Psychotic disorder

What is psychotic disorder?

A psychotic disorder describes a severely impaired understanding of reality. It may manifest in many ways, including delusions, hallucinations, confusion, disorganized speech, exaggerated or diminished emotions, or bizarre behavior. It may manifest as a severe impairment of functioning, with social withdrawal and inability to take care of work, relationships, or even basic personal care. The individual generally has no awareness of his or her abnormality.

Psychotic symptoms, though present, do not meet all the diagnostic criteria for a specific psychotic disorder, such as schizophrenia. There may be insufficient information or contradictory findings to diagnose a specific psychotic disorder. Psychotic symptoms are described as positive or negative. Positive symptoms are delusions, hallucinations, thought broadcasting and bizarre behaviors. Negative symptoms show a reduction or loss of normal functions, such as restriction and flattening of emotions, severely reduced speech or thought, and lack of interest in any goal-directed activities.

A delusion is a firm belief that others cannot verify. The delusional person will cling to the belief despite evidence to the contrary. A common type of delusion involves thoughts of persecution, such as being spied upon or conspired against. There may also be delusions of grandeur, in which individuals believe they have extraordinary powers, are on a special mission, or think they are an important person such as Jesus Christ. The delusion is termed bizarre if it is not based on ordinary life experiences; an example would be that one's body and/or thoughts are being controlled by aliens.

Hallucinations are sensory perceptions that no one else can detect. They can involve the sense of sight, touch, hearing, smell, or taste. However, hearing voices is the most frequent hallucination in psychosis. The hallucinations occur with the person is wide awake.

Disorganized thoughts (loosening of associations) are another characteristic of psychosis, in which the person may jump from one topic to another. Grossly disorganized behavior can result in neglect of personal appearance and hygiene, making meals, and other tasks of living. The person may dress inappropriately and act unpredictably, shouting or swearing in public. At the other behavioral extreme is catatonia, becoming withdrawn, immobile, and unaware of the surrounding world.

Emotional flatness may be seen, with an unresponsive face and little eye contact with another person. Or, the emotions may be inappropriate for the situation, laughing at a situation that no one else finds amusing. Unexplained fear, anger, or sadness can also be seen. Abnormal movements can be seen, such as continuous pacing, rocking, facial grimacing, or rigid immobility in strange postures.

How is it diagnosed?

History during a psychotic episode can involve any combination of delusions, hallucinations, abnormal speech, bizarre or highly disorganized behavior, emotions that are flat or inappropriate, or lack of any purposeful and productive activity.

Physical exam findings do not establish the diagnosis. Observation of the individual's orientation, dress, mannerisms, behavior and content of speech provide essential signs to diagnose the illness.

Tests are not helpful to establish this diagnosis.

How is psychotic disorder treated?

Psychiatric hospitalization may be needed to protect individuals from their own loss of reality, judgment, and impulse control. Antipsychotic medication is given, along with any appropriate psychotherapy.

Medications

Seroquel (Quetiapine), Geodon (Ziprasidone), Zyprexa (Olanzapine)

What might complicate it?

Accidental injuries, suicide, or homicide could occur during a psychotic episode.

Predicted outcome

Outcome is unclear, given this nonspecific diagnosis.

Alternatives

Medical causes of psychotic symptoms include temporal lobe epilepsy, brain tumor, stroke, an endocrine or metabolic disturbance, a severe vitamin (thiamine) deficiency, an infection (neurosyphilis), autoimmune disease such as systemic lupus, or toxic heavy metal poisoning. Drug intoxication with stimulants, hallucinogens, or anticholinergic drugs could also cause psychotic symptoms, as could barbiturate or alcohol withdrawal. Other possible psychiatric disorders are brief reactive psychosis, delusional disorder, panic disorder, depersonalization disorder, obsessive-compulsive disorder, major depression, a personality disorder, or malingering.

Appropriate specialists

Psychiatrist, psychologist, or other mental health professionals.

Last updated 6 April 2018