Unspecified Schizophrenia Spectrum And Other Psychotic Disorder

A diagnosis of unspecified schizophrenia spectrum and other psychotic disorders is called a “diagnosis of exclusion.” Diagnoses of exclusion apply when a person has symptoms that align with a general category of mental disorders but don’t meet the diagnostic criteria for any of the specific mental disorders in that category. 

To receive a diagnosis of USS or OPD, an individual must be experiencing some form of psychotic symptoms causing them distress or inhibiting their ability to function. These symptoms can include hallucinations, delusions, disorganized thinking, abnormal motor behavior, and negative symptoms. 

Hallucinations 

Hallucinations are sensory perceptions that are not linked to any environmental stimulus. Hallucinations can involve perceiving images, sounds, smells, tastes, or sensations that do not exist. Auditory hallucinations (“hearing voices”) are the most common hallucinations experienced during psychosis.

Delusions 

Delusions are illogical belief systems maintained without supporting evidence or despite clear evidence to the contrary. Persecutory delusions, or the belief that a specific person or group is seeking to harm oneself, are some of the most common delusional experiences. Persecutory delusions fall under the umbrella of non-bizarre delusions, or delusions that are hypothetically possible but usually unlikely, such as a person’s belief that they are being monitored by the FBI. Other delusions are categorized as bizarre delusions because they are scientifically impossible, such as a belief that aliens are controlling one’s thoughts. 

Disorganized speech 

Disorganized speech manifests as an inability to talk in a way that allows for effective communication. It can involve randomly switching between topics, responding to questions with completely unrelated answers, or “word salad,” where there are no associations between words.

Abnormal motor behavior 

Abnormal motor behavior includes difficulty in goal-directed activities, such as walking that rise to the level of negatively impacting a person’s ability to perform tasks associated with daily living. Abnormal motor behavior includes catatonia, in which a person no longer reacts to external stimuli.

Negative symptoms 

Negative symptoms describe a lack of typical behaviors. These symptoms can include absent facial expressions or gestures, difficulty experiencing pleasure, and a lack of interest in interaction with others.

Unspecified schizophrenia spectrum and other psychotic disorder can be a placeholder diagnosis, a means of treating acute symptoms of psychosis while a medical team gathers more information. In some instances, a psychotic episode first diagnosed as USS or OPD is eventually understood to be a form of substance or medication-induced psychotic disorder or an early indication of schizophrenia. 

Given the shifting nature of this diagnosis, it can be challenging to ascertain concrete causes of USS and OPD. However, various risk factors have been found to increase the likelihood that a person may experience psychosis, which could result in a USS and OPD diagnosis. These factors may include the following: 

• Being assigned female at birth (AFAB) 
• A family history of psychotic disorders or mood disorders (the closer the relative, the higher the risk)
• Elevated dopamine levels in the brain
• The use of cannabis or methamphetamine, particularly at a young age, even if use has not continued
• A stroke or traumatic brain injury
• Dementia, Alzheimer’s disease, or a brain tumor
• HIV or AIDS
• Chronically high levels of alcohol consumption
• Lack of sufficient maternal nutrition during pregnancy

Often, the goal of treatment for unspecified schizophrenia spectrum and other psychotic disorder, like the goal for many psychotic disorders, is to eliminate the symptoms of psychosis or reduce them to a point where they are no longer inhibiting functioning. For USS and OPD, effective treatment often involves gathering information to make a more specific diagnosis.

Medication

Because the mechanism underlying the psychosis in this condition is often unknown, pharmacological intervention by healthcare professionals may focus on initially addressing the symptoms while determining the root cause. Antipsychotic medications may be prescribed to stabilize the individual’s symptoms of psychosis.

Because USS and OPD are often associated with a client’s first experience with psychotic symptoms, individuals diagnosed with this condition may be in significant distress. Anxiety medications like benzodiazepines may be effective in soothing the client to lower their agitation to a point where communication is more effective, a more precise history can be taken, and any necessary testing can be performed safely.

Self-care

Research has indicated that people who experience at least one psychotic episode have a much higher likelihood of experiencing another than the general population. This finding does not mean that if a person demonstrates psychotic symptoms once, they have a psychotic disorder. They may never experience such symptoms again. However, regardless of whether a person develops an ongoing psychotic disorder, one might practice self-care to reduce the risk or severity of a future psychotic episode.

It can be crucial for people with a predisposition for psychosis to develop a daily routine and remain consistent. A routine may help individuals adhere to their medication and could reduce potential stressors that often cause psychotic symptoms. Developing a routine does not mean a person must take the same steps every day but have a reasonable expectation of what might happen on any given day, as well as a schedule to keep them focused. 

For people whose USS and OPD are reclassified as a psychotic disorder, it can be valuable to involve family members and loved ones in ongoing care. A community can provide emotional support and ensure an individual is taking appropriate care of themselves and can accurately communicate with medical providers during a psychotic episode.

Experiencing psychosis for the first time can be scary. In instances of USS or OPD, where it is typical for neither the patient nor the clinician to fully understand what is causing the psychotic symptoms, psychosis can seem even more overwhelming. In situations where this diagnosis evolves into a diagnosis of another psychotic disorder, the individual may feel significant shame. They may be embarrassed that a life stressor could have led to a psychotic episode, such as in brief psychotic disorder, or that their substance use negatively impacted their mental states, such as in substance or medication-induced psychotic disorder.

Such fear and shame can make it difficult for individuals to seek therapy in their area. Online therapy through platforms like BetterHelp may seem more accessible in these situations. With online therapy, clients can attend appointments from the convenience of their own homes. Mental illness, and psychosis in particular, continues to be stigmatized in US society. While seeking mental health care should not be stigmatized, it can be beneficial for clients to seek care in a way that makes them comfortable and safe. 

Additional resources exist to support people experiencing psychotic symptoms. For people who have been diagnosed with USS and OPD and are frustrated about the lack of information available on their diagnosis, the “Understanding Psychosis: Resources and Recovery” pamphlet published by the National Alliance on Mental Illness (NAMI) can be helpful. The Early Psychosis Intervention Network (EPINET) provides comprehensive information on how to address an initial psychotic experience, as the sooner a person receives treatment for psychosis, the better their long-term prognosis may be.

Medical professionals can view unspecified schizophrenia spectrum and other psychotic disorder as a placeholder diagnosis that can’t be adequately treated until more information is gathered and a more specific diagnosis is made. However, approximately one-third of people with this condition continue to experience psychotic symptoms that do not meet the criteria for a named DSM-V psychotic disorder. Given this high proportion of people with USS and OPD whose diagnoses do not change, a better understanding of risk factors, disorder progression, and treatment specifically for USS and OPD can be crucial.  

One study examined the differences between clients presenting with psychotic symptoms who met the criteria for USS and OPD versus those who met the criteria for named psychotic disorders. The researchers found that, despite medical perceptions of those with USS and OPD as having less severe symptoms than those with other psychotic disorders, the only psychotic disorder that was more functionally inhibiting than USS and OPD was schizophrenia. This finding could be due to a higher likelihood for USS and OPD patients to also meet diagnostic criteria for a substance use disorder, meaning treatments that address aspects of both disorders may be the most effective.

Below are several statistics on unspecified schizophrenia spectrum and other psychotic disorder:

• Unspecified schizophrenia spectrum and other psychotic disorder is one of the more uncommon psychotic disorders, with roughly 8% of people with psychotic symptoms receiving this diagnosis. 
• About 67% of people initially diagnosed with USS and OPD will eventually have their diagnosis changed to another psychotic disorder, with schizophrenia being the most common new diagnosis (33%).  
• Substance use disorders and psychotic disorders can often co-occur. One study found that people with USS and OPD were more likely to meet the criteria for a co-occurring substance use disorder than those with schizophrenia or bipolar I disorder with psychotic features.
• Research on the treatment of psychosis in emergency room settings (where USS and OPD is most common) found that early intervention by a mental health professional was a strong predictor of future improved outcomes.