Psychotic Disorders

Psychotic Disorders

Psychotic Disorders, Types, Symptoms, Causes, Schizophrenia & Dual Diagnosis Treatment

What is Psychotic Disorder?

Psychotic disorders are severe mental disorders that cause abnormal thinking and perceptions. People with psychoses lose touch with reality. Two of the main symptoms are delusions and hallucinations [1]. Delusions are false beliefs, such as thinking that someone is plotting against you or that the TV is sending you secret messages. Hallucinations are false perceptions, such as hearing, seeing, or feeling something that is not there. Other symptoms include incoherent or nonsense speech, and behavior that is inappropriate for the situation. A person in a psychotic episode may also experience depression, anxiety, sleep problems, social withdrawal, lack of motivation, and difficulty functioning overall. Treatment depends on the cause of the psychosis. It might involve medications to control symptoms and psychotherapy.

According to the National Institute of Mental Health (NIMH) [2], Approximately 3 percent of the people in the U.S. (3 out of 100 people) will experience psychosis at some time in their lives. With early diagnosis and appropriate treatment, it is possible to recover from psychosis. Many people who receive early treatment never have another psychotic episode. For other people, recovery means the ability to live a fulfilling and productive life, even if psychotic symptoms return sometimes. If you think someone you know is experiencing psychosis, encourage the person to seek treatment as early as possible. Psychosis can be treated effectively, and early intervention increases the chance of a successful outcome.

Left untreated, psychotic symptoms can lead to disruptions in school and work, strained family relations, and separation from friends. The longer the symptoms go untreated, the greater the risk of additional problems. These problems can include substance abuse, going to the emergency department, being admitted to the hospital, having legal trouble, or becoming homeless. Studies have shown that many people experiencing first-episode psychosis in the United States typically have symptoms for more than a year before receiving treatment.

Psychotic Disorders
As schizophrenia and alcohol abuse occur together so frequently, it is crucial to treat both conditions at the same time. 

What are the Types of Psychotic Disorders?

Psychotic disorders can be long, or short-term conditions. Individuals can experience a single psychotic episode triggered by extreme stress or other temporary changes to the brain. They can also deal with multiple psychotic breaks. Many types of psychotic disorders exist. Schizophrenia is the most common type of psychotic disorder and is one of the leading causes of disability worldwide. But other types of psychotic conditions can also create significant health problems.

Schizophrenia

Schizophrenia comprises negative and positive symptoms. 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 take the form of silence.

Negative symptoms of schizophrenia include:

  • 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)

Positive symptoms add abnormal cognitive or perceptual experiences and are the symptoms most commonly associated with schizophrenia, including:

  • Delusions
  • Hallucinations
  • Disorganized speech
  • Disordered movement

The way these symptoms manifest can vary from person to person.

Schizophreniform Disorder

Schizophreniform disorder is a type of short-term schizophrenia. A diagnostic criterion 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. Schizophreniform disorder is often an early precursor or stage of schizophrenia. Over two-thirds of individuals develop schizophrenia after being diagnosed with schizophreniform disorder.

Schizoaffective Disorder

Schizoaffective disorder is a condition involving both psychotic and mood symptoms. These symptoms of the condition make it a particularly serious diagnosis, with a high risk of self-harm and suicide.

To be diagnosed with schizoaffective disorder, an individual must experience an uninterrupted period in which they have symptoms of schizophrenia during a manic, hypomanic, or major depressive episode.

People with the schizoaffective disorder must also experience hallucinations and delusions when no mood symptoms are present. Schizophrenic symptoms are primary and prominent in schizoaffective disorders. They are not secondary to mood disorder symptoms.

Psychotic Disorders
No one is sure what causes schizophrenia, but your genetic makeup and brain chemistry probably play a role.

Substance Induced Psychotic Disorders

When psychotic disorders and substance abuse co-occur, substance-induced psychotic disorders can develop. The substance-induced psychotic disorder has the same features as schizophrenia but is solely caused by the effects of alcohol or drugs.

The symptom of substance-induced psychotic disorder is psychosis. Unlike other disorders involving psychosis, substance-induced psychotic disorder produces psychosis caused by using alcohol or drugs.

To be diagnosed with a substance-induced psychotic disorder, a person must experience:

  • Elaborate and prominent drug-induced hallucinations
  • No insight that these hallucinations are caused by alcohol or drugs
  • Prominent delusions that they believe are real or those that are acted upon

To be diagnosed with substance-induced psychotic disorder, symptoms must happen during intoxication or withdrawal from a substance. Symptoms cannot happen exclusively in a delirious state and cannot be secondary to a psychotic disorder that is not substance-induced.

For example, if a person experienced psychotic symptoms before they began using alcohol or drugs, it is likely that their substance use worsened or triggered an underlying condition. In this instance, the substance-induced psychotic disorder is not applicable.

Delusional Disorder

Delusional disorder is a condition characterized by the presence of delusions rather than auditory or visual hallucinations. Individuals with the delusional disorder do not experience significant functional impairments or overtly bizarre behavior.

Individuals with delusional disorder deal with false beliefs that typically involve plausible yet untrue scenarios. People with this condition usually show at least one of 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)

To be diagnosed with delusional disorder, these symptoms cannot happen exclusively alongside a mood episode. They also cannot be induced by alcohol or drug use.

Brief Psychotic Disorder

The brief psychotic disorder happens in people who experience psychotic symptoms — such as hallucinations, delusions, disorganized speech, or disorganized behavior — for less than a month.

Individuals with brief psychotic disorder return to their previous level of functioning after the short psychotic episode have passed. This condition often happens in response to physical conditions that affect the brain or significantly increase stress.

Psychotic Disorder Causes

The exact cause is not always clear and it must be taken into account that each type of psychosis is different. However, there are certain diseases that cause it, there are also triggers such as drug use, lack of sleep and other environmental factors, and certain situations can lead to the development of specific types of psychosis.

Diseases

Illnesses that can cause psychosis includes:

  • Parkinson disease
  • Huntington‘s disease and some chromosomal disorders
  • Brain tumors or cysts
  • Some types of dementia

Genetics

  • Research shows that schizophrenia and bipolar disorder may share a common genetic cause.

Hormones/Sleep

  • Postpartum psychosis occurs very soon after giving birth (usually within two weeks), the exact causes are not known, but some researchers believe it could be due to changes in hormone levels and disturbed sleep patterns.

Recreational drugs

Psychotic Disorder Symptoms

While the specific symptoms for a certain type of psychotic disorder will vary, there are some general signs that individuals will experience upon the onset of psychotic disorders. The early symptoms then progress to the more intensified signs of psychosis. The signs of psychotic disorders include:

  • Sleep disturbances
  • Lack of attention to personal hygiene
  • Social withdrawal, isolating behaviors
  • Depressed mood
  • Decline in functioning at work, at school, or in self care
  • Anxiety
  • Difficulty concentrating
  • Mood swings
  • Feeling uneasy around others
  • Difficulty communicating thoughts
  • Having strong inappropriate emotions or no emotions at all
  • Fatigue, decreased motivation
  • Difficulty managing daily stress
  • Confused thinking
  • Paranoia
  • Angry outbursts
  • Delusional thoughts
  • Visual and audible hallucinations

Schizophrenia and Alcohol

Substance abuse in general (that is the abuse of alcohol or the use of street drugs) is a significant problem for people living with schizophrenia with over half of all people with schizophrenia having co-occurring drug or alcohol abuse issues. Those most likely to abuse alcohol are young males with a family history of alcohol abuse. 

Research shows that people with schizophrenia are more likely to abuse street drugs than the general population, in the case of alcohol abuse, the evidence is not so clear cut with some studies finding that as many as one in three people with schizophrenia will suffer from alcoholism at some stage in their life and others suggesting that in fact, abuse of alcohol is no greater a problem for people with schizophrenia than in the general population.

People with schizophrenia who abuse alcohol will experience more frequent relapses of their psychotic symptoms. Alcohol use will also cause problems with relationships with family and friends, risks bringing them into contact with the criminal justice system. Moreover, it will damage their reputation and increase the risk of physical health problems, including high blood pressure, heart disease, stroke, and stomach ulcers.

Perhaps one of the greatest threats that alcohol abuse for someone with schizophrenia is that, in providing a temporary feeling of well-being, it distracts them from the very real necessity of dealing with the complex problems in their lives caused by this cruel condition the disease. Substance abuse is also a clear predictor to dangerous behavior in schizophrenia, such as suicide or violence.

Dual Diagnosis Treatment

To provide proper treatment for dual diagnosis or co-occurring disorders, the Substance Abuse and Mental Health Services Administration (SAMHSA) recommends an integrated treatment approach. Integrated treatment involves coordinating mental health and substance abuse interventions rather than treating each disorder separately without consideration for the other.

Integrated or dual diagnosis treatment often involves forms of behavioral treatment, such as cognitive-behavioral therapy (CBT) or dialectical behavior therapy (DBT), that can help improve coping skills and reduce maladaptive behaviors. These may be used in combination with medication-assisted treatment (MAT). Integration is key to achieving a healthy balance and long-term recovery.

Treating co-occurring disorders is a critical aspect of our inpatient treatment experience because co-occurring disorders are strongly connected with instances of substance abuse. Creating a treatment plan that addresses the physical aspects of withdrawal, the psychological connection with drug abuse, and addressing underlying mental health disorders is all a part of setting clients up for success.

At We Level Up NJ, we believe that if the client can identify the underlying mental health issue and treat it simultaneously with their treatment for substance abuse, the client’s chances of a successful, relapse-free recovery are much improved. In fact, once we can identify and properly begin treatment on the underlying issues such as psychotic disorders that are driving or co-occurring with the dependency on alcohol or other drugs, clients will have reached a major milestone and will be that much closer to long-term sobriety.

Psychotic Disorders
People who have experienced psychosis from any cause are more likely to experience it again, especially when under the influence of a substance. 
Sources:

[1] NIH – https://medlineplus.gov/psychoticdisorders.html#:~:text=Psychotic%20disorders%20are%20severe%20mental%20disorders%20that%20cause,of%20the%20main%20symptoms%20are%20delusions%20and%20hallucinations.

[2] NIMH – https://www.nimh.nih.gov/health/topics/schizophrenia/raise/raise-questions-and-answers#3