Psychotic disorders are mental disorders that involve thinking and perceptions that are disconnected from reality. This group of disorders includes the diagnoses of schizophrenia, schizoaffective disorder, and delusional disorder, among others. These disorders are considered serious mental illnesses, and they are characterized by the presence of psychosis. Psychosis refers to a collection of symptoms that affect the mind, causing a person to have difficulty recognizing what is real and what is not. Psychotic symptoms may include hallucinations (sensing things that are not really there, such as hearing voices) and delusions (having strong beliefs that are not true and may seem irrational to others, such as believing that people on television are sending special messages). Psychosis is a hallmark of psychotic disorders, but it can also appear in other disorders, such as mood disorders and substance use disorders, both discussed later in this section.

Early treatment is associated with the best long-term outcomes for people experiencing psychosis, and the federal government maintains a list of providers who offer treatment for first-episode psychosis [Website]. Take a look if you are interested in more information about the topic of first-episode psychosis, which is often preceded by gradual changes in thinking, mood, and social functioning (SAMHSA, 2022b).

Schizophrenia

Schizophrenia is estimated to impact less than 1% of the overall population in the United States, though like many disorders it is more prevalent in the criminal justice system and affects as much as 4% of prison inmates (American Psychiatric Association, 2020; Watson, 2022).

People with schizophrenia are usually diagnosed between the ages of 16 and 30 after the first episode of psychosis. Alongside psychotic symptoms, which may be characterized as positive symptoms, a person with schizophrenia may experience negative symptoms (e.g., loss of motivation, lack of personal hygiene, and difficulty showing emotions) as well as cognitive symptoms (e.g., problems in attention, concentration, and memory) (SAMHSA, 2023b). The symptoms of schizophrenia can be very upsetting and frightening for the individual who experiences them and for their loved ones (NIMH, n.d.-b.).

Schizophrenia cannot be cured, but effective treatments focus on helping people manage their symptoms so that they can improve their daily functioning and achieve their goals. Where a person with schizophrenia also has a substance use disorder, known as a co-occurring disorder, it is important that treatment programs address these issues as well. People with schizophrenia typically benefit from the use of psychiatric medications, as well as therapy, education, and community support.

All psychiatric medications require a prescription by a qualified medical provider—often a psychiatrist or psychiatric nurse practitioner (roles that are discussed in Chapter 10). These medications can ease the symptoms of a disorder to improve quality of life, as well as allow the person to more effectively engage in other therapies. There are many psychiatric medications available, including several antipsychotic medications that specifically treat psychosis symptoms such as those that appear in schizophrenia. All medications have different risks, benefits, and levels of efficacy. Oftentimes, patients will need to try several medications to find the one or combination that they can take consistently to provide them with relief (NAMI, n.d.-c).

Patients must balance the effectiveness of medications against problems like side effects and lack of accessibility. Some antipsychotic medications are available in pill or liquid formulations, while others are offered in long-acting injectable forms that can be taken as infrequently as every few months. Injectable formulations can be extremely helpful for people who have challenges taking daily medications (NAMI, n.d.-c). Some medications may be more effective than others at treating symptoms but come with downsides. For example, one newer antipsychotic medication is a drug called clozapine. While clozapine can be remarkably effective at reducing symptoms of schizophrenia, it can also have serious health impacts that must be closely monitored with regular blood draws, which can be a burdensome and even intolerable requirement for some patients (NAMI, 2023b).

Watch the short video in figure 2.9 to hear some information about schizophrenia (diagnosis, symptoms, and treatments) from a representative of NAMI, the National Alliance on Mental Illness.

https://www.youtube.com/watch?v=WS1TXT3cGyw

Schizoaffective Disorder

Schizoaffective disorder may be diagnosed when a person displays symptoms of schizophrenia, including psychosis, in addition to symptoms of a mood disorder (described in the next section), such as depression or mania (NAMI, 2015). Schizoaffective disorder is often misdiagnosed and can be difficult to treat (NAMI, n.d.-b). Watch the short video in figure 2.10 for a mental health professional’s description of schizoaffective disorder, as well as a discussion of positive versus negative symptoms in psychotic disorders.

https://www.youtube.com/watch?v=ydxe6HI6wvs

Delusional Disorders

A delusional disorder may be diagnosed where a person has at least one delusion, a fixed belief that is not objectively true or reality-based, that lasts at least a month. Delusional disorders are different from schizophrenia and schizoaffective disorders in that they usually first appear in midlife or later in life, and the delusions occur without the other symptoms of psychotic disorders. An impacted person may function quite well in areas of their life not related to the delusion (Tamminga, 2022).

A person with a delusional disorder can experience different types of delusions, some of which could occur in real life (e.g., being followed or poisoned) and others that are inconsistent with reality (e.g., an internal organ has been removed from their body) (Tamminga, 2022). Delusions are classified in the DSM based on the type of belief that is involved in the delusion. A grandiose delusion, for example, might involve a belief that the person holds special powers, while a persecutory delusion might cause someone to believe that others are spying on them (Tamminga, 2022). Psychotherapy is most useful in treating delusional disorders, and antipsychotic medication can sometimes be helpful as well (Tamminga, 2022).

Licenses and Attributions for Psychotic Disorders

Open Content, Original

“Schizoaffective Disorder” by Anne Nichol is licensed under CC BY 4.0.

“Delusional Disorders” by Anne Nichol is licensed under CC BY 4.0.

Open Content, Shared Previously

“Psychotic Disorders” (introductory paragraphs) is adapted from “Understanding Psychosis” by National Institute of Mental Health, which is in the Public Domain. Modifications by Anne Nichol, licensed CC BY 4.0, include revising and condensing the content.

“Schizophrenia” is adapted from:

• “Understanding Psychosis” by National Institute of Mental Health, which is in the Public Domain
• “Schizophrenia” by National Institute of Mental Health, which is in the Public Domain

Modifications by Anne Nichol, licensed under CC BY 4.0, include combining, revising, and condensing the content.

All Rights Reserved Content

Figure 2.9. What is Schizophrenia by NAMI is licensed under the Standard YouTube License.

Figure 2.10. The Difference In Symptoms Between Schizoaffective Disorder and Schizophrenia by BrightQuest Treatment Centers is licensed under the Standard YouTube License.