Psychotic disorders aren’t as common as other mental disorders like depression and anxiety. But they present unique challenges for those they affect and the people who love them.

What are psychotic disorders and psychosis?

Psychotic disorders are mental health issues that affect the way you perceive reality. There are different types of psychotic disorders. A common symptom among all of them is psychosis.

During a period of psychosis, a person may experience:

• delusions (false beliefs)

• hallucinations (seeing or hearing things that aren’t there)

• depression or anxiety

• difficulty functioning or lack of motivation

• inappropriate behavior

• incoherent or nonsensical speech

• insomnia

How common are psychotic disorders or psychosis?

About 3 in 100 people will experience psychosis at some point during their lifetimes. An estimated 100,000 Americans will have an episode of psychosis this year.

What are the common types of psychotic disorders?

Common types of psychotic disorders include:

• paranoia and delusional disorders

• schizophrenia

• schizoaffective disorder

Paranoia and delusional disorders

People who have paranoia falsely believe that there are threats or conspiracies against them. These thoughts can cause severe anxiety and fear that disrupts everyday life. Paranoia becomes delusions when these thoughts become so fixed that a person is unable to accept reality despite evidence to the contrary. The false beliefs are often far-fetched.

A person who has paranoia or a delusional disorder may be:

• easily angered or argumentative

• hypervigilant about safety

• mistrustful of others

Schizophrenia

Schizophrenia affects a person’s ability to tell the difference between reality and fantasy. Signs of schizophrenia may come on gradually over months or years, or they may appear suddenly.

Symptoms of schizophrenia include:

• delusions

• hallucinations

• incoherent or nonsensical speech

• impulsive behaviors

• lack of empathy and emotion

• poor hygiene

• withdrawing from loved ones and social gatherings

Schizoaffective disorders

People who develop schizoaffective disorders have both schizophrenia and a mood disorder like depression or bipolar disorder. Periods of psychosis tend to worsen during a depressive or manic episode.

Someone with schizoaffective disorder may have a mix of depression, manic, and psychosis symptoms, including:

• compulsive talking

• confused or bizarre thinking

• inability to concentrate

• inappropriate emotional reactions

• loss of interest in everyday life

• mood swings (cheerfulness that suddenly turns to anger or irritability)

• paranoia

• sleeping or eating too little or too much

• spending sprees

What causes psychotic disorders?

A variety of factors can contribute to the development of a psychotic disorder. There isn’t one particular cause.

Potential risk factors for psychotic disorders include:

• brain chemical imbalances or injuries

• drug or alcohol abuse

• environmental triggers like viral infections or autoimmune diseases

• family history of mental illness (genetics)

• sleep deprivation

• traumatic events, such as abuse, assaults, and accidents

How are psychotic disorders diagnosed?

People with psychotic disorders receive care from multiple specialists, including a:

• psychiatrist, a doctor who specializes in diagnosing mental health disorders and using medicines and therapy to treat them

• psychologist, a mental health professional who provides counseling services (therapy) but can’t make a diagnosis or prescribe medications.

Psychiatrists perform assessments to look for symptoms of a psychotic disorder or other mental illness. They refer to disease criteria established by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose mental disorders.

How are psychotic disorders treated?

Treatment for psychotic disorders involves a combination of:

• antipsychotic medications

• cognitive behavior therapy

Antipsychotic medications

Antipsychotic medicines can clear up confusion during a period of psychosis. Long-term use of these drugs can prevent psychosis. These drugs are also known as tranquilizers or neuroleptics.

Antipsychotic medicines work by blocking the brain’s production of a chemical called dopamine. This neurotransmitter carries messages between nerve cells, the brain, and the body. Some people with psychotic disorders produce too much dopamine.

Most psychiatrists prescribe what’s known as second-generation antipsychotics (SGAs). These medicines may be as effective as first-generation (conventional) antipsychotics. They’re less likely to cause a side effect called tardive dyskinesia, which causes involuntary movements. However, SGAs may increase your risk of metabolic syndrome. This group of conditions include high blood pressure, abnormal cholesterol levels, diabetes, and abdominal fat.

Depending on the diagnosis and symptoms, you may take antipsychotic medicines in combination with:

• antidepressants

• anti-anxiety medicines

• mood stabilizers like lithium for bipolar disorder

Cognitive behavior therapy

People with psychotic disorders may have better symptom management when they take antipsychotic medicines while also undergoing therapy from a psychologist or psychiatrist. Cognitive behavioral therapy (CBT) is a common therapy for psychotic disorders.

CBT helps by asking a person to examine how they:

• think about a situation

• act in response to the situation

• feel about their thoughts and responses

CBT can help a person who is prone to psychosis change the way they think about and respond to delusions and hallucinations. Ultimately, these periods of psychosis become less disrupting and distressing.

People with psychotic disorders can also benefit from family counseling. These sessions with a mental health professional can help everyone affected by the disorder learn better ways to communicate and manage symptoms. It helps create a supportive environment for the person with mental illness.

What are the side effects of antipsychotic medications?

It’s estimated that 1 in 4 people who take antipsychotic medications develop tardive dyskinesia. This medication side effect causes uncontrollable facial or body movements. Symptoms of tardive dyskinesia may include tongue thrusting, rapid eye blinking, lip smacking, and grimacing.

Second-generation antipsychotics are less likely to cause tardive dyskinesia, which affects more than half a million Americans.

What’s the prognosis for someone with a psychotic disorder?

Early treatment for a psychosis episode may lower the risk of future ones. Medications can help manage psychotic disorders, allowing most people to enjoy productive, fulfilling lives.

From the community: “I have had schizophrenia/schizoaffective disorder for over 20 years. The acute stages are always hard because people typically haven't developed the coping skills to deal with it. Improvement comes with time. Don't condemn yourself for having an illness or having confusion. Things do get better. I now have two Master's degrees and I am looking forward to working full time after many years of part time work. You can definitely get better. I hope you continue to pray and realize that sometimes the hallucinations are extensions of your own thoughts or beliefs. I think schizophrenia also involves dissociation. I think we block our feelings and thoughts which may result in hallucinations. I could be wrong, of course. In any case, try to respect what you feel and take appropriate actions to help yourself. Don't despair. Things do improve.” – Inspire member

Sources

• About DSM-5. American Psychiatric Association.

• How does CBT help people with psychosis? Child Mind Institute.

• Psychotic disorders. MedlinePlus. April 2020.

• Paranoia and delusional disorders. Mental Health America.

• Psychosis. Mental Health America.

• Schizoaffective disorder. Mental Health America.

• Schizophrenia. Mental Health America.

• Tardive dyskinesia. Mental Health America.

• Therapy. Mental Health America.

• Antipsychotic drugs. Merck Manual (Consumer Version). May 2020.

• Psychosis. National Alliance on Mental Illness. 

• Tardive dyskinesia. National Alliance on Mental Illness. March 2019.

• Questions and answers about psychosis. National Institute of Mental Health.

Disclaimer

Member comments are lightly edited for length and to remove identifying information but are otherwise reproduced as they appear in the community as part of public posts.

This content is for general informational purposes only and does not necessarily reflect the views and opinions of any organization or individual. The content should not be used as a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider about any questions you may have regarding a medical condition.