Schizophrenia Psychosis: Understanding The Symptoms And Coping

Various mental health conditions are associated with psychosis, which can involve different symptoms depending on the cause or correlation. People with schizophrenia may experience unique psychotic symptoms when in an active episode. Understanding psychosis in relation to schizophrenia may be beneficial in further understanding this symptom and treatments.

What are schizophrenia and psychosis?  

Schizophrenia is a serious mental illness that interferes with an individual’s perception of reality. Symptoms can be severe, affecting how one thinks, behaves, and relates to the world. Psychosis is a term referring to a cluster of symptoms characteristic of schizophrenia and other disorders categorized as psychotic. 

Schizophrenia is a relatively uncommon disorder, affecting approximately 0.32% of individuals globally in 2022. Because psychosis is featured as a symptom in several mental illnesses, psychosis is slightly more common, affecting an estimated 1.5% to 3.5% of the population. Schizophrenia typically emerges in one’s late teens to early adulthood, but the condition can manifest earlier or later in some people. Schizophrenia and psychosis affect individuals from all races, genders, cultures, and backgrounds.

The difference between schizophrenia and psychosis

Schizophrenia is listed as one of several psychotic disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which features psychosis as a symptom. Other disorders in the same category include:

• Schizophreniform disorder
• Schizoaffective disorder
• Delusional disorder
• Brief psychotic disorder

While primarily associated with psychotic disorders, psychosis can also appear as a symptom in other conditions. These include mental illnesses like bipolar disorder, major depression, and certain personality disorders.

Psychotic symptoms may also present in neurological conditions like dementia or epilepsy, as a side-effect of certain medications, and in some cases of substance misuse. Symptoms of psychosis often include hallucinations, delusions, and disordered thoughts that contribute to unusual speech and behavioral patterns. 

Positive symptoms of schizophrenia 

Schizophrenia symptoms are often complex, presenting in different ways according to the phases of an episode or disturbance. Depending on how they impact the individual, they are typically grouped into positive, negative, and cognitive clusters.  

Positive symptoms, also referred to as psychotic symptoms, “add” abnormal thoughts or behaviors to the individual’s mental state that aren’t based in reality. These symptoms are considered part of psychosis, including the following. 

Delusions

Hallucinations

Hallucinations are sensory experiences that aren’t real, although they may seem real to the person experiencing them. Hallucinations can involve hearing, seeing, feeling, tasting, or smelling sensory stimuli that don’t exist. Auditory hallucinations, in which the individual hears voices, are the most common.

Disorganized thoughts and speech

People with schizophrenia may have difficulty thinking coherently or expressing their thoughts, resulting in disorganized speech patterns. 

Disorganized behaviors

Disorganized behaviors, including random, odd, or agitated movements, are typical symptoms of schizophrenia. Some individuals present catatonic behavior, an absence of movement or reaction to external stimuli.

Negative symptoms of schizophrenia 

Negative symptoms of schizophrenia signify an absence of behaviors that would otherwise be considered typical. These symptoms are often associated with mood, affect, and social behaviors, including the following: 

• Anhedonia: Diminished joy or a lack of ability to experience pleasure 
• Avolition: Significant decrease in motivation
• Diminished affect: Lack of emotional expression
• Social withdrawal: Avoidance of social interaction

Cognitive symptoms of schizophrenia 

Cognitive symptoms of schizophrenia reflect an individual’s cognitive functioning. People experiencing cognitive symptoms of schizophrenia may experience: 

• Problems with executive functioning
• Impaired working memory
• Difficulty concentrating 
• Reasoning and problem-solving deficits
• Difficulties with verbal learning
• Impaired social cognition

Phases of schizophrenia 

As with other psychotic disorders, schizophrenia symptoms emerge in phases. Below are the three phases physicians and providers may mention: 

The prodromal stage

Negative symptoms often emerge during the prodromal phase before more intense psychotic symptoms. During this stage, one may experience mood changes, disruption in sleep and eating patterns, irritability, and anxiety. Individuals may be misdiagnosed with depression, anxiety, or another disorder featuring non-specific symptoms during this stage. Changes to look out for might include suspicious thoughts, distrust of others, and difficulty responding to external stimuli, as these warning signs can point to psychosis. 

The active stage 

Characteristic psychotic symptoms emerge during the active phase. One may begin having disorganized thinking, behaviors, and delusions at this point. Hallucinations might also appear. During the active stage, symptoms are considered a crisis, and one may benefit from seeking crisis or emergency support. 

The residual stage 

The residual stage is no longer listed in the DSM-5 as a criterion for diagnosis. However, clinicians might reference it to understand symptoms that persist after an active psychotic episode. This stage is characterized by a decline in positive symptoms and an increased presentation of negative symptoms similar to those in the prodromal phase.

Diagnostic criteria for mental illness

The DSM-5 lists a set of criteria one must meet to receive a diagnosis of schizophrenia. These criteria are similar to other conditions that feature psychotic symptoms, with a few exceptions. For example, symptoms like mania, major depression, and mood swings are included in the diagnostic criteria for schizoaffective disorder and not schizophrenia. 

Below are the primary diagnostic criteria for schizophrenia: 

• The individual must present at least two core symptoms— at least one of which must be a positive symptom— for a significant portion of time during a one-month period (or less with successful treatment).
• One’s level of functioning must be significantly decreased in primary areas like social, occupational, and self-care compared to pre-symptom onset. 
• Signs of disturbance must persist for at least six months, with at least one month of prodromal, active, or residual symptoms. 
• Disturbance cannot be better explained by other mental disorders like major depression, bipolar, or schizoaffective disorder. Symptoms cannot be attributable to a medical condition, substance use, or medication side effects.

Etiology

The definitive causes of schizophrenia and other psychotic disorders remain unclear, but scientists believe a combination of factors may contribute. However, individuals exposed to risk factors for psychosis may not develop the condition, and one does not have to have any risk factors to be diagnosed with schizophrenia. Below are a few factors that may increase the risk of developing schizophrenia and psychosis.

Genetics

Twin and family studies on schizophrenia reveal there are gene variations that, when combined, may raise the risk of schizophrenia. These genes are associated with how nerve cells in the brain develop, chemical signals in the brain, and the mechanisms in the brain that regulate the body’s circadian rhythms.

Medical conditions

While researchers are still exploring the associations between neurological conditions and schizophrenia, current studies point to a few possibilities. For example, research suggests that abnormal brain activity in some patients with epilepsy may incite psychotic symptoms. Additionally, research on viral infections that affect the brain indicates that certain infections might play a contributing role in schizophrenia onset.

Environmental factors

Some studies also point to a connection between schizophrenia and different environmental factors. For example, one review published in The Journal of Schizophrenia Research found multiple variables leading to a bi-directional relationship between schizophrenia and drug use. Another review published in Frontiers found a potential relationship between schizophrenia and childhood trauma or developmental complications in utero.

Treatment of psychotic symptoms in schizophrenia

Schizophrenia treatment strategies are often similar to those of other psychotic disorders. While intervention strategies can vary according to individual needs, they are often comprehensive and involve a combination of approaches, including the following.

Medications

Medications for psychosis and schizophrenia might include the following: 

• Antipsychotics: Antipsychotic medications are the first line of treatment for psychosis symptoms. 
• Mood stabilizers: Mood stabilizers like benzodiazepines are sometimes prescribed for individuals experiencing severe emotional dysregulation, such as mania, major depression, or both. 
• Antidepressants: Although they may not be effective for every schizophrenia patient, certain antidepressant medications may improve treatment outcomes, reduce instances of psychosis hospitalization, and decrease the risk of all-cause mortality for some individuals with schizophrenia. 

Psychosocial interventions

Medications are often used in tandem with psychotherapeutic intervention methods, including the following: 

• Individual therapy: Methods like cognitive-behavioral therapy (CBT) can help individuals with schizophrenia and other psychotic disorders understand their thoughts, emotions, and behaviors to develop coping strategies to manage symptoms. 
• Family therapy: Family involvement can be integral to treatment plans. Family therapy aims to educate and cultivate better communication, problem-solving, and conflict resolution between family members. 
• Group therapy: Individuals with psychosis symptoms may benefit from interacting with others in a group setting who share similar experiences. In group therapy, individuals can share experiences and successes and provide support for their peers.
• Community support programs: Community support programs offer practical help for individuals with psychosis. They may include skill-building, supported employment, housing assistance, and help with managing daily responsibilities and setting goals. 

If you or someone you love is in active psychosis, reach out to crisis resources for support. 

Caregiving for someone who is psychotic

Living with schizophrenia and psychosis can present serious challenges in daily life. Individuals may struggle with employment, academic goals, maintaining healthy relationships, and caring for themselves. However, with effective therapeutic strategies, treatment adherence, and a solid support system, disorders like schizophrenia are treatable.

In addition to clients, caregivers of people with psychosis may benefit significantly from psychotherapeutic treatments. Caring for someone with a psychotic disorder can be difficult and overwhelming, potentially causing mental health challenges for caregivers, including, but not limited to:

• Exhaustion
• Isolation and loneliness
• Loss of interest in activities one previously enjoyed
• Agitation and anger
• Chronic pain or headaches
• Sleep and appetite disruptions
• Loss of motivation to care for oneself

Navigate the impact of psychosis with professional care

Connect with a therapist

Alternative mental health services

Due to barriers like time constraints, scheduling, and financial obligations, getting in-person professional help may be challenging for caregivers. In such cases, virtual therapy may be an effective solution to overcoming treatment obstacles. Online therapy platforms like BetterHelp may eliminate geographical barriers, offering connections to a broader pool of mental health professionals. 

Individuals can attend sessions from the comfort of home when convenient for them and message their therapist between appointments for extra support. Additionally, online therapy is often more affordable than traditional treatment without insurance coverage. 

Studies also back up the effectiveness of online therapy for individuals with schizophrenia. One study, published in 2015 in HHS Public Access, found that individuals with schizophrenia who tried an online intervention group with their family members had lower perceived stress and a higher perceived level of social support after three months of treatment.