What Are Psychotic Disorders?

Losing contact with reality is a major feature

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Psychotic disorders are mental health illnesses characterized by an impaired relationship with reality, usually with associated behavioral changes. There are several different psychotic disorders, and they each have diagnostic criteria described in the fifth edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5).

Psychotic disorders can be highly distressing, impacting a person’s quality of life and ability to maintain self-care. However, most of these conditions can be managed with medication and therapy.

If you or a loved one is diagnosed with a psychotic disorder, it’s important that you maintain consistent psychiatric care to help reduce the effects of your disorder on your life.

Psychotic disorders

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Types of Psychotic Disorders

The different types of psychotic disorders are: 

  • Schizophrenia: Schizophrenia is characterized by delusions, hallucinations, disorganization, unusual behavior, and withdrawal.
  • Schizoaffective disorder: Schizoaffective disorder is characterized by a combination of psychotic features and mood symptoms.
  • Schizophreniform disorder: Schizophreniform disorder is characterized by symptoms of schizophrenia lasting for longer than one month and for less than six months.
  • Delusional disorder: This condition is characterized by delusions, without the other symptoms that are seen in schizophrenia.
  • Brief psychotic disorder: This condition is characterized by an episode of psychotic behavior that lasts for less than one month. 
  • Substance-induced psychotic disorder: The short-term and long-term effects of certain drugs, such as LSD, can cause symptoms of psychosis.
  • Psychotic disorder due to a medical condition: Medical conditions can cause temporary or prolonged psychosis.

Psychotic Disorder Symptoms

Psychotic disorders are characterized by a loss of touch with reality characterized by altered thinking, perceptions, and behavior.

Often, people who have psychotic disorders also manifest behavioral symptoms. Symptoms of psychotic disorder are often characterized as positive or negative. Positive symptoms involve hallucinations, delusions, and disorganization. Negative symptoms involve behaviors such as withdrawal from others and diminished emotional expression.

Many psychotic disorders are lifelong illnesses, often beginning during early adulthood. They may progress or stabilize over time. Some psychotic disorders are limited in their duration, however, and can resolve.

Hallucinations

Hallucinations are false sensory experiences. The most common are visual hallucinations (seeing things that aren’t real) or auditory hallucinations (hearing voices that aren’t real). Other false sensations, such as smell, taste, or touch are less common with psychotic disorders, but they can occur. 

Hallucinations can occur intermittently, and they may follow a theme, such as repeatedly hearing voices giving commands or seeing a specific type of animal or person that isn't really there.

Delusions

Delusions are fixed false beliefs. Often, with psychotic disorders, the delusions involve a sense of persecution and a belief that people are involved in sabotaging or harming the person who is experiencing the delusion.

Sometimes delusions are grandiose, and a person might believe that they have supernatural or superhuman powers, or that they have a special designation that others cannot understand.

It is not unusual for someone who has a psychotic disorder to experience grandiose delusions along with delusions about persecution.

A person who has a psychotic disorder might share some of the details of their delusions with a few trusted people, but could be worried that everyone is in on the conspiracy or may avoid telling loved ones about the beliefs in an effort to protect them. 

Behavioral Symptoms

Some of the behavioral effects of psychotic disorders include speaking incoherently, erratic or odd behaviors, agitation, and restlessness.

Negative symptoms of psychotic disorders can include apathy, withdrawal, lack of emotional expressions, and lack of self-care. Negative symptoms are not usually as disruptive as hallucinations and delusions, and they can go unnoticed by family and friends, and even by the person who is experiencing them.

A key characteristic of psychotic disorders is that a person may have a lack of insight into their symptoms—genuinely believing their hallucinations or delusions to be true, and may not perceive that the behavioral manifestations are unusual. 

Complications

Psychotic disorders can result in a lack of self-care. This can cause a person to neglect things like eating, changing clothes, and/or bathing.

A person who has a psychotic disorder might not seek medical attention for symptoms like pain or discomfort, and this can allow physical problems to worsen—potentially leading to complications of infections, injuries, or medical illnesses. Medical problems can exacerbate the symptoms of a psychotic condition.

People who have a psychotic condition may experience suicidal ideation (thinking about suicide) or might attempt suicide. 

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

Causes 

Psychotic conditions have a strong genetic component. They are more common among people who have one or more family members with a psychotic disorder. However, a person can develop one of these conditions without having a family history, and a person who has family members with psychotic disorders will not necessarily develop one.

The specific genes involved in psychotic disorders are not well established. Psychotic disorders are associated with brain and neurotransmitter dysfunction. Disruption of dopamine and serotonin, among others, is believed to play a role in these conditions.

Certain psychotic disorders are associated with brain atrophy (shrinking) in certain parts of the brain, such as the frontal and/or temporal lobes. Sometimes the ventricles of the brain can be enlarged. And the presence of certain antibodies has also been associated with psychotic disorders, but the overall significance of immune dysfunction in psychotic disorders is not clear.

Diagnosis 

The diagnosis of psychotic disorders is based on a set of criteria that is used for each of these conditions. The criteria generally include a list of thoughts, behaviors, and duration of symptoms. Usually, diagnosis of a psychotic disorder requires that a person has a certain number or combination of the clinical criteria, not necessarily all of them.

If you are getting a medical evaluation for a possible psychotic disorder, your healthcare provider might discuss your symptoms with you, and may also listen to friends and family members that you have with you during your evaluation.

Your healthcare provider will also ask about your medical and psychiatric history, any stresses you are undergoing, medications or recreational drugs that you take, and your family medical and psychiatric history as well. 

Some of the symptoms of psychotic disorders occur due to other medical, neurological, and psychological conditions. If your assessment does not meet the criteria for a psychotic disorder and/or there is concern that you also might have another medical condition, you might have further diagnostic testing.

There are no blood tests or imaging tests that are considered indicative or that can confirm psychotic disorders. However, diagnostic tests may be used to rule out other potential causes of the symptoms. 

Diagnostic tests you might need include:

These tests can help determine if there are other causes of your symptoms. For example, a brain tumor, which can be identified with brain imaging studies, might cause visual hallucinations.

Encephalitis (a brain infection), which could be identified with brain imaging or LP, can cause changes in behavior. Some types of liver disease can cause mental status changes that can seem similar to psychotic disorders. 

Treatment 

The treatment of a psychotic disorder is tailored to the underlying condition and may include a combination of prescription medication and counseling. You may be prescribed one or more antipsychotic medications, and you might also be prescribed a medication for treatment of a mood disorder if present.

Your healthcare provider will likely also recommend that you have counseling or psychotherapy as part of your treatment plan for your psychotic disorder.

Medications used to treat psychotic disorders include typical antipsychotics and atypical antipsychotics. Medications in both of these categories can control symptoms, and your healthcare provider will work with you to determine which might be best for managing your condition.

Some typical antipsychotics include:

  • Haldol (haloperidol)
  • Prolixin (fluphenazine)
  • Navane (thiothixene)
  • Loxitane (loxapine)
  • Mellaril (thioridazine)
  • Stelazine (trifluoperazine)

The most common side effect of these medications is sleepiness. Typical antipsychotics are associated with extrapyramidal side effects—tremors, spasms, muscle rigidity, and diminished control of movement. Side effects can diminish with medication adjustments, but sometimes extrapyramidal symptoms remain even after the medication is discontinued.

Some atypical antipsychotics include:

  • Clozaril (clozapine)
  • Abilify (aripiprazole)
  • Risperdal (risperidone)
  • Zyprexa (olanzapine)
  • Seroquel (quetiapine)

Atypical antipsychotics are not as likely to cause extrapyramidal side effects as typical antipsychotics. They can cause side effects, including constipation, sleepiness, weight gain, high cholesterol, and decreased sex drive.

You might have episodes during which the effects of your psychotic condition worsen substantially, necessitating in-patient treatment. During this time, you will be kept safe, and your medication may be adjusted. Any other medical problems that you have (like an infection) would be managed as well.

Coping

Living with a psychotic disorder can be challenging. You might have fluctuations in your symptoms, and you can experience side effects from your medications.

It can be difficult for you to keep up with employment, and your relationships and social life can be affected as well. The social stigma can affect your life and the lives of your family members.

As you are coping with your condition, it’s important that you know that your psychotic disorder is not something that you or anyone else is to blame for. It is an illness, just like any other medical condition. You might consider some approaches that could help you cope with your condition to optimize your quality of life.

Counseling/Therapy

Managing your psychotic illness doesn’t have to stop with controlling the symptoms. You might have concerns or apprehensions about your condition. Speaking with a professional therapist or with your psychiatrist about any feelings you have about your condition can help.

Join a Support Group

Sometimes, interacting with others who are going through the same things you are going through can help you feel less alone. Be sure to give yourself a chance to find a group that makes you feel comfortable.

Some support groups are moderated by a professional, and you might find a professionally moderated group to be a good type of group for you. When you feel that the time is right, you can also be a valuable source of support for others who are searching for hope and camaraderie.

Family/Community

How much you want to share about your condition is up to you. But since psychotic illnesses are characterized by altered perceptions of reality, it would be beneficial for you if you can talk about your condition with one or more people who you trust. They can get help for you if your symptoms worsen or if you need urgent medical attention.

Caregiver Support 

Psychiatric disorders affect the quality of life of the people who are experiencing them, as well as the lives of family, friends and loved ones. If someone who is a part of your life is showing the symptoms of a psychotic disorder or has been diagnosed with a psychotic illness, the condition can cause distress for you as well.

Even though you want to maintain a relationship with your parent, sibling, spouse, child, or friend suffering from psychosis—but you might not know how best to do so when they have a psychotic disorder.

Talking with someone who you care about when they are not in touch with reality can be overwhelming and you might not know how much you should engage in a discussion about their delusions or hallucinations.

It may be important that you seek professional guidance as you navigate the challenges that your loved one’s illness can pose in your own life, rather than trying to reinvent the wheel and learn how to do it on your own.

Consider seeking professional counseling or therapy and/or joining a support group so you can learn how to manage your relationship and how to participate in their care in the way that works best for you.

You and the person who you care about might also decide that you can accompany them to their healthcare appointments and/or help them as they manage their medical and psychiatric care.

You should also make sure that you or another trusted friend, family member, or caregiver understand the signs of an emergency that might necessitate urgent medical attention—and have a plan in place for getting urgent medical help right away if needed.  

If you or a loved one are struggling with a psychotic disorder, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

A Word From Verywell

You can have an emotionally and physically healthy life if you are living with a psychotic disorder. This involves maintaining consistent psychiatric and medical care.

Because insight may be impaired in psychotic illness, it can be difficult to know when your symptoms are recurring or when medication adjustments are needed. Having a routine for taking your medications and going to your medical appointments can help with this process.

A community support structure from family, friends, and your healthcare team can help optimize the quality of life for a person who is living with a psychotic illness.

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