Psychosis is one of the most overwhelming and severe forms of mental illness. Popular ways of speaking about it spread misconceptions that make it hard for people to know what to do when they experience symptoms of a psychotic disorder. Contrary to common ideas, psychosis is neither permanent nor impossible to manage on an outpatient basis. It is a specific and treatable psychiatric condition that can be controlled with medication and therapy.
What Is Psychosis?
Psychosis is a break from reality characterized by delusions, hallucinations, and disorganized speech and behavior. While it can occur suddenly and as an isolated instance, it more typically arises in the course of a psychiatric disorder and rarely occurs without warning. The onset of a psychotic episode is frequently referred to by clinicians as a psychotic break.
There are usually subtle warning signs of an impending psychotic break. These signs include social isolation, worsening self-care, paranoia and gradual shifts in thinking and perception. The first psychotic break in schizophrenia or other chronic psychotic disorders usually occurs in early adulthood, with an average age of 24 at first onset.
Types of Psychotic Disorders
Psychotic disorders are also called thought disorders. The symptoms of psychosis reflect disordered thought processes and primarily distorted perceptions and cognition. These may be caused by changes to brain chemistry, organic brain damage, genes or environmental factors.
Different types of psychosis include both short-term and long-term conditions. Psychosis can occur as a single episode triggered by extreme stress or other temporary changes to the brain, or multiple times over the course of a disorder characterized by episodic psychotic breaks. One of the most well-known types of psychosis disorder is schizophrenia.
Schizophrenia is classically defined as having positive and negative symptoms. Positive symptoms add abnormal cognitive or perceptual experiences and are the symptoms most commonly associated with schizophrenia, including:
- Disorganized speech
- Disordered movement
Negative symptoms are those that subtract something that psychiatrically stable people normally experience or do. For example, while schizophrenia can manifest through rambling, excessive speech, it can also manifest in silence and an absence of speech. Negative symptoms of schizophrenia include the following:
- Flat affect (reduced emotional expression)
- Social withdrawal (loss of interest in social activities)
- Anhedonia (reduction or loss of ability to experience pleasure)
- Avolition (reduced motivation or inability to sustain normal activities)
The way these symptoms manifest can vary from person to person.
Schizophreniform disorder is a form of short-term schizophrenia. One of the diagnostic criteria for schizophrenia is that symptoms must persist for at least six months. The symptoms are the same for schizophreniform disorder, but they only last for one to five months. This disorder is often an early stage or precursor to schizophrenia. Over two-thirds of people develop schizophrenia after being diagnosed with schizophreniform disorder.
Schizoaffective disorder is a condition involving both psychotic and mood symptoms. This makes it a particularly serious diagnosis with a high risk of self-harm and suicide. To be diagnosed with schizoaffective disorder, a person must experience an uninterrupted period in which they have symptoms of schizophrenia during a hypomanic, manic or major depressive episode.
They must also experience delusions and hallucinations at times no mood symptoms are present. Schizophrenic symptoms are prominent and primary in schizoaffective disorders. They are not secondary to mood disorder symptoms.
Substance-induced psychosis has similar features to schizophrenia but is solely caused by the effects of a substance. To be diagnosed with a substance-induced psychotic disorder, a person must experience the following:
- Prominent and elaborate drug-induced hallucinations
- No insight that these hallucinations are caused by drugs
- Prominent delusions that they believe are real or those that are acted upon
For a person to be diagnosed with substance-induced psychosis, these symptoms must occur in the course of intoxication or withdrawal from a substance or otherwise be linked to substance or medication abuse. They cannot occur exclusively in a delirious state and cannot be better accounted for by a psychotic disorder that is not substance-induced. For example, if someone experienced psychotic symptoms before they began using substances, it’s more likely their substance use worsened or triggered an underlying condition that caused it.
Delusional disorder is a condition in which delusions are present, but not visual or auditory hallucinations. In addition to lacking the hallucinations that typify schizophrenia, people with the delusional disorder don’t have overtly bizarre behavior or significant functional impairments.
People with delusional disorder do have false beliefs, but these typically involve plausible real-life scenarios that happen not to be true for them. People with this disorder typically have one or more of the following five categories of delusions:
- Erotomanic delusions (beliefs that another person is in love with them)
- Grandiose delusions (beliefs that they have special status, power, or relationships)
- Jealous delusions (unsupported beliefs that sexual partners are being unfaithful)
- Persecutory delusions (beliefs that others intend them harm or are harming them)
- Somatic delusions (beliefs that the body has been changed or had parts replaced)
For someone to be diagnosed with delusional disorder, these delusions cannot occur exclusively in the context of a mood episode or due to the effects of substances.
Brief Psychotic Disorder
This diagnosis is given to individuals who experience one or more psychotic symptoms, including delusions, hallucinations, disorganized speech, or disorganized behavior, but only experience these symptoms for less than a month. They must also return to their previous level of functioning after the brief psychotic episode has passed. The brief psychotic disorder often occurs in response to significantly increased stress or physical conditions that affect the brain.
Causes of Psychosis
Perhaps more than any other psychiatric disorder, psychosis is linked with physical differences in the brain. While trauma can trigger the onset of psychotic disorders, it is rarely considered to be the sole cause. Acute stress can provoke a sudden psychotic break, especially when it occurs in the course of a medical condition or substance abuse, but unless a person has an underlying disorder, these episodes quickly resolve and rarely recur. Psychotic episodes triggered by substance use and stress rarely develop into chronic conditions like schizophrenia.
While the specific brain mechanisms behind schizophrenia are disputed, research suggests it is linked to atypical patterns of communication between the prefrontal cortex, the part of the brain that controls judgment and planning, and the temporal lobes and limbic system, which control emotion and memory. Specifically, one of the causes of psychosis is overabundant levels of dopamine in these areas.
Symptoms of Psychosis
Negative symptoms often arise as early signs of psychosis. However, a diagnosis is not confirmed until one or more of the following positive symptoms of psychosis develops.
Delusions are beliefs that are not consistent with reality or social or religious norms. For example, common superstitions like worrying that breaking a mirror causes seven years of bad luck are not considered delusions.
However, believing that a malevolent entity caused a mirror to break into a specific number of shards to send a message would be the type of delusion that is one of the signs of psychosis. Not only is it not a shared belief, it features typical delusional elements like paranoia and ideas of reference. In addition to these symptoms, common delusions in psychotic disorders include the following:
- Ideas of reference (beliefs that neutral events are meaningful messages)
- Delusions of control (beliefs that an individual has been taken over by an outside force — particularly that thoughts are being inserted into or removed from the mind)
- Magical thinking (beliefs that an individual is able to control or influence the outside world with thoughts, such as being able to communicate telepathically)
Depending on how disorganized a person’s thinking is, delusions may be completely bizarre and hard to place in any of the standard categories.
Hallucinations are perceptual disturbances that a person sees, hears, smells, feels or tastes but are not there in reality. They are not exclusive to psychotic disorders and can occur in a wide range of circumstances. For example, they may arise in the course of medical disorders that affect the brain or in response to sleep deprivation.
Auditory hallucinations are the most common types of hallucinations in psychotic disorders, especially schizophrenia. This phenomenon is colloquially known as “hearing voices.” Voices may be benevolent, but more commonly are critical or threatening. Command hallucinations are not typical but do sometimes occur. These are auditory hallucinations in which a voice commands an individual to do something, often something harmful to themselves or others.
People with psychotic disorders sometimes also experience visual hallucinations. The most common type of visual hallucination in schizophrenia is seeing a person, especially a family member or beloved religious figure, who isn’t actually there. In some cases, people with schizophrenia may have frequent hallucinations of a character known only to them.
Disorganized thinking is often one of the first signs of schizophrenia or another psychotic disorder, especially as exhibited through speech. Thought or speech distortions commonly associated with psychotic disorders include:
- Circumstantial, indirect, or vague speech
- Derailment, or complete loss of topic or focus
- Illogical speech, inferential errors, or odd conclusions
- Echolalia, or responding to questions or statements by repeating them
- Tangential speech, or meandering and only loosely connected thoughts
- Clanging or speech focused on the sound of words instead of their meanings
- Neologism and word approximations, or using words in nonstandard or illogical ways
- Perseveration, or fixating on and excessively repeating particular words or statements
- Flight of ideas, or rapid topic changes based on connections that are difficult to follow
- Thought blocking, or suddenly becoming silent in the middle of a goal-directed speech
- “Word salad,” or incoherent speech with no logical connection between thoughts at all
These symptoms range in severity. Early symptoms of psychosis are often subtler, while more severely disorganized speech patterns, like echolalia and “word salad” typically only arise in the acute phase of a psychotic disorder.
Abnormal Motor Behavior
People with psychotic disorders often move in unusual ways. Motor disturbances are especially prevalent in people with schizophrenia, which may involve differences in the parts of the brain associated with movement. The following are common types of abnormal motor behavior:
- Catatonia (restricted movement)
- Parakinesia or dyskinesia (involuntary movement)
- Parkinsonism or bradykinesia (rigidity or slow movement)
People with psychotic disorders sometimes walk with an unusual gait or put themselves in unusual postures. They may make stereotyped, repetitive movements that don’t have a clear purpose, grimace or exhibit facial tics, or have prominent, idiosyncratic mannerisms. Often, they react slowly, staring for long periods of time or failing to move out of the way of obstacles.
How Psychotic Disorders Diagnosed?
The distorted thought processes and disorganized speech of psychotic disorders can make straightforward clinical interviews difficult, even impossible, for acutely psychotic individuals. Diagnosing psychosis often involves observing voluntary speech and action made outside of the context of clinical interviews and confirming the presence of hallucinations and delusions.
Unfortunately, psychotic disorders are rarely detected before the first psychotic break. Negative symptoms are subtle and can signal a range of other conditions, requiring a long process of differential diagnosis to rule out other conditions that could be indicated by the same symptoms.
The emergence of positive symptoms of psychosis for the first time is called a psychotic break and is often accompanied by dangerous or bizarre behavior and a heightened risk of harm to self or others. While people experiencing a psychotic episode might have thoughts of harming themselves and, in rarer cases, thoughts of harming others, they most typically are at risk of harm through being unable to care for themselves or to protect themselves from harm.
Many people are first diagnosed with a psychotic disorder after involuntary commitment to inpatient treatment. The behavior that leads to hospitalization is often first noticed by other concerned individuals, especially loved ones.
Who Is at Risk for Psychotic Disorders?
Risk factors for schizophrenia and other psychotic disorders include:
- Having a family history of psychosis
- Being exposed to viruses before birth
- Experiencing malnutrition before birth
- Experiencing alterations in brain chemistry
- Dealing with head trauma or brain damage
- Abusing substances in teen or early adult years
Chronic psychotic disorders are much more likely to arise in people with inherited brain differences or those whose brains were changed by physical or chemical events early in their lives.
Statistics about psychosis show that while these disorders are severe, they are treatable:
- About 3 percent of people have a psychotic episode as adults
- Half of the people with schizophrenia have at least one other co-occurring disorder
- Of people who develop psychosis, 25 percent never have another episode
- Half of the people who have a psychotic episode can receive effective treatment that makes their condition manageable and helps them live normal lives
It is not unusual for people with psychotic disorders to abuse substances in an effort to seek relief from their symptoms. It can be overwhelming to know where to go when you or someone you care about needs treatment for psychotic and substance use disorders, but there are many targeted interventions that can help.
The Recovery Village is one of the rehab facilities that is equipped to provide treatment for psychosis and addiction. To learn more about specific ways these services can help you, contact The Recovery Village today.