What Is the Difference Between Psychosis and Schizophrenia?

While sometimes erroneously used interchangeably, psychosis and schizophrenia are not the same things.

• Psychosis refers to losing touch with reality.
• Schizophrenia is a type of psychotic disorder characterized by psychotic symptoms.

People who have schizophrenia experience psychosis; however, people experiencing psychosis do not necessarily have schizophrenia.

About 3% of Americans will experience psychosis in their lifetimes.

Antipsychotic medications are often used to treat schizophrenia and other psychotic disorders.

Psychosis

Psychosis is a general label for conditions of the mind that involve a distortion or break from reality. A period of psychosis is called a psychotic episode.

During a psychotic episode, a person has difficulty distinguishing what is real from what is not.

Psychosis does not have one specific cause, but rather is brought on by one or more triggers including:

• Mental illness, including schizophrenia and bipolar disorder
• Sleep deprivation
• General medical conditions
• Certain prescription medications
• Substance use, including alcohol and marijuana

Behaviors/Symptoms 

Behaviors and symptoms associated with psychosis include:

• Hallucinations: Sensory experiences that are not real or observable by others. Hallucinations can involve any of the five senses, but auditory hallucinations ("hearing things/voices") and visual hallucinations ("seeing things") are the most common.
• Delusions: False beliefs that conflict with reality. A person experiencing delusions will not change their beliefs when confronted with evidence that the belief is false. Examples of delusions include: Believing that a stranger on TV is sending messages to them; paranoia such as the belief they are being spied on or are a target for malice; or beliefs of grandeur ("I am God").
• Agitation: Excessive physical movement or verbal activity. Symptoms of agitation can include emotional distress, restlessness, or pacing.
• Disorganized thinking or behavior: Jumbled, incoherent, or nonsensical speech, writing, or thinking. Disorganized thought processes make it difficult for someone to communicate verbally with others and to keep their thoughts straight.

Depression, anxiety, sleep problems, social withdrawal, lack of motivation, and difficulty functioning are also associated with psychosis.

Other Psychotic Disorders

In addition to schizophrenia, other psychotic disorders include:

• Schizoaffective disorder: Symptoms of schizophrenia—including psychosis—alongside characteristics of a mood disorder such as depression.
• Schizophreniform disorder: A person meets the requirements for a diagnosis of schizophrenia, except that symptoms last less than six months.
• Delusional disorders: Strong, unchangeable beliefs in things that are not real or true, without experiencing hallucinations.
• Brief psychotic disorders: Psychotic behavior with a sudden onset, lasting one month or less. Another episode may or may not occur in the future.
• Substance-induced psychotic disorder: Psychosis brought on by the use of substances such as cannabis, cocaine, ecstasy, ketamine, LSD, amphetamines, and alcohol.
• Psychotic disorder due to a medical condition: Conditions such as brain tumors, brain infections, or strokes can cause psychotic symptoms.

Schizophrenia

Schizophrenia is a psychiatric disorder that impacts thought processes, emotions, and behavior.

To receive a diagnosis of schizophrenia, a person must meet the criteria described in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) published by the American Psychiatric Association.

To be diagnosed with schizophrenia, a person needs to experience at least two of the following symptom types, with at least one of the symptoms being delusions, hallucinations, or disorganized speech. Symptom types include:

• Delusions
• Hallucinations
• Disorganized speech (e.g., frequent derailment or incoherence)
• Grossly disorganized or catatonic behavior
• Negative symptoms (i.e., diminished emotional expression or avolition).

Symptoms must persist for at least six months and must cause significant difficulties in the level of functioning in one or more major areas, such as work, interpersonal relations, or self-care.

Before a diagnosis of schizophrenia is made, other medical conditions, mood disorders, other psychotic disorders, and substance use must be ruled out.

Psychosis in Schizophrenia

Schizophrenia occurs in stages.

1. Prodromal phase: Symptoms develop gradually and typically involve loss of interest in activities, social withdrawal, or difficulty concentrating. Intense preoccupation with ideas or subjects can also develop. This phase can last from weeks to years.
2. Active phase: This is the acute stage of schizophrenia in which psychotic symptoms occur. Symptoms can develop gradually after a prodromal phase or appear suddenly.
3. Residual phase: The period after an active phase in which symptoms have settled down, but the person may feel listless, withdrawn, or have trouble concentrating, similar to the symptoms of the prodromal phase.

While the length of these stages differs from person to person, these phases tend to occur in sequence and repeat throughout the life of a person with schizophrenia.

Psychotic symptoms (also known as positive symptoms) associated with schizophrenia include:

• Delusions
• Hallucinations
• Disorganized thought and speech
• Disorganized behavior

These psychotic symptoms can manifest in people with schizophrenia as:

• Paranoia, such as the belief that they are being spied on, being controlled by outside forces, or being pursued by someone who aims to cause them harm. They may believe others can read their thoughts.
• Believing that ordinary events hold special meaning specifically to them, like that a person is sending them messages through song lyrics, or on TV.
• Illusions of grandeur, such as believing they are of great importance, are very powerful, or have special powers. They may believe they are a divine being such as God or the devil.
• Hearing noises or voices that aren't there. These may be benign or distressing.
• Hearing commands to perform actions
• Switching quickly from subject to subject when speaking
• Making up words or using nonsense words
• Discussing ideas that seem unrelated
• Discussing things or answering questions in ways that are off-topic or irrelevant
• Speaking in rhyming words without meaning
• Having difficulty performing everyday tasks such as self-care and hygiene
• Difficulty planning and following through on plans
• Behaving strangely or inappropriately, such as laughing at a funeral
• Experiencing symptoms of catatonia, including motionless, physical rigidity, repetitive movements, or lack of a response to their environment (less common)

Antipsychotics

Psychosis is almost always treated, at least in part, with medication. Antipsychotics are typically the medication prescribed to help reduce or relieve symptoms of psychosis.

Antipsychotics can take up to six weeks to reach their full effect, but they begin to help people with acute psychosis within hours or days.

Antipsychotics do not cure underlying conditions and causes of psychosis, but help control symptoms, and when taken long-term can help prevent future psychotic episodes. They are most effective when started early.

Antipsychotics are believed to work by blocking the effects of the overactivity of a brain chemical called dopamine. This overactivity is thought to be at least part of the cause of psychotic symptoms. Symptoms do not always go away completely with antipsychotics treatment, but generally become more manageable.

Antipsychotic drugs generally fall into two categories:

Atypical (Second Generation) Antipsychotics

This medication blocks dopamine and affects serotonin levels. They are usually the first choice to treat schizophrenia.

Types of these medications include:

• Risperidone (Risperdal)
• Quetiapine (Seroquel)
• Olanzapine (Zyprexa)
• Ziprasidone (Zeldox)
• Paliperidone (Invega)
• Aripiprazole (Abilify)
• Clozapine (Clozaril)

Typical (First Generation) Antipsychotics

These antipsychotics are older and block dopamine but do not affect serotonin. They include:

• Chlorpromazine (once marketed as Largactil)
• Flupenthixol (Fluanxol)
• Afluphenazine (Modecate)
• Haloperidol (Haldol)
• Loxapine (Loxapac), perphenazine (Trilafon)
• Pimozide (Orap)
• Trifluoperazine (Stelazine)
• Thiothixene (Navane)
• Zuclopenthixol (Clopixol)

Antipsychotic medication can cause a range of side-effects. Speak with your health care provider to determine the risks and benefits of these medications.

Different medications work differently for each person. If one medication is not effective or not well-tolerated, discuss switching doses or medications with your health care provider.