A psychotic disorder is characterized by the loss of touch with reality and the inability to perform normal day-to-day tasks. ¹ While schizophrenia is the most common psychotic disorder, there are many different types of these conditions. Each of these comes with its own set of symptoms and treatments.

Throughout this article, we’re going to explore the types of psychotic disorders, their related signs and symptoms, their diagnosis, and the best treatment options.

Psychotic Disorder Symptoms

Psychotic disorders are often categorized by the following symptoms:

• Abnormal behavior
• Difficulty in thinking clear
• Ineffective communication
• Loss of touch with reality
• Trouble responding to emotions
• Unable to make good judgments

The more severe these symptoms present themselves, the more difficult it can be to grasp reality.

To receive a diagnosis, mental health professionals will check to see if you struggle with any of the above symptoms. If you struggle with more than one, you may have one of the following psychotic disorders:

Schizophrenia

Perhaps the most common psychotic disorder, schizophrenia is defined by a change in behavior and struggle with specific symptoms (see below) for longer than six months. More often than not, schizophrenia affects your ability to perform tasks at work and/or school and to maintain a relationship. ²

While researchers still aren’t 100% sure what causes schizophrenia, it’s been observed that many people begin to experience the condition during adolescence. With that, it’s believed there’s an interaction with your genes and environment that onsets this disease. ³

Schizophrenia Symptoms

If you struggle with schizophrenia, you may experience highly exaggerated actions, ideas, and perceptions. These develop due to a loss of sense of reality and can lead to the following symptoms:

• Delusions – Holding beliefs that are abnormal to others and can be easily proved wrong. Delusions can take several different forms, including: ⁴
  
  • Persecutory Delusions – Holding the belief that someone is after you (i.e. you’re being stalked, hunted, framed, or tricked).
    
  • Referential Delusions – Believing that forms of public communication (i.e. song lyrics) are an exclusive message just for you.
    
  • Somatic Delusions – False beliefs concerning the body (i.e. you struggle with a rare, bizarre health problem).
    
  • Erotomanic Delusions – False beliefs concerning intimacy (i.e. you believe a celebrity is in love with you or your significant other is cheating on you).
    
  • Religious Delusions – Thinking that you have a special relationship with a deity (i.e. God) or that you are possessed by demons.
    
  • Grandiose Delusions – Thinking you’re a major player on the world stage (i.e. a politician or celebrity).

• Hallucinations – When you see, hear, smell, and/or feel things that no one else does. Hallucinations can take several different forms, including: ⁵
  
  • Auditory – When you hear voices in your head. These voices may be angry and demanding. Some experience one voice while others have many.
    
  • Visual – When you see lights, objects, people, and patterns, that aren’t really there. For example, you may see a loved one who is no longer alive.
    
  • Olfactory and Gustatory – Depending on whether a smell is good or bad, you experience an unreasonable reaction. For example, you may not eat food that smells bad as you believe it’s poisoned.
    
  • Tactile – When you feel things moving on your body (such as insects or hands).

• Disorganized Thoughts and Speech – You have difficulty organizing your thoughts and speech patterns. You may find it hard to listen to someone or to prevent yourself from zoning out/becoming distracted. Sometimes, another person’s dialect may sound jumbled and not make sense. ⁶

• Difficulty Concentrating – Due to disorganized thoughts, you may become easily distracted. For example, you may find it difficult to follow a television show.

• Movement Complications – You might find you lack complete control over your movements. This can appear in several manners, from being jumpy to not moving. It should be noted that this often doesn’t result in violence.

Schizophrenia Diagnosis

Health professionals often have a difficult time diagnosing schizophrenia. Those who struggle with it don’t usually realize they’re ill. Due to this, many avoid seeking medical help altogether.

There is also a problem known as prodrome – when the signs of schizophrenia are identical to normal life changes. As mentioned, schizophrenia is most commonly diagnosed in adolescence. During this period, teenagers may drop old friends, make new ones, and have behavioral changes (such as difficulty sleeping). ⁷

It’s currently believed that individuals in the early stages of schizophrenia can delay the onset of serious symptoms with a low dose of antipsychotic medication. However, there needs to be more research to fully understand this.

Schizoaffective Disorder

Schizoaffective disorder is marked by signs and symptoms of schizophrenia along with a mood disorder. Cases of schizoaffective disorder are very rare, with only affected 0.03% of the population.

Therefore, there is no set and stone treatment plan available. However, medical professionals tend to treat both schizophrenia and mood disorders simultaneously. ⁸

Two types of mood disorders can run adjacent to schizophrenia:

1. Bipolar Type – Episodes of mania that leave one with high energy followed by episodes of major depression.
   
2. Depressive Type – Solely episode of major depression.

Due to the rarity of this disease, it’s difficult for a healthcare provider to make a proper diagnosis.

Schizoaffective Disorder Symptoms

The symptoms associated with schizoaffective disorder are a combination of schizophrenia and major depressive symptoms. Some may experience bipolar symptoms as well. The most common include:

• Delusions – False beliefs that you cannot give up, even when presented with the facts.

• Depression Symptoms – Feelings of sadness, emptiness, and worthlessness.

• Difficulty with Communication – Inability to listen to someone or maintain a conversation. You may become easily distracted during a discussion. When asked questions, you may only offer partial answers. This is sometimes referred to as disorganized thinking.

• Hallucinations – Seeing and hearing things that aren’t really there (or, that nobody else can witness). These false realities can stem from your sense of taste, smell, and touch.

• Lack of Personal Care – Not caring for your hygiene or maintaining your appearance.

• Manic Episodes – Having sudden high amounts of energy and happiness. This is accompanied by racing thoughts, risky behavior, and other out-of-character traits.

If you have more than one of the above symptoms and these symptoms are causing problems in your work, school, or social life, a mental health professional may run an assessment for schizoaffective disorder.

Schizoaffective Disorder Diagnosis

Since scientists don’t know what causes schizoaffective disorder. Therefore, it can be difficult to come to a proper diagnosis. When being evaluated, a psychiatrist will look into a few different risk factors, including:

• Brain Structure – It’s been found that individuals with schizophrenia and mood disorders often have complications within their brain circuits that are responsible for mood and thought. Not to mention, this condition has been linked to lower dopamine levels. ⁹

• Environment – While it isn’t 100% clear how our environment plays a role in mental health, scientists believe people who are highly stressed are more at risk of schizoaffective disorder. ¹⁰

• Genetics – If a close relative (i.e. parent or sibling) struggles with either schizophrenia, depression, or bipolar disorder, you are more likely to develop schizoaffective disorder. ¹¹

• Substance Abuse – Certain drugs have been linked to the development of schizophrenia and its related disorders. ¹²

To identify whether you struggle with schizoaffective disorder or not, a doctor must rely on your medical history along with an assessment. The assessment will include brain scans, blood tests (to ensure symptoms aren’t of another illness), and a personal evaluation. Within this evaluation, the following will be observed:

• Whether or not you’ve experienced periods of uninterrupted illness.

• Whether or not you have experienced an episode of mania, major depression, or a mix of both.

• Whether or not you’re struggling with symptoms of schizophrenia.

• Whether or not you’ve had at least two psychotic symptoms (each of which lasted 2 weeks or more). If so, one of these episodes must occur without depressive or manic symptoms.

Schizophreniform Disorder

Schizophreniform disorder is almost identical to schizophrenia, but symptoms only last between 1 to 6 months. If symptoms carry on for a longer period, then it’s considered to be schizophrenia. ¹³

This condition is much more common than other psychotic disorders, with one in 1,000 people developing schizophreniform disorder at some point in their lifetime. Most of those affected are between the ages of 18 and 24.

Mental health professionals believe the causes of schizophreniform disorder are directly related to those of schizophrenia. With that said, you’ll receive an assessment for a diagnosis similar to schizophrenia. The major difference is the period in which your symptoms have occurred.

Brief Psychotic Disorder

Just as the name suggests, a brief psychotic disorder is when psychotic symptoms appear suddenly and only last for a short period (less than a month). There are three different forms of this condition: ¹⁴

• Brief Psychotic Disorder With Obvious Stressor – Sometimes referred to as “Brief Reactive Psychosis,” you may experience a psychosis shortly after a trauma or major stress (i.e. car accident, natural disaster, death of a loved one).

• Brief Psychotic Disorder Without Obvious Stressor – When you enter a psychosis without any apparent trauma or stress to trigger the symptoms.

• Brief Psychotic Disorder With Postpartum Onset – When a woman experiences a psychosis within four weeks of giving birth.

Since a brief psychotic disorder only happens for a short period, it’s much easier to treat than other psychotic disorders.

Brief Psychotic Disorder Symptoms

Symptoms for brief psychotic disorder are very similar to those of schizophrenia. The major difference is they only last for up to four weeks. The most common include:

• Abnormal behavior and appearance
• Confusion or disorientation
• Delusions
• Difficulty with decision-making
• Disorganized thoughts
• Hallucinations
• Inability to speak properly
• Memory complications
• Sleep and appetite changes

The severity of the above symptoms will vary from person to person. Not to mention, not everyone will experience the same symptoms.

Brief Psychotic Disorder Diagnosis

When there’s a clear trigger for these symptoms, such as a traumatic or stressful event, mental health professionals will be able to come to an easy diagnosis. However, if there’s no clear indication as to what caused your brief psychotic episode, you’ll need an interview and assessment tools to identify the condition.

Since brief psychotic disorder has symptoms very similar to other psychotic disorders, it’s important to make sure you aren’t struggling with another condition. To ensure this, a mental health professional will run brain imaging studies (such as an MRI), a physical exam, and possibly a blood test (to rule out other health conditions).

Delusional Disorder

A delusional disorder is characterized by false, fixed beliefs that often involve situations that could be true but aren’t. For example, you may have the delusion that someone is following you or that you’ve been infected with a chronic disease. ¹⁵ Delusions tend to take one of the following types:

• Erotomanic – Believing that someone is in love with you. You may go as far as to try and contact that person. More often than not, this person holds some form of importance (i.e. a celebrity). Sometimes, this leads to stalking.

• Grandiose – Holding the belief that your sense of worth, power, knowledge, and/or identity is above others. You may think you hold a special talent or made a vital discovery others haven’t.

• Jealous – Believing that your significant other is unfaithful even with evidence that they’re not.

• Persecutory – Believing that someone is spying on you and going to harm/mistreat you or someone close to you. This could result in complications with law enforcement.

• Somatic – Believing you have a physical defect or health condition even when proven you don’t.

• Mixed – Having two or more types of delusions.

It should be noted that scientists have observed people with delusional disorder will experience symptoms for more than one month. However, in rarer cases, some people may only have partial psychosis. ¹⁶

Delusional Disorder Symptoms

Delusional disorders are often marked by the delusions themselves. In other words, the false beliefs one holds are the biggest indication of struggle with this condition. Some other symptoms of delusional disorder one may experience include:

• Hallucinations
• Irritability
• Low mood
• Non-bizarre delusions (most obvious symptom)

Not everyone will experience these symptoms and, more often than not, diagnosis is based primarily on the delusion itself.

Delusional Disorder Diagnosis

Before a doctor diagnoses you with a delusional disorder, they will most likely make sure your symptoms aren’t caused by other illnesses. The most common overlapping symptoms include:

• Alzheimer’s disease
• Delirium
• Epilepsy
• Obsessive-compulsive disorder (OCD)
• Other psychotic disorders

From there, you’ll be referred to a mental health professional who will provide an interview and assessment. While scientists still aren’t sure what exactly causes a delusional disorder, there are some key factors a psychiatrist will take note of. These include:

• Biological – Research has found that abnormal brain activity in regions responsible for perception and thinking may be connected with delusional disorder symptoms. ¹⁷

• Environment – There are a few aspects of our environment that can lead to a delusional disorder. While stress is the most prevalent, alcohol and drug abuse may also play a significant role. Furthermore, individuals who feel isolated (i.e. immigrants) are also more susceptible. ¹⁸

• Genetics – It’s been observed that delusional disorder is much more prevalent in families with this condition or another psychotic disorder (most notably, schizophrenia). With that, parents risk passing on a delusional disorder to their children. ¹⁹

Shared Psychotic Disorder

A shared psychotic disorder (sometimes referred to as folie à deux) is when one person in a relationship struggles with delusions that another person adopts. For example, if one person believes someone is stalking them, their spouse will also begin to believe these false beliefs. In turn, this can lead to abnormal behavior. ²⁰

The biggest difficulty here is delusions are encouraged and therefore, can become worse over time. A shared psychotic disorder happens mostly in long-term relationships where a close emotional connection has already been formed.

However, shared psychotic disorders can also happen in groups of people who are involved with someone who’s struggling with a psychotic disorder. For example, a cult leader with a psychotic disorder may pass their delusions down to their followers.

Shared Psychotic Disorder Diagnosis

Experts aren’t entirely sure why a shared psychotic disorder happens in the first place. It’s largely believed that stress and social isolation play a major role in its development. ²¹

However, when a psychotic disorder happens between two or more people, it’s much easier to identify than other psychotic disorders. More often than not, a psychiatrist will run evaluations for all parties involved in which they’ll listen to symptoms, observe behaviors, and develop an understanding of the relationship.

Substance-Induced Psychotic Disorder

A substance-induced psychotic disorder will appear in two manners: ²²

1. The use of drugs (with delusions being produced when inebriated)
2. The withdrawal of drugs

Since several different substances have various effects on the body, it’s important to identify that only certain drugs hold the potential to cause psychosis. However, if drug withdrawals are intense enough, the risk for psychosis remains.

It’s been found that drugs that depress the nervous system (such as depressants) and stimulants (such as cocaine or methamphetamine) play a major role in your brain’s activity. So much so, that delusions can start to form when these drugs are abused. ²³ ²⁴

While it’s been noted that most cases of substance-induced psychosis go away after an individual stops using drugs or alcohol, there have been some cases where symptoms continue. Researchers believe that drug use may uncover certain psychiatric conditions, such as schizophrenia, within high-risk individuals. ²⁵

Psychotic Disorder Due to Another Medical Condition

Hallucinations and delusions could be an indication of a severe health condition that affects brain activity. The most common physical cause is a brain tumor.

This is much easier to recognize as physical evidence suggests where the problems lie. However, most doctors will assume delusional symptoms will go away once a patient is treated. Still, some people may continue to struggle with a psychotic disorder – especially, if the health condition that led to it was a traumatic experience.

The difficulty here is some patients may continue to believe they’re chronically ill even when medical professionals can confirm that the patient has been treated. In such cases, it’s important to see a psychiatrist as they’ll help treat these continuing symptoms.

Paraphrenia

Paraphrenia is a type of psychotic disorder where symptoms are extremely similar to schizophrenia. The major difference is symptoms develop later in life, usually in their elderly years (age 65 or older). ²⁶

It’s estimated that 2% to 3% of the elderly population will develop psychotic symptoms. However, the accuracy of this figure remains in question as many elderly people are reluctant to admit to psychotic symptoms. In fact, it’s estimated that up to 10% of nondemented elderly over the age of 85 experience symptoms.

Paraphrenia Diagnosis

Psychotic disorders in the elderly can be difficult to diagnose as they may reflect other medical conditions, such as Alzheimer’s disease and dementia. A mental health professional will look into certain risk factors to make a proper diagnosis. These include:

• Being divorced
• Dependence on community care
• Holding a lower education
• Paranoid personality traits
• Poor social network (low social functioning)
• Self-isolation (living alone)
• Sensory impairment (i.e. deafness)

Another difficult aspect of diagnosis is the fact that many prescription medications can produce psychotic symptoms. These drugs include:

• Anticholinergics
• Antiparkinsons
• Beta-blockers
• Psychostimulants
• Steroids

It should be noted that paraphrenia can be temporary. However, in long-term cases, it’s usually managed through antipsychotic medications.

How to Treat Psychotic Disorders

The majority of psychotic disorders mentioned here will be treated with medications and psychotherapies. Since these conditions are very particular in their symptoms and diagnosis methods, there is no one-size-fits-all approach to treatment.

Medications

The most important medication a medical professional will prescribe for psychotic disorders is known as antipsychotics. While these medicines don’t cure symptoms, they can be effective in helping individuals manage the most severe symptoms, such as delusions and hallucinations. ²⁷

Your doctor will prescribe you certain antipsychotics depending on your diagnosis, symptoms, and their severity. The most common antipsychotics prescribed for psychotic disorders include:

• Aripiprazole (Abilify)
• Asenapine (Saphris)
• Brexpiprazole (Rexulti)
• Cariprazine (Vraylar)
• Chlorpromazine (Thorazine)
• Clozapine (Clozaril)
• Fluphenazine (Prolixin)
• Haloperidol (Haldol)
• Iloperidone (Fanapt)
• Loxapine (Loxitane)
• Lurasidone (Latuda)
• Olanzapine (Zyprexa)
• Paliperidone (Invega)
• Paliperidone palmitate (Invega Sustenna, Invega Trinza)
• Perphenazine (Trilafon)
• Quetiapine (Seroquel)
• Risperidone (Risperdal)
• Thioridazine (Mellaril)
• Ziprasidone (Geodon)

Some of these medications are meant to be taken by injection once or twice a month for three consecutive months. Others are taken orally daily.

It’s important to note that since medication can’t treat psychotic disorders, it’s vital you also look into psychotherapies.

Psychotherapies

Psychotherapy can take on many different forms, each of which is designed to help individuals identify symptoms and develop coping mechanisms. The most common psychotherapies include: ²⁸

• Family therapy
• Group therapy
• Individual therapy

For people with psychotic disorders, it’s most common for them to be treated as outpatients. In other words, they don’t live at the hospital to be treated. Hospitalization only occurs in cases where an individual presents evidence that they’re in danger of hurting themselves or others.

Final Word

The majority of people with a psychotic disorder do recover from their symptoms through medications and psychotherapies. While this improvement isn’t immediate (often, taking weeks or months) the progress will become apparent over time.

While you’re recovering, it may help to speak with others who have had a psychotic disorder and get to know their experiences. This will give you an idea of any challenges you may come up against in the future.

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