Understanding Psychosis Tests

The term “psychosis” refers to a set of symptoms that relate to an individual’s relationship with reality and that affect how they think, feel, and behave. Psychosis often indicates the presence of a psychotic disorder, which is a specific category of mental illness. These types of disorders can be challenging to diagnose for many reasons, which is why multiple psychosis tests are often used.

Below, we’ll give a brief overview of key psychotic disorder characteristics, the types of testing healthcare professionals may use to determine if an individual might have a psychotic disorder, and how these testing and diagnosis processes shape psychosis treatments.

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Psychosis: A brief overview

The American Psychological Association defines psychosis as “an abnormal mental state involving significant problems with reality testing,” which is an ability that “enables the individual to distinguish between self and nonself and between fantasy and real life.” More contemporary versions of this definition have emerged as new discoveries and perceptions around the nature of psychotic disorders arise. Regardless, the core characteristic of impaired reality associated with symptoms like hallucinations, delusions, and disordered thinking/behavior persists in most definitions.

Types of psychotic disorders

There are several types of psychotic disorders listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Each one has its own diagnostic criteria and characteristics designed to help clinicians differentiate between them. Some examples of psychotic disorders include:

• Schizophrenia
• Schizoaffective disorder
• Delusional disorder
• Brief psychotic disorder
• Schizophreniform disorder
• Substance/medication-induced psychotic disorder
• Psychotic disorder due to another medical condition 

Note, however, that psychotic disorders aren’t the only types of mental illnesses that may cause an individual to present with psychotic symptoms. Other mental health conditions like post-traumatic stress disorder (PTSD), bipolar disorder, and severe depression might have psychotic symptoms such as delusions, hallucinations, and disordered thinking/behavior in rare cases. Some people may also experience psychosis symptoms without a mental illness, as in some cases of sleep deprivation or substance misuse.

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

Common symptoms of psychotic disorders

Delusions, hallucinations, and disordered thoughts and behaviors are the core symptoms of psychotic conditions. There are also others that may present differently based on the individual and the specific disorder. Psychosis tests are designed to measure such symptoms to determine if the individual has a psychotic disorder and, if so, its severity and any potential treatment challenges.  

Symptoms of psychotic disorders are typically classified according to these three categories:

• Positive symptoms. These refer to symptoms that manifest as a break in reality and are often outwardly apparent in the individual’s speech and behavior. They include hallucinations, delusions, and disordered thoughts, speech, and behaviors. 
• Negative symptoms. Negative symptoms involve mood, affect, and relationships. They also include a significant reduction in motivation, emotional expression, and/or social engagement. Individuals with negative symptoms may lose interest in activities they once enjoyed and have a diminished ability to experience pleasure. 
• Cognitive symptoms. These affect an individual’s executive functioning. For example, someone experiencing cognitive symptoms associated with psychosis might have trouble with memory, problem-solving, and concentration.

Diagnostic criteria for psychotic disorders

Diagnostic criteria listed in the DSM-5 are primarily structured around symptom timing, severity, and impact on the individual. To qualify for a psychotic disorder diagnosis, one must generally: 

• Present at least two core symptoms for a significant portion of time during a one-month period 
• Experience significant impairment in the ability to function in areas of socialization, occupation, and/or self-care 
• Show continuous signs of disturbance for at least six months, with at least one month of active-phase symptoms 
• Not be experiencing the disturbance due to substance use or a medical condition

What causes psychosis?

Research on the potential causes of psychosis is ongoing, but scientists believe this condition stems from a combination of genetics, differences in brain structure and functioning, and environmental factors like trauma or stress. Studies also suggest a connection between psychosis and certain medications or recreational drugs (classified as substance-induced psychotic disorder), though these substances can generally only trigger the onset of a psychotic disorder in an individual who was prone to one in the first place.

The process of psychosis testing and diagnosis

A given type of psychosis test is typically designed to measure symptom length, severity, and context. Although some tests for measuring psychotic symptoms can be self-administered, the results of any psychological assessment should be interpreted by a mental health professional with experience in psychological testing. Also note that no single test can positively diagnose psychosis; they’re usually one of many tools that clinicians use to determine if an individual has psychotic symptoms. 

The assessment process is comprehensive and often tailored to individual needs and circumstances. This process typically consists of several steps, including some or all of the following.

1. Mental status exam (MSE)

In the beginning stages of the diagnostic process, clinicians may perform an MSE to assess the individual’s psychological state. This may include observing their appearance, behavior, speech, motor activity, affect, and evidence of thought processes. 

During this evaluation, the clinician may ask specific questions about how the individual feels, thinks, and perceives the outside world to assess their insight, judgment, and cognitive functioning in areas of alertness, memory, and reasoning. An MSE can also help detect the presence of any comorbid mental illnesses that frequently present in people experiencing psychosis, such as depression and anxiety. 

2. A physical examination and/or imaging tests

A medical doctor may perform a physical exam to rule out any underlying medical conditions that could be causing symptoms of psychosis. Imaging tests such as MRI or CT scans may also be used to detect or rule out any structural abnormalities in the brain that could be causing psychosis.

3. Blood tests

Blood tests have traditionally been used to detect underlying medical conditions, abnormalities, medications, or other substances that could be contributing to psychosis. However, scientists have recently discovered specific molecules in the blood that might predict whether a person is at risk for psychotic symptoms. If the research results are correct, a blood test may eventually be designed to detect those molecules. This development could result in earlier intervention, more accurate diagnoses, and more effective treatment outcomes.

4. Testing and screening tools

Many healthcare professionals also use specific screening tools and questionnaires that can help assess the presence, severity, and frequency of psychotic episodes or symptoms. Some examples include the positive and negative syndrome scale (PANSS), the brief psychiatric rating scale (BPRS), and the scale for the assessment of positive symptoms (SAPS). 

Many of these tests feature a scale designed to quantify the severity and frequency of an individual’s symptoms. For example, the BPRS lists descriptions of common psychosis indicators and asks clients to rate their experience with them from one (not present) to seven (extremely severe).

Other psychosis tests have a more straightforward “yes or no” format. For example, the Mental Health America Psychosis and Schizophrenia Test features yes or no questions like “Have you had experiences with telepathy, psychic forces, or fortune telling?” and “Have you seen unusual things like flashes, flames, blinding light, or geometric figures?” However, the test also asks the individual to give a more detailed description of their experiences for any “yes” answers.

Treatment for psychotic disorders

Once a diagnosis is reached, the clinician can develop a treatment plan based on the individual’s unique needs. If you’re experiencing signs of psychosis, experts recommend that you seek treatment from a healthcare professional right away. Treatments for psychotic disorders are multi-faceted and often take a holistic approach to managing the person’s symptoms, improving their quality of life, and teaching skills they can use to manage symptoms day to day. Treatment often includes some or all of the following. 

Medications

Antipsychotic medications are typically the first-line treatment for psychotic symptoms. In some cases, physicians or psychiatrists may also prescribe mood stabilizers or antidepressants to help manage negative symptoms.

Psychosocial interventions

There are multiple types of psychological interventions for psychotic disorders, including the following. Whether an individual may benefit from one or several depends on their individual needs. 

• Hospitalization. In severe cases, hospitalization may be necessary to provide a safe, structured environment for individuals experiencing psychotic symptoms and prevent harm to themselves or others. 
• Individual therapy. Research suggests that talk therapy approaches like cognitive behavioral therapy (CBT) may be effective in treating some symptoms of psychotic disorders. CBT may help people with symptoms of psychosis examine the thoughts and emotions that lead to problematic behaviors, reframe them to better reflect reality, and then adjust their behaviors accordingly.
• Family therapy. With family therapy, a mental health professional can help an individual and their family better understand the individual’s condition, develop healthy coping strategies for symptoms, cultivate more productive communication, and strengthen conflict-resolution abilities. The goals of family therapy are usually to nurture compassion and improve the overall well-being of the individual and the family.
• Community support programs. In some cases, individuals may participate in programs that help people with psychotic disorders find employment, develop social skills, cultivate self-care strategies, and more. Peer-led support groups are also an option, which allow individuals with psychosis or psychotic disorders to discuss their experiences and give/receive support from others with similar circumstances.

Online therapy as a supplemental treatment

Psychosis symptoms are often complex and can be severely troubling for the individuals who experience them. With time and treatment, however, it’s often possible to manage them in order to improve quality of life and overall well-being. 

Talk therapy, like CBT or another form, is often a part of treatment for certain psychotic disorders as well as commonly comorbid conditions like anxiety and depression. In many instances, talk therapy can be effectively conducted online or in person. Some individuals experiencing psychosis symptoms find that virtual therapy offers a convenient alternative to traditional psychotherapy in an office. 

Online therapy platforms typically offer more flexibility in scheduling and a broader pool of available, licensed mental health professionals. These benefits can allow an individual to find the right therapist for them and avoid certain barriers to care like provider shortages or scheduling issues. Additionally, online therapy is sometimes less expensive than in-person treatment without insurance. Online therapy is not only convenient, but also effective, with treatment outcomes often comparable to in-person CBT. However, some individuals may need to seek in-person support. If you or someone you love is experiencing psychosis symptoms, help is available. You can reach out to a mental health professional to get started on the path to healing.