What Are the Types of Psychotic Disorders?

Delusions can be an underlying symptom of various types of psychotic disorder. From schizophrenia to paraphrenia, here’s everything you need to know.

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A psychotic disorder is often characterized by people who lose touch with reality and are unable to perform normal day-to-day tasks. ¹ While schizophrenia is the most common psychotic disorder, there are many different types of this condition – each of which come with their own set of symptoms and treatment.

Throughout this article, we’re going to explore the types of psychotic disorders, their related signs and symptoms, diagnosis, and the best treatment options. At the end, we invite you to ask further questions.

Psychotic Disorder Symptoms

Psychotic disorders are often categorized by the following symptoms:

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

The more severe these symptoms present themselves, the more difficult time an individual will have grasping reality.

Mental health professionals will check to see if you’re struggle with any of the above symptoms. If you are struggling with more than one, you may have a psychotic disorder.

In order to get a proper idea of what these conditions are, we’re going to take a deeper look into each the types of psychotic disorder:

Schizophrenia

Perhaps the most common psychotic disorder, schizophrenia is defined by those who have shown a change in behavior and struggle with specific symptoms (see below) for longer than six months. More often than not, schizophrenia effects one’s 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

People who struggle with schizophrenia often experience highly exaggerated actions, ideas, and perceptions. These are often developed due to a loss of sense with 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 a number of different forms, including: ⁴
    • Persecutory Delusions – Holding the belief that someone is after you – that 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’re struggling 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 that 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 a number of different forms, including: ⁵
    • Auditory – When you hear voices in your head. These voices may be angry and demanding. Some experience on voice while others have experienced 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 a 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 – As with disorganized thoughts, you may find yourself easily distracted. For example, it can be difficult for your to follow a television show as you watch it.
  • Movement Complications – You might find you lack complete control over your movements. This can appear in a number of manners, from being jumpy to not moving at all. It should be noted that this often doesn’t result in violence.

Schizophrenia Diagnosis

Mental health professionals often have a difficult time diagnosing schizophrenia as 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. This is when the signs of schizophrenia are identical to normal life changes. As mentioned, schizophrenia often happens during adolescents. During this period, it’s quite common for teenagers to 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

People who struggle with schizoaffective disorder show signs and symptoms of schizophrenia along with a mood disorder. Cases of schizoaffective disorder are extremely rare – only affected 0.03% of the population. With that, there is not set and stone treatment plan available. However, medical professionals tend to treat both schizophrenia and the mood disorder simultaneously. ⁸

There are two types of mood disorders that can run adjacent to schizophrenia:

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

Being the rarity of this disease, it can be extremely difficult for mental health professionals to make a proper diagnosis.

Schizoaffective Disorder Symptoms

The symptoms associated with schizoaffective disorder are a combination of schizophrenia and major depressive symptoms. Some individuals 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 carry out 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 to your sense of taste, smell, and touch.
  • Lack of Personal Care – Not taking care of your personal hygiene or maintaining your appearance.
  • Manic Episodes – Having sudden high amounts of energy and happiness. This 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 problem in your work, school, or social life, a mental health professional will most likely run an assessment for schizoaffective disorder.

Schizoaffective Disorder Diagnosis

Since scientists don’t know what exactly causes schizoaffective disorder, it can be extremely difficult for mental health professionals to make 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 levels of dopamine. 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, aunts and uncles) struggle 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

In order to identify whether you’re struggling 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 make sure symptoms aren’t of another illness), and – from there – a personal evaluation.

Within this evaluation, a mental health professional will observe the following:

  • 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 have 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, the major difference being symptoms only last between 1 to 6 months. If symptoms carry on for a longer period of time, then it’s considered to be schizophrenia. ¹³

This condition is much more common than other psychotic disorders – with 1 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 a similar assessment for diagnosing to schizophrenia – the major difference being the time period of which your symptoms have occurred.

Brief Psychotic Disorder

Just as the name suggests, a brief psychotic disorder is when psychotic symptoms appear suddenly but only last for a short period of time (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 usually within 4 weeks of giving birth.

Since a brief psychotic disorder only happen for a short period of time, it is 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 4 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

If there is a clear trigger for the above-mentioned symptoms – such as a traumatic or stressful event – mental health professionals will be able to diagnose you much easier than other conditions discussed within this article. If there is no clear indication as to what caused your brief psychotic episode, a mental health professional will give you an interview and assessment tools in order 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. In order 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 have false, fixed beliefs that often involve situations which could be true, but aren’t. For example, one may have the delusion that someone is following them or they’ve been infected with a chronic disease. ¹⁵

Delusions tend to take one of the following seven types:

  • Erotomanic – Believing that someone is in love with you and going as far as to try and contact that person. More often than not, this person holds some for 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 that you’ve made a vital discovery others haven’t found.
  • Jealous – Believing that your significant other is unfaithful even with evidence that they’re not.
  • Persecutory – Believing that someone is spying on your 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 it’s been 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 a 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 their 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, diagnosing 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 with overlapping symptoms include:

From there, you’ll be referred to a mental health professional who will provide you with 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. Not to mention, 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 encourage 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, being as a psychotic disorder is happening 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 different manners: ²²

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

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

It’s been found that drugs which 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 goes 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.

For many doctors, this is much easier to recognize as there’s physical evidence to suggest where the problems lie. However, most doctors will assume delusional symptoms will go away once a patient is treated.

Some people may continue to struggle with a psychotic disorder – especially, if their health condition that lead 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 will be able to help treat these continuing symptoms.

Paraphrenia

Paraphrenia is a type of psychotic disorder where symptoms are extremely similar to schizophrenia. The major difference is people begin to develop symptoms later in life, when they are in their elderly years. ²⁶

It’s estimated that 2% to 3% of the elderly population (anyone over the age of 65) will develop psychotic symptoms. However, the accuracy of this figure remains in question as many elderly people are reluctant to admit of 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 only 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 certain 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 are 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 take by injection once or twice a month for three consecutive months. Others are taken orally on a daily basis.

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

Psychotherapies

A 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 in order to be treated. Only in cases where an individual presents evidence that they’re in danger of hurting themselves or others will a patient be placed in an inpatient program.

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.

Your Questions

Still have questions about the types of psychotic disorders?

We invite you to ask them in the comment section below. If you have any further knowledge on the topic to share – whether personal or professional – we’d also love to hear from you.

Reference Sources

¹ MedlinePlus: Psychotic Disorders

² National Institute of Mental Health (NIMH): Schizophrenia

³ frontiers in Behavioral Neuroscience: Schizophrenia: a consequence of gene-environment interactions?

⁴ Harvard Health Publishing (Harvard Medical School): Delusional Disorder

⁵ Industrial Psychiatry Journal (Medknow Publications: Hallucinations: Clinical aspects and management

⁶ Language and linguistics compass (HHS Public Access): Language in schizophrenia Part 1: an Introduction

⁷ Indian Journal of Psychiatry (Medknow Publications): Understanding the schizophrenia prodrome

⁸ MedlinePlus: Schizoaffective Disorder

⁹ Acta Psychiatrica Scandinavica (John Wiley & Sons): Brain structural changes in schizoaffective disorder compared to schizophrenia and bipolar disorder

¹⁰ Dialogues in clinical neuroscience: Environmental risk factors for psychosis

¹¹ Schizophrenia Bulletin (Oxford University Press): Genetic Relationships Between Schizophrenia, Bipolar Disorder, and Schizoaffective Disorder

¹² Dialogues in clinical neuroscience: Substance abuse in patients with schizophrenia

¹³ National Library of Medicine: Schizophreniform disorder, delusional disorder, and psychotic disorder not otherwise specified.

¹⁴ MedlinePlus: Brief psychotic disorder

¹⁵ Harvard Health Publishing (Harvard Medical School): Delusional Disorder

¹⁶ Schizophrenia Bulletin (Oxford University Press): Delusional Disorder as a Partial Psychosis

¹⁷ Industrial Psychiatry Journal (Medknow Publications): Understanding delusions

¹⁸ Schizophrenia Bulletin (Oxford University Press): Evidence That Environmental and Genetic Risks for Psychotic Disorder May Operate by Impacting on Connections Between Core Symptoms of Perceptual Alteration and Delusional Ideation

¹⁹ National Library of Medicine: Genetic associations between delusional disorder and paranoid schizophrenia

²⁰ NCBI Bookshelf: Shared Psychotic Disorder

²¹ Schizophrenia Bulletin (Oxford University Press): Loneliness in Psychosis: A Meta-analytical Review

²² NCBI Bookshelf: Substance Abuse Treatment for Persons with Co-Occurring Disorders. 9 Substance-Induced Disorders

²³ National Institute on Drug Abuse (NIDA): Prescription CNS Depressants DrugFacts

²⁴ Cureus (Journal of Medical Science): A Case Study of Acute Stimulant-induced Psychosis

²⁵ National Institute on Drug Abuse (NIDA): Common Comorbidities with Substance Use Disorders Research Report

²⁶ National Library of Medicine: What’s happened to paraphrenia? A case-report and review of the literature

²⁷ NCBI Bookshelf: Antipsychotic Medications

²⁸ Psychiatry (Edgmont) (Matrix Medical Communications): Supportive Psychotherapy for a Patient with Psychosis

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