What is Psychosis?
Many of us have encountered a person who appears to be living with delusions, hallucinations, speaking with “word salad phrases,” or other symptoms of psychosis. They may be an elderly relative, a member of the immediate family, or a person in our community. While sometimes it can be frightening, it is critical to understand the basic symptoms of this illness, the origins, and what types of treatments are available.
The term “psychosis,” aka “psychotic disorders,” means having a state of mind disconnected from reality. This altered state of mind may occur from a psychiatric illness, health condition, drug use, or other condition. A person experiencing psychosis usually doesn’t know their behavior is different from reality. Treatment for these types of problems typically includes medication and therapy.
There are several types of psychosis commonly known as “Schizophrenia and Related Disorders .”The specific terms used to identify which disorder is present are important to understand the cause, symptoms, treatment, and predicted outcomes. This article will briefly explain the different types of psychotic disorders, symptoms one might observe, the duration, and treatment that can help with improvement and recovery.
Schizophrenia and other psychotic disorders have five symptom categories: delusions, hallucinations, disorganized thinking, abnormal movements, and a negative mood. Understanding the symptoms helps caretakers and providers treat the person and provide care.
Defining the Symptoms
Delusions
Delusions are beliefs that a person holds that are not open to change despite contradictory evidence. Often the belief is related to a particular theme, such as being persecuted by others. Another theme of delusional thoughts is referential, which is the belief that there are gestures, comments, or cues that are directed at the individual. Another theme is grandiose beliefs, where someone thinks they have exceptional abilities, wealth, or fame. Other delusional thought themes are erotic, catastrophic, or hypochondriacal. Sometimes delusions are labeled bizarre if they are completely impossible, such as thought or body control.
Hallucinations
Hallucinations include visual, auditory, or physical observations without any external input that are not under a person’s control. The most common are sights and sounds. Auditory hallucinations are usually voices other than the person’s thoughts.
Disorganized Thinking
Disorganized thinking is inferred from the person’s speech, such as going from one topic to another or answers to questions being unrelated to the topic. Sometimes, the patient’s speech is disorganized, sounds more like bits and pieces, and is hard to understand.
Abnormal Motor Behavior
Abnormal Motor Behavior can range from childlike behavior to unpredictable aggression. This symptom can result in an inability to perform everyday activities for self-care. Another form of abnormal behavior is when a person becomes catatonic, decreases interaction with their environment, or has very stiff movements or posture. Aside from decreased activity, the person may also show reduced engagement during a physical exam or excessive or peculiar movements. Sometimes catatonia can be observed as a pose that the person assumes for a prolonged time.
Negative Symptoms
Negative symptoms are most prominent in schizophrenia compared to other psychotic disorders and include depression, a decrease in expressing emotions, and becoming unmotivated to do any activities.
Types of Psychotic Disorders
Brief Psychotic Disorder
As the name implies, this is a short-term presence of psychosis. This diagnosis requires at least one of the primary symptoms, including delusions, hallucinations, or disorganized speech, for at least one day, but less than one month, with a total return to normal afterward. Sometimes these psychotic symptoms are brought on when a person experiences a traumatic event. The person may also experience catatonia (or a trance-like state) as part of the stress response.
An example of this could be observed in a person who was present at the scene of a crime and then experiences the sudden onset of disorganized speech that progresses to a catatonic state. After a few days, but not more than 30, the person returns to normal.
Other possible causes for psychotic symptoms might be a different medical condition, substance abuse, depression, faking, or personality disorders.
Schizophreniform Disorder
This diagnosis requires two or more symptoms of psychotic disorders, with at least one including delusions, hallucinations, or disorganized speech, and may include disorganized, catatonic behavior or negative symptoms. The symptoms last at least one month but less than six months and cannot be attributed to an illness or substance use.
An example may be a young adult who begins to hear voices, experiences a lack of motivation, and loses interest in activities previously enjoyed. These symptoms are similar to schizophrenia, but the main difference is the symptoms are gone in 6 months or less.
Schizophrenia
This diagnosis is similar to schizophreniform in that it requires two or more symptoms of psychotic disorders, with at least one including delusions, hallucinations, or disorganized speech, and also may include disorganized or catatonic behavior, or negative symptoms, with both being present for most of a month or more, and persisting for at least six months. Also, the person will be functioning at a lower level than before the onset of symptoms. In addition, people with schizophrenia are more likely to have other mental health issues, including anxiety, depression, or substance use.
An example of the onset of this disorder would be an adolescent who was getting good grades but then gradually starts to hear voices and begins to lack motivation to complete assignments and neglects their hygiene. If this were to continue for more than six months of consistent symptoms, their family might take them to see a professional. After meeting with a mental health provider and getting a complete evaluation, which includes ruling out other possible causes, they might be diagnosed with schizophrenia.
Schizoaffective Disorder
This disorder is similar to schizophrenia in that it requires two or more symptoms of a psychotic disorder, with at least one including delusions, hallucinations, or disorganized speech, and also may include disorganized or catatonic behavior, or negative symptoms, with both being present for most of a month or more, and persisting for at least six months.
In addition to the psychotic symptoms, there is a period of significant depression and sometimes mania. This illness may be acute or in partial or complete remission.
Substance/Medication Induced Psychotic Disorder
This disorder includes either delusions or hallucinations. The symptoms develop during or soon after intoxication or withdrawal from a substance. The substance is capable of inducing these types of symptoms. An alternative diagnosis can be given if the delirium lasts for a substantial period after the substance wears off. The symptoms cause significant distress or impairment.
Psychotic Disorder Due to Another Medical Condition
This disorder occurs when there are prominent hallucinations or delusions and evidence of a medical condition known to cause these symptoms. Illnesses that may induce psychosis include brain injury, epilepsy, stroke, or other neurological disorders.
Unspecified/Specified Schizophrenia Spectrum and Other Psychotic Disorders
This diagnosis may be given when the person has not met the full criteria for a diagnosis but has some traits, including persistent auditory hallucinations, delusions, or the symptoms come and go. This diagnosis may be used in a situation such as an emergency room, where a doctor does not have enough exposure to the patient for a full evaluation.
Treatment of Illnesses on the Schizophrenia Spectrum
Schizophrenia is a medical condition usually treated with the group of medications called “anti-psychotics.”Working closely with a mental health professional will help the patient become stable, decrease their symptoms, and improve their quality of life. Often, other mental health issues co-occur, and sometimes it is helpful for a patient to receive in-patient care until they are stabilized.
The course and severity of the illness can be varied, as some patients have more self-awareness of their condition while others do not. People who accept treatment typically fare better due to medication adherence and lifestyle choices that improve their overall health. Individual therapy, group sessions, medication management, and ongoing care help keep the patient engaged in their treatment plan.
