Examples Of Psychosis: Understanding Psychotic Disorders

Psychosis is a flexible term that can be used to refer to a set of symptoms characterized by a mental state where someone seems disconnected with reality. Psychosis is associated with severe mental health conditions, like schizophrenia spectrum disorders and some mood disorders, and can sometimes be caused by specific medical conditions, like dementia. 

Psychosis symptoms typically emerge in adolescence to young adulthood. However, early-onset psychosis has been observed in children, and late-onset psychosis in older individuals can be associated with conditions like dementia.

Because research is ever-evolving, the prevalence rate of psychosis in the general population can be difficult to quantify. Some research estimates that roughly 1.5% to 3.5% of individuals will meet diagnostic criteria for a psychotic disorder at some point in their lives. However, prevalence rates for psychosis symptoms may be higher than those of psychotic disorders, because psychosis symptoms can result from many different conditions. In this article, we’ll explore psychosis symptoms and psychotic disorders.

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What are symptoms of psychosis?

While someone who develops psychosis symptoms will have their own unique experience, there are core symptoms that most people with psychosis may experience.

Symptoms of psychosis can be severe, and, in some cases, they may warrant hospitalization when an individual appears to be a threat to themselves or others. However, symptoms are typically treatable with antipsychotic medications and therapeutic interventions. 

Delusions

Delusions can be described as fixed, false beliefs or judgments that are not based on reality. Delusions are often irrational and cannot be changed with reason or evidence. People experiencing delusions are usually unable to distinguish the difference between their delusions and reality. Individuals can have delusions associated with present perceptions as well as memories (for example, the person believes something happened in the past that did not) and ideas. 

There are many different types of delusions, including:

• Persecutory/paranoid delusions: The individual may believe they are being targeted, harassed, or conspired against by others. 
• Grandiose delusions: Someone may believe they have exceptional abilities, wealth, or fame. 
• Somatic delusions: The individual may believe they have a severe medical condition or physical issue that is not supported by medical evidence.
• Erotomanic delusions: Someone may believe that an individual they don’t know or who is of higher status (like a celebrity) is in love with them.
• Religious delusions: The individual may believe they have an exclusive relationship with a higher power or deity, often with no basis in religious doctrine. These types of delusions may not be rooted in genuine belief but in an individual’s environment, culture, and experience.
• Thought insertion/broadcasting: The individual may believe they can project their thoughts into others or that an outside entity is inserting thoughts into their mind. 
• Mixed delusions: An individual may experience a combination of delusional themes. 

Hallucinations

Hallucinations are false sensory experiences (i.e. when you hear, taste, smell, etc.) that someone may experience, but aren’t real. People experiencing hallucinations typically think their perceptions are based on reality, and they can seem very vivid to the individual experiencing them. 

Different types of hallucinations may include:

• Auditory hallucinations: These generally involve hearing voices, music, or other sounds that aren’t present. Auditory hallucinations tend to be the most common type experienced by people with schizophrenia spectrum disorders.
• Visual hallucinations: These usually refer to seeing things that are not there, such as people, animals, or objects. Visual hallucinations can occur in psychotic disorders, but also alongside substance use and conditions like migraine and dementia. 
• Olfactory hallucinations: Olfactory hallucinations may involve smelling odors that are not present, such as burning rubber or rotting food. Olfactory hallucinations can occur in conditions like epilepsy and brain tumors. 
• Gustatory hallucinations: A person with gustatory hallucinations may taste flavors or sensations in the mouth that aren’t actually present. 
• Tactile hallucinations: These generally refer to feeling sensations on the skin, such as tingling, crawling, or itching, without any external cause. Tactile hallucinations can occur in conditions like substance withdrawal and delirium. 
• General somatic hallucinations: Somatic hallucinations can involve experiencing sensations inside the body caused by things that don’t exist. These visceral sensations are typically associated with correlating delusions.  
• Mixed hallucinations: A person may experience hallucinations involving multiple senses simultaneously. 

Disorganized thinking and speech

Disorganized thinking and speech are among the four core symptoms of psychosis. They can be common in many conditions and can make it difficult for individuals to communicate effectively, often leading to confusion and misunderstanding in conversations. 

Symptoms associated with disorganized thinking and speech may also create problems in social situations for individuals who lack of insight into their mental health disorders. Individuals exhibiting disordered speech may have: 

• Thoughts that wander off-topic or become disconnected from a main concept or conversation, making it challenging to remain focused on a specific subject
• Speech patterns that are difficult to follow, with disjointed or nonsensical sentences that may not make sense to others
• Irrational thought processes leading to connections between ideas, contributing to disjointed or fragmented conversations 
• Rapid, impulsive speech patterns that can make it difficult for others to follow the conversation, or they might suddenly stop speaking in the middle of a sentence for no reason, as if their thoughts have been interrupted or blocked
• Repetitive speech patterns in which they excessively repeat words, phrases, or ideas that may or may not be relevant to the conversation

Disorganized behavior

Disordered behavior can be a common symptom of psychosis and may vary widely in intensity. This type of behavior can be disruptive or distressing to the individual experiencing it, as well as those around them. People with disorganized behavior may appear disheveled, unusually dressed, or as if they’ve neglected self-hygiene practices. Examples of disorganized behavior may include:

• Agitation in the form of restlessness, pacing, or fidgeting
• Immobility and unresponsiveness to outside stimuli (catatonia)
• Impulsivity, hastiness, disregard of consequences, and risky behavior
• Social withdrawal and avoidance of social interaction
• Aggression or violence
• Self-harming behaviors, such as cutting, burning, or other forms of self-injury
• Disorientation and confusion about time, place, or identity

Negative symptoms

Negative symptoms of psychosis are secondary symptoms that are typically associated with mood and sociality. Negative symptoms often emerge in the beginning stages of psychotic disorders (referred to as the prodromal phase), but may continue throughout the acute and recovery phases as well. People with psychosis experiencing negative symptoms may have:

• A lack of emotional expression or reduced emotional intensity
• A lack of motivation or an inability to initiate and complete tasks
• Diminished speech output (poverty of speech)
• An inability to experience pleasure or lack of interest in previously enjoyable activities
• Avoidance of social interactions and isolation from others
• An inability to recognize or understand one’s own mental illness or the need for treatment (anosognosia)
• Difficulty with memory, attention, and problem-solving skills
• Unresponsiveness, immobility, or unusual movements
• Incoherent speech, bizarre actions, or unpredictable behavior
• A diminishment in personal hygiene, nutrition, or other basic needs

Cognitive impairment

Individuals experiencing psychosis often have cognitive difficulties that persist throughout the duration of a disturbance and between episodes. These can interfere with practical tasks and, in severe cases, a person’s ability to function independently. Common cognitive symptoms of psychosis may include:

• Difficulty remembering information or events
• Difficulty focusing, paying attention, or staying on task
• Difficulty planning, organizing, problem-solving, and decision-making
• Decreased processing speed or delays in responding to stimuli
• Difficulty understanding cause-and-effect relationships or making logical conclusions

Common psychotic disorders that may contribute to psychosis symptoms

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) lists several mental health conditions under the umbrella of psychotic disorders, each with its own set of symptoms and diagnostic criteria. The DSM-V is a manual or guide used by mental health professionals in the US to help them diagnose mental health patients.

Schizophrenia

Schizophrenia is a complex, chronic disorder characterized by a disconnect from reality; put simply, the affected individual can’t tell what is real and what isn’t. Schizophrenia can affect how an individual thinks, feels, and behaves, significantly impacting every area of daily life. Schizophrenia usually involves both “positive” symptoms (such as hallucinations, delusions, and disorganized thinking and speech) and “negative” symptoms (such as social withdrawal, lack of motivation, and inability to experience pleasure). Those with schizophrenia often cycle between active psychosis and recovery.

Bipolar disorder with psychotic features

Bipolar disorder with psychotic features usually has the core symptoms of psychosis with the added mood-related symptoms of bipolar disorder, such as severe mood swings, mania, and major depression. Bipolar psychosis is typically classified into two categories: 

• Mood-congruent: An individual’s psychotic symptoms reflect their mood, and their hallucinations reflect the content of their delusions.
• Mood-incongruent: The individual’s mood and psychotic symptoms are unrelated.

Schizoaffective disorder

Schizoaffective disorder is sometimes confused with bipolar disorder with psychotic features. Both tend to share psychotic and mood-related symptoms. However, schizoaffective disorder typically features less prominent mood-related symptoms and more prominent cognitive impairment than bipolar disorder with psychotic features. Schizoaffective disorder can be grouped into two subtypes:

• Bipolar type: Characterized by episodes of mania and sometimes major depression.
• Depressive type: Characterized by episodes of severe depression.

Delusional disorder

Individuals with delusional disorder usually experience “non-bizarre” delusions in which their delusional beliefs involve situations that can occur in reality. For example, an individual may believe they’re infected by a disease, deceived by a loved one, or poisoned by their surroundings. In general, hallucinations aren’t prominent (if present at all), and if they are present, they are often associated with the delusion’s theme.

Brief psychotic disorder

Symptoms of brief psychotic disorder tend to be similar to those of schizophrenia, but their onset is sudden, and the symptoms normally last between one day and one month. 

Substance-induced psychotic disorder

Symptoms of hallucinations or delusions that result from substance use typically emerge during or within a month of intoxication or withdrawal. 

Postpartum psychosis

Although postpartum psychosis isn’t categorized in the DSM-V as an independent disorder, it is sometimes recognized as a type of psychotic disorder. Symptoms of postpartum psychosis may include hallucinations, delusions, changes in mood (such as mania and major depression), and disorganized thinking or behavior. 

Major depression with psychotic features

Major depression with psychotic features isn’t usually categorized as a psychotic disorder, but a mood disorder. With psychotic depression, individuals usually experience core symptoms of depression plus hallucinations and delusions. 

Risk factors for developing psychosis symptoms

Scientists are still studying the etiology of psychosis symptoms and psychotic disorders, but most believe they emerge from a combination of contributors, including, but not limited to, the following: 

• Genetics: Studies suggest a link between psychotic disorders and genetics. In schizophrenia, for example, numerous twin and family studies indicate a heritability rate of approximately 80%.
• Trauma or early life stress: Experiencing trauma, abuse, neglect, or significant stress during childhood or later in life can increase the risk of psychosis. 
• Brain injuries or neurological conditions: Traumatic brain injury (TBI), brain tumors, infections, and other neurological conditions like dementia and epilepsy can increase one’s risk of psychosis. 
• Environmental factors: Many environmental factors may work in tandem with genetics to increase one’s risk of developing psychosis. Birth complications, season of birth, living in a migrant community, and other factors have been linked.

Seeking professional help for psychosis

Therapeutic intervention for psychosis typically involves a combination of medication, individual therapy, and psychosocial support in the form of family therapy, group therapy, and support programs. If you or someone you love are showing symptoms of psychosis, it can be crucial to immediately seek help from a medical professional who can design a plan tailored to your needs. 

However, antipsychotic medication, which must be prescribed and monitored by a psychiatrist or doctor, is usually only one part of a psychosis treatment plan. Psychotherapy can also be an integral part of a comprehensive strategy for people with psychosis and their families. Finding the right therapist and regularly attending appointments can be challenging for some.

Although it may not be appropriate during times of acute psychosis, many people find that virtual treatment can be an excellent mental health care option for individual psychotherapy. Online therapy platforms can eliminate geographical barriers to treatment, giving individuals access to a broad pool of experienced mental health professionals. Online therapy is typically more flexible than traditional in-person treatment and is often more affordable than conventional treatment without insurance. 

According to a 2022 systematic review and meta-analysis, technology-based interventions like online therapy “are effective for the management of neurocognition, symptomatology, functioning, social cognition, and quality of life outcomes in patients with psychosis.” Online therapy may be a valuable addition to the treatment plans of individuals who have experienced psychotic episodes.