Psychotic disorders
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Contents |
Overview
When most people think of psychotic disorders, they usually think of schizophrenia. Not a surprise, really, as it afflicts approximately 1% of the population. But there are actually nine different disorders listed in the current DSM (Diagnostic and Statistical Manual of Mental Disorders). These are:
• Schizophrenia
• Schizophreniform Disorder
• Schizoaffective Disorder
• Delusional Disorder
• Brief Psychotic Disorder
• Shared Psychotic Disorder
• Psychotic Disorder due to a General Medical Condition
• Substance-Induced Psychotic Disorder
• Psychotic Disorder Not Otherwise Specified
There are several other disorders, such as major depressive disorder, bipolar disorder, Alzheimer’s dementia, borderline personality, or delirium for example, that may include psychotic symptoms at times. However, unlike the disorders listed above, psychosis is not the primary defining aspect of the disorder.
What is Psychosis?
Over the years (and depending on who you ask) the term “psychotic” has been defined in varying ways. An oversimplified definition would be “a term used to describe someone who is out of touch with reality”. Or, to put it in layman’s terms: “crazy”.
Psychotic symptoms primarily involve hallucinations or delusions. A broader definition of psychosis would also include things such as disorganized behavior or speech, or catatonic behavior. Hallucinations may involve any of the senses – hearing, sight, taste, touch, or smell. When a person is hallucinating, he or she is experiencing something that isn’t based in reality – for example, hearing a voice when no one is around, or seeing something that isn’t actually there.
With psychosis, the most common types of hallucinations involve the sense of hearing. These types of hallucinations are known as “auditory hallucinations”. Auditory hallucinations typically involve voices. Someone experiencing auditory hallucinations may hear voices commentating on his activities. Or, the voice or voices may be telling him what to do – these are known as command hallucinations. Command hallucinations can be very compelling and may cause the person to hurt himself or someone else in some way.
Delusions involve a firmly held belief about something that is not based in reality. For example, a person with paranoid delusions may believe aliens have implanted a tracking device in his body, or that the CIA has hidden multiple cameras and listening devices in his home. Someone with grandiose delusions may believe that he has special powers, such as the ability to read minds or control the actions of others. As you can imagine, when someone is psychotic he or she is not going to act rationally. Psychotic individuals may engage in behaviors that are erratic. They may put themselves or others in danger, either directly or indirectly. When the psychosis is florid, they often end up in the hospital until it is treated and stabilized. Following are brief overviews of each of the psychotic disorders.
Schizophrenia
Schizophrenia is sometimes referred to as the “cancer” of mental illness. It can be extremely disabling, typically lasts a lifetime, and to date, there is no cure. It is also the most common of all the psychotic disorders, afflicting approximately 1% of individuals aged 18 or over.
In addition to hallucinations and delusions, people with schizophrenia usually exhibit many other symptoms. These may include behavior that is extremely disorganized or catatonic, speech that is very odd or is gibberish (known as “word salad”), lack of emotional expression, or difficulties initiating or engaging in tasks or activities that are goal-directed. In males, symptoms usually first appear in the late teens or early twenties. In females, signs of schizophrenia often appear in the late twenties. However, schizophrenia is sometimes diagnosed in childhood, and on rare occasions symptoms may first appear later in life.
While the exact cause has not yet been determined, schizophrenia is likely caused by a combination of genetics and environmental triggers – such as exposure to certain toxins or trauma. It runs in families, and brain scans reveal anomalies not found in normal individuals.
There are five different types of schizophrenia:
• Paranoid
• Disorganized
• Catatonic
• Undifferentiated
• Residual
Paranoid schizophrenia is the most common type, while catatonic schizophrenia is very rare.
Two disorders that are closely related to schizophrenia (and which will be discussed next) are schizophreniform disorder and schizoaffective disorder.
Schizophreniform Disorder
The primary difference between schizophrenia and schizophreniform disorder is the period of time that symptoms are present. It is shorter – lasting at least one month and no longer than six months. Also, the person’s overall functioning may not become as impaired as with schizophrenia. About two-thirds of individuals diagnosed with this disorder eventually end up with a diagnosis of schizophrenia or schizoaffective disorder.
Schizoaffective Disorder
Schizoaffective disorder is also very similar to schizophrenia. The primary difference is that during the period that psychotic symptoms are active, individuals with this disorder also experience a significant mood episode – either mania or depression. Additionally, they must have a period of 2 weeks during which the psychotic symptoms are present without any symptoms of depression or mania.
Sometimes these fine distinctions make it difficult to accurately determine if a person should be diagnosed with schizoaffective disorder rather than schizophrenia. This is especially true if the patient is a poor historian and no collateral information is available. Many individuals with schizophrenia experience mood symptoms, particularly depression. However, they may not meet the full criteria for schizoaffective disorder.
Other Psychotic Disorders
Delusional Disorder
Delusional disorder is much less common than schizophrenia. The primary symptom of this disorder is the presence of a “non-bizarre” delusion for a period of at least one month. A non-bizarre delusion is one that is plausible. For example, if a woman believes she is being followed by FBI agents, then that would be considered non-bizarre as it could actually happen. However, if she believes she has been impregnated by aliens and will soon give birth to hundreds of alien offspring, then that would be considered a bizarre delusion.
While there are many different types of delusions, the most common types of themes in delusional disorder are:
• Erotomanic
• Grandiose
• Jealous
• Persecutory
• Somatic
Brief Psychotic Disorder
Brief psychotic disorder is also relatively rare. A person with this diagnosis exhibits psychotic symptoms for less than a month but for at least a 24-hour period. It may be that it occurs more often than reported because it is so brief and treatment may not be sought before the symptoms subside.
Shared psychotic disorder is another rare psychotic disorder. It occurs when someone who is not psychotic is in a close relationship with a delusional person and begins to share that person’s delusions. This is why it is sometimes referred to as “Folie a Deux” – which is translated as “a madness shared by two”.
Typically the dominant person in the relationship is the one with delusions, and the passive partner is strongly influenced by him or her. The disorder is more likely to develop if they are quite isolated socially. If the second person is removed from the situation, his or her psychotic symptoms will often subside.
Psychotic Disorder due to a General Medical Condition
This diagnosis is given when the occurrence of psychotic symptoms is best explained by a medical condition. For example, a brain tumor may cause hallucinations in some individuals.
Substance-Induced Psychotic Disorder
When a person becomes psychotic as the direct result of a substance such as street drugs, alcohol, prescription medications or something toxic, then this diagnosis would be the best fit. In many cases, the psychosis subsides once the substance is no longer in the person’s system.
Psychotic Disorder Not Otherwise Specified
Sometimes individuals exhibit psychotic symptoms but they don’t meet the criteria for one of the known psychotic disorders. Or, the clinician may not have sufficient information in order to determine the most fitting diagnosis. In those cases, a diagnosis of psychotic disorder NOS (not otherwise specified) is given. Once further information is obtained, then it is changed to a specific diagnosis. Other disorders that may include psychotic symptoms
As mentioned above, psychotic symptoms may appear as part of many other disorders. For example, individuals with borderline personality disorder may experience fleeting psychotic symptoms at times. People with paranoid, schizoid, or schizotypal personality disorders may also periodically exhibit psychotic symptoms.
Severe mood episodes may trigger psychotic symptoms. For example, individuals with bipolar disorder may become quite psychotic during a manic episode, and someone with severe major depression can develop psychotic features. People who have Alzheimer’s dementia or other types of dementia may experience hallucinations and delusions from time to time. Hallucinations may occur during an episode of delirium as well.
What Causes Psychosis?
Psychosis may be caused by different things or by a combination of things. As mentioned earlier, although the exact cause of schizophrenia is not yet known it is believed to be a combination of genetics and environmental factors. Environmental factors may involve exposure to toxins as well as physiological or emotional trauma. The cause of most of the other psychotic disorders is also not fully understood in most cases.
Treatment
Although treatment may vary, psychotic symptoms are typically treated with antipsychotic medication regardless of the diagnosis. Many individuals who are acutely psychotic require hospitalization until they are stabilized. This is because psychosis often significantly impairs one’s judgment and can cause people to become a danger to themselves or others.
Individuals with schizophrenia often remain on antipsychotic medication throughout their lifetime in order to help control their symptoms. For many other psychotic disorders, however, antipsychotic medication may be needed only temporarily.
