effective modality for the treatment of psychosis. Weekly, clients meet to talk with a mental health counselor with the goal of changing thinking and behaviors. Research indicates that this approach is effective in helping people make changes that aid in managing their symptoms and increasing their overall functioning (What are Psychotic Disorders? n.d.) However, I also utilize motivational enhancement efforts to aid my clients in developing goals and Dialectical Brief Treatment (DBT) methods to stabilize any moods altered from their psychotic thinking.
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