Psychotic Disorder Due To Another Medical Condition

The DSM-V outlines specific criteria for a person’s symptoms to rise to the level of being diagnosed with psychotic disorder due to another medical condition. These symptoms include:

• The individual is experiencing hallucinations or delusions.
• The person’s medical history or associated results of lab findings or physical examination indicate the presence of a medical condition that is not a psychotic disorder but is causing symptoms of psychosis.
• The psychotic symptoms are impeding the patient’s ability to function or causing them emotional distress.³ 

Additionally, psychotic symptoms must not be substance induced or attributable to another mental health disorder (e.g., bipolar disorder).

Hallucinations can be hearing-, sight-, scent-, taste-, or touch-based. The type of hallucination is often related to the medical condition causing the psychotic symptoms. For example, temporal lobe epilepsy can cause individuals to smell scents that don’t exist. 

Delusions can be somatic, grandiose, religious, or persecutory, and, unlike hallucinations, there may not be a link between the medical condition and the type of delusions a person is experiencing. The individual may also demonstrate other symptoms of psychosis, such as garbled speech or unusual movements.

It can be crucial to differentiate between psychosis directly caused by a medical condition and psychotic symptoms resulting from the severe stress a medical condition may impose on someone, in which case the individual would potentially be diagnosed with brief psychotic disorder⁴ due to a stressor. 

Initial signs of psychotic disorder due to another medical condition 

Some signs psychotic symptoms are related to a medical condition include:

• Symptoms emerged when the medical condition began or was exacerbated. Psychotic symptoms may also occur when a condition enters remission, but this situation is rarer. 
• The symptoms are unusual and are not typically associated with other forms of psychotic disorders. As an example, people with schizophrenia often start demonstrating symptoms in early adulthood, so if psychotic symptoms are emerging outside of that time frame, a medical cause may be suspected.
• The individual does not have a family history of psychosis. 

Depending on the medical condition, an individual may experience a singular psychotic episode or recurring psychotic symptoms. In some cases, symptoms of psychosis may continue after the medical condition is addressed.

Several medical conditions can lead to the rise of psychotic symptoms. Psychotic episodes can occur because of an illness or an injury, a discrete medical event such as a stroke, or an ongoing disease such as HIV and AIDS. Medical conditions for which associated psychotic symptoms are more common are listed below, although, in most of these conditions, psychotic symptoms are unusual and rare.

• Endocrine disorders: Endocrine disorders may include hyperthyroidism, hypothyroidism, Grave’s disease, thyrotoxicosis pheochromocytoma, Hashimoto’s disease, thyroid storm, toxic nodular goiter, Addison’s disease, and autoimmune, subacute, or painless thyroiditis.
• Immune system disorders: Immune system disorders can include but are not limited to systemic lupus erythematosus, NMDA receptor autoimmune encephalitis, HIV and AIDS, autoimmune hepatitis, celiac disease, and Sjogren’s syndrome.
• Nervous system disorders: Nervous system disorders may include epilepsy, multiple sclerosis, cerebrovascular disease, Huntington’s disease, Fahr’s syndrome, Niemann-Pick disease type C, neurosyphilis, metachromatic leukodystrophy, and Tay-Sachs disease. 
• Metabolic system disorders: These conditions can include hypoglycemia, Wilson’s disease, alpha mannosidosis, niacin deficiency (typically relating to chronic excessive alcohol consumption), hypercalcemia, thiamine deficiency, cobalamin deficiency, vitamin B12 deficiency, and fluid and electrolyte imbalances. 
• Cardiovascular system disorders: These conditions may include hemorrhages, atherosclerosis, hypoxia, hypercarbia, pernicious anemia, hypersensitivity vasculitis, and hemolytic anemia. 
• Infections: Infections can include toxoplasmosis, Lyme disease, malaria, any infection affecting the central nervous system, and any infection involving the ears or the eyes. Due to these organ’s proximity to the brain, infections in these areas can spread to the brain and cause psychotic symptoms. 
• Disorders typically related to aging: Aging disorders may include dementia, Alzheimer’s disease, and Parkinson’s disease. 
• Conditions directly impacting the brain: These conditions may include traumatic brain injuries, strokes, migraines, and brain tumors.

The goal of treatment for psychotic disorder due to another medical condition is often to reduce or eliminate the psychotic symptoms. In some cases, addressing the underlying medical condition causes the symptoms of psychosis to resolve. For some conditions, notably chronic conditions such as epilepsy or lupus, ongoing intervention may be necessary. 

Medication

Antipsychotic medication may be the most effective treatment for symptoms of psychosis. In cases where a medical condition is causing psychotic symptoms, medical professionals may first attempt to use pharmacological treatments to address the medical condition, such as the use of antibiotics for infection. Antipsychotic medications may be a secondary line of treatment because of the significant side effects some patients may experience when using these medications, including:

• Restlessness
• Blurred vision and dizziness
• Muscle spasms and twitching
• Drowsiness
• Trembling
• Dry mouth
• Constipation
• Suicidal thoughts

Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis.

Self-care

For psychotic symptoms associated with an acute medical condition, such as malaria, receiving treatment for the medical condition and taking steps to take care of oneself throughout one’s recovery can have the most significant positive impact. For some medical conditions, self-care principles like sleeping close to eight hours a night, exercising regularly, and eating nourishing and nutritious food may resolve symptoms.

For ongoing psychotic symptoms, self-care often involves the assistance of other people. The National Institute of Mental Health recommends a program known as “coordinated specialty care” for people with chronic psychotic disorders. Coordinated specialty care brings a patient, medical and mental health providers, and a client’s family members together to develop a support system to provide the client with the resources to prevent future psychotic episodes and navigate such episodes if they occur. 

In cases of acute psychotic episodes where there is a danger that the individual may harm themselves or others, inpatient treatment at a hospital may be valuable to help the client reach the point where they can meaningfully engage with their recovery.

Psychosis can be misunderstood by society and may be inaccurately portrayed in violent and disturbing ways in the media. These perceptions of psychosis can contribute to a sense of shame and embarrassment around experiencing psychotic symptoms. Such shame may make it challenging to seek in-person therapeutic treatment for symptoms of psychosis. 

In addition, experiencing psychotic disorder due to another medical condition could involve managing the symptoms of psychosis and a serious medical disease at the same time. The time and energy demands associated with this situation may make the thought of another appointment overwhelming. In these scenarios, online therapy can be a helpful option. Through a legitimate online therapy platform like BetterHelp, individuals can find therapists and schedule and attend appointments from the convenience of their own homes. 

Other resources exist to support people navigating psychotic disorders, including psychotic disorder due to another medical condition. The National Association of State Mental Health Program Directors (NASMHPD) and the Early Psychosis Intervention Network (EPINET) both provide hubs of information related to the treatment of psychotic symptoms shortly after they emerge, which can be vital to reducing the harm and distress such symptoms may cause. The National Alliance on Mental Illness has created a document entitled “Understanding Psychosis: Resources and Recovery” that can serve as a comprehensive guide to navigating psychotic symptoms for individuals impacted and their family members.

For those with thoughts of suicide, contact 988 Suicide & Crisis Lifeline at 988. Please also see our Get Help Now page for more immediate resources.

Advanced age is a known risk factor for psychotic disorder due to another medical condition, with many conditions associated with aging also linked to an increased risk of developing psychotic symptoms. Parkinson’s disease is one such condition. Individuals with Parkinson’s disease frequently report the presence of benign hallucinations (such as hearing music) that gradually become more menacing and disruptive as the disease progresses. Such symptoms can manifest in close to 40% of people with this condition over the course of the disease.

Researchers have examined risk factors and treatments for psychotic symptoms associated with Parkinson’s disease. One study found that people living with depression, sleep disorders, and dementia were more likely to experience psychosis. Because antipsychotic medications may worsen Parkinson’s symptoms, the researchers also examined whether non-pharmacological interventions were beneficial for this population. They found that treatment, specifically therapy incorporating sensory or art-based elements, could be effective.

Below are several statistics on psychotic disorder due to another medical condition:

• Epilepsy is one of the most common medical conditions that can lead to psychotic symptoms. One study found that people with epilepsy have an almost eight times greater risk of developing psychosis than the general population. 
• Symptoms of psychosis have been reported in almost 10% of combat veterans who experienced traumatic brain injuries.
• Psychosis as a result of systemic lupus erythematosus (SLE) remains rare, with psychotic symptoms manifesting in less than 3% of people. For individuals with psychosis due to SLE, psychotic symptoms typically emerge within the first year of the disease. 
• Dementia can be correlated with the onset of psychotic symptoms. One study found that cognitive-behavioral therapy, in conjunction with art therapy and music therapy, significantly reduced the presence of hallucinations and delusions in a population of older men diagnosed with dementia.