Psychotic disorders are not as common as other mental health illnesses like 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. 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. Medications are needed to stabilize its symptoms. Statistics on people ten years after their initial psychotic break show that 25% of people have experienced recovery. 25% are much improved and living independently. Another 25% improve but need 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. But, psychosis is different from schizophrenia. Schizophrenia is a mental health illness. Psychosis 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. As a result, they are 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 may have symptoms of psychosis. These include: depression, dementia, and borderline personality disorder. Along with schizophrenia, these mental health conditions have symptoms that set them apart from other psychotic disorders and mental illnesses (Psychotic Disorders, n.d.).
Types of Psychotic Disorders
My clients with this type of psychosis have symptoms that include hallucinations and delusions for at least six months. Yet, 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. 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. 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.).
My clients with schizophreniform disorder only have psychotic symptoms for less than six months. This differs from schizophrenia which is not diagnosed until 6 months of psychotic symptoms. The symptoms of delusions and/or hallucinations may stay the same and persist into schizophrenia. They may also progress into another psychiatric diagnosis with more symptoms of bipolar disorder or schizoaffective disorder.
Brief Psychotic Disorder:
My clients with this psychotic disorder are triggered by a sudden response to a major stressor such as the death of a family member. Delusions and/or hallucinations of psychosis usually lasts less than a month.
My clients with this psychosis have strong thoughts of things and/or situations that are unreal. They have 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.
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 who think they are hearing voices criticizing them may feel depression and hopelessness.
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.
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.
My clients with drug-induced psychosis have symptoms of delusions and hallucinations resulting from alcohol and drugs. Illicit use of hallucinogens such as LSD, mushrooms, and even marijuana can cause clients to experience things that are not there. One incident, frequent use, or extended use of substances (i.e., amphetamines) can cause psychotic symptoms.
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. These may include Dementia, Alzheimer’s Disease, and neurological illnesses such as Parkinson’s Disease and Huntington’s disease. (Psychosis, n.d.).
Causes of Psychotic Disorder
Internal biological factors can cause psychosis as can external environmental factors. Biologically, it can be related to genetics and family history. Those clients with a family history of psychosis are more likely to have symptoms than those 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 are types of paraphrenia that 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. Obtaining a family history, and completing medical tests is important. These help 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. Some clients with psychotic symptoms only need to stay on medication for a short time. 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. They need to be hospitalized until they are stabilized on medications (rapid tranquilization). Emergency response personnel or a medical doctor gives the patient a fast-acting shot or liquid medicine to relax them. Clients with psychotic disorders can live in a psychiatric residential/inpatient program. Then attend an Intensive Outpatient program until they learn how to manage their symptoms.
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. It helps people make changes that aid in managing their symptoms and increasing their overall functioning. (What are Psychotic Disorders? n.d.) But, I also use 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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