About psychotic disorders

What is psychotic disorders?

Psychotic disorders include schizophrenia and a number of lesser-known disorders.

  • The number of people who develop a psychotic disorder tends to vary depending on the country, age, and gender of the sufferer, as well as on the specific kind of disorder.
  • There are genetic, biological, environmental, and psychological risk factors for developing a psychotic disorder.
  • Usually with any psychotic disorder, the person's inner world and behavior have notably changed.
  • When assessing a person suffering from psychotic symptoms, health-care professionals will take a careful history of the symptoms from the person and loved ones as well as conduct a medical evaluation, including necessary laboratory tests and a mental-health assessment.
  • Most effective treatments for psychotic disorders are comprehensive, involving appropriate medications, mental-health education, and psychotherapy for the sufferer of psychosis and his or her loved ones. It will also include the involvement of community supportive services when needed.
  • Prevention of psychosis primarily involves preventing or decreasing the impact of factors that put the person at risk for developing a psychotic disorder.

What are the different types of psychotic disorders?

Psychotic disorders are now referred to as schizophrenia spectrum and other psychotic disorders. In addition to the more commonly known mental disorders like schizophrenia, other mental disorders in this group include brief psychotic disorder, schizotypal personality disorder, delusional disorder, schizophreniform disorder, schizoaffective disorder, catatonia, substance/medication-induced psychotic disorder, psychosis due to a medical condition, other specified schizophrenia spectrum, unspecified schizophrenia spectrum, and other psychotic disorder. Besides catatonia, other catatonia-related disorders include catatonic disorder due to another medical condition, as well as unspecified catatonia. Women who recently had a baby (are in the postpartum state) may uncommonly develop postpartum psychosis. Also, mood disorders like major depressive disorder and bipolar disorder can become severe enough to result in psychotic symptoms like hallucinating or having delusions, also called psychotic features.

How common are psychotic disorders?

The percentage of people who suffer from any psychotic symptom at any one time (prevalence) varies greatly from country to country, from as little as 0.66% in Vietnam to 45.84% in Nepal. While the figure of one out of 100 people who qualify for the diagnosis of schizophrenia may sound low, that translates into about 3 million people in the United States alone who have schizophrenia. The first time a person has psychotic symptoms is usually between the ages of 18 and 24 years; related but less severe (prodromal) symptoms often start during the teenage years. Statistics for postpartum psychosis include that it occurs in one or two out of 1,000 births but increases greatly, up to one in seven mothers, in women who had postpartum psychosis in the past. Men are thought to develop psychotic disorders more often and at younger ages than women.

What are the symptoms for psychotic disorders?

The symptoms of Psychosis can vary between mental health disorders, but below are some possible signs:

  • concentration difficulties
  • brain fog
  • increased Anxiety or agitation
  • loss of interest or joy in your normal activities
  • increased or decreased appetite
  • hallucinations, where you hear or see things that seem real to you
  • social withdrawal
  • neglected personal hygiene
  • holding strong beliefs that aren’t actually true
  • Paranoia over people and situations around you

What are the causes for psychotic disorders?

There’s no one cause of psychosis. Genetics and brain chemical changes are strong links. Traumatic events, substance use, and underlying health conditions can sometimes lead to changes in the way your brain works.

Past research has indicated that dopamine, serotonin, and glutamate disruptions in the brain may cause certain psychotic disorders. However, there’s not enough evidence to associate any one neurotransmitter disruption with psychosis.

What are the treatments for psychotic disorders?

Antipsychotic medications are proven effective in treating acute psychosis and reducing the risk of future psychotic episodes. For example, the treatment of schizophrenia or bipolar disorder with psychotic features thus has two main phases: an acute phase, when higher doses of medication might be necessary in order to treat psychotic symptoms, followed by a maintenance phase, which could be lifelong. During the maintenance phase, the medication dosage is gradually reduced to the minimum required to prevent further episodes. If symptoms reappear on a lower dosage, a temporary increase in dosage may help prevent a relapse.

Even with continued treatment of the more chronic or recurring psychotic disorders, some patients experience relapses. By far, though, the highest relapse rates for such disorders are seen when medication is discontinued. The large majority of patients experience substantial improvement when treated with antipsychotic agents. Some patients, however, do not respond to medications, and a few may seem not to need them.

Antipsychotic medications are the cornerstone in the management of psychosis. They have been available since the mid-1950s, and although antipsychotics do not cure the illness, they greatly reduce the symptoms and allow the patient to function better, have better quality of life, and enjoy an improved outlook. The choice and dosage of medication is individualized and is best done by a physician who is well trained and experienced in treating severe mental illness.

The first antipsychotic was discovered by accident and then used for schizophrenia. This was chlorpromazine (Thorazine), which was soon followed by medications such as haloperidol (Haldol), fluphenazine (Prolixin), thiothixene (Navane), trifluoperazine (Stelazine), perphenazine (Trilafon), and thioridazine (Mellaril). These medications have become known as "neuroleptics" because, although effective in treating positive symptoms (for example, acute symptoms such as hallucinations, delusions, thought disorders, loose associations, ambivalence, or mood swings/emotional lability), they cause side effects, many of which affect the neurologic (nervous) system. Examples of such neurologic side effects include muscle stiffness or rigidity, painful spasms, restlessness, tremors, and muscle twitches. These older medications are thought to be not as effective against so-called negative symptoms such as decreased motivation and lack of emotional expressiveness.

Since 1989, a new class of antipsychotics (atypical antipsychotics) has been used. At clinically effective doses, none (or very few) of these neurological side effects of traditional antipsychotics, which often affect the extrapyramidal nerve tracts, are observed.

Clozapine (Clozaril), the first of the new class, is the only agent that has been shown to be effective in situations where other antipsychotics have failed. Its use is not associated with extrapyramidal side effects, but it does produce other side effects, including a possible decrease in the number of white blood cells. Therefore, blood cell counts need to be monitored every week during the first six months of treatment and then every two weeks to detect this side effect early if it occurs.

Other atypical antipsychotics include risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify), paliperidone (Invega), asenapine (Saphris), iloperidone (Fanapt), and lurasidone (Latuda). The use of these medications has allowed successful treatment and release back to their homes and the community for many people suffering from schizophrenia.

Although more effective and better tolerated, the use of these agents is also associated with side effects, and current medical practice is developing better ways of understanding these effects, identifying people at risk, and monitoring for the emergence of complications.

Most of these medications take two to four weeks to take effect. Patience is required if the dose needs to be adjusted, the specific medication changed, or another medication added. In order to be able to determine whether an antipsychotic is effective or not, it should be tried for at least six to eight weeks (or even longer with clozapine).

Since people with a psychotic disorder are at increased risk of also developing depression, medications that address that symptom may be of great benefit as well. Serotonergic medications like fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro) are often prescribed because of their effectiveness and low incidence of side effects. Other often-prescribed antidepressant medications for the depression that can be associated with psychotic disorders include venlafaxine (Effexor), duloxetine (Cymbalta), desvenlafaxine (Pristiq), and buproprion (Wellbutrin).

Because the risk of relapse of illness is higher when antipsychotic medications are taken irregularly or discontinued, it is important that people with a psychotic disorder follow a treatment plan developed in collaboration with their doctors and with their families. The treatment plan will involve taking the prescribed medication in the correct amount and at the times recommended, attending follow-up appointments, and following other treatment recommendations.

People with psychosis often do not believe that they are ill or that they need treatment. Other possible things that may interfere with the treatment plan include side effects from medications, substance abuse, negative attitudes toward treatment from families and friends, or even unrealistic expectations. When present, these issues need to be acknowledged and addressed for the treatment to be successful.

What are the risk factors for psychotic disorders?

Psychotic disorders are mental illnesses that make it difficult to think logically and clearly. They can cause hallucinations, which are false perceptions of things that aren't really happening, and delusions, which are false beliefs about what's happening in the world. Psychotic disorders can also affect your mood and behavior.

Psychotic disorders are often grouped into two categories: schizophrenia and bipolar disorder with psychotic features. Schizophrenia is a severe mental illness affecting your thoughts, feelings, and behavior. People with schizophrenia may hear voices or have other strange beliefs that aren't real. People with bipolar disorder with psychotic features have manic or depressive episodes that include hallucinations or delusions.

The four risk factors of psychotic disorders are:

1. Family history: People who have a family member with a psychotic disorder are more likely to develop the same disorder.

2. Genetic factors: Some people may be genetically predisposed to developing psychosis, and this can also be passed down from parents to children.

3. Environmental factors: Environmental factors such as drug use, stress, and trauma can trigger psychotic episodes in people who are already at risk for them because of their genetics or family history.

4. Brain changes: The brain is still developing during adolescence, so this is when many psychotic disorders emerge (even in children).

Hallucinations,Delusions,Disorganized speech and behavior,Catatonia,Disturbance in mood and thought processes,Negative symptoms
Schizophrenia,Depression,Bipolar disorder,Anxiety disorders,ADHD
Antipsychotics,Mood stabilizers,Atypical antipsychotics,Anti-anxiety medications,Antidepressants

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