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Psychotic Disorders

Psychotic disorders are mental illnesses that are characterized by symptoms, which can generally be described as a loss of contact with reality.

What Is a Psychotic Disorder?

Psychotic disorders are mental health conditions in which a person experiences psychosis—a cluster of symptoms that reflects a disrupted sense of reality. During psychosis, changes in thinking and perception make it hard to tell what’s real from what isn’t.

  • Core features often include:
  • Delusions: fixed false beliefs (e.g., persecution, reference, grandiosity, somatic concerns).
  • Hallucinations: seeing, hearing, smelling, tasting, or feeling things others do not (auditory are most common).
  • Disorganized thinking/speech: off-topic replies, tangentiality, loose associations, or incoherence (“word salad”).
  • Disorganized or abnormal motor behavior: agitation, unpredictable or inappropriate behavior; may include catatonia.
  • Negative symptoms: reduced motivation (avolition), diminished emotional expression, limited speech (alogia), anhedonia, and social withdrawal.
  • Psychosis can occur in primary psychotic disorders, mood disorders, substance use, or medical/neurologic illnesses. A careful evaluation is essential to identify the cause.

Types of Psychotic Disorders (DSM-5 spectrum)

  • Schizophrenia: ≥2 core symptoms (at least one of delusions, hallucinations, or disorganized speech) for ≥1 month, with overall illness ≥6 months and functional decline.
  • Schizophreniform disorder: same active symptoms as schizophrenia, lasting 1–6 months.
  • Schizoaffective disorder: schizophrenia-type symptoms with mood episodes (depressive or manic), plus periods of psychosis outside mood episodes.
  • Delusional disorder: one or more delusions for ≥1 month with otherwise relatively preserved functioning.
  • Brief psychotic disorder: sudden onset of psychosis lasting <1 month with full return to baseline; often stress-related.
  • Substance/medication-induced psychotic disorder: symptoms due to intoxication, withdrawal, or medication effects.
  • Psychotic disorder due to another medical condition: e.g., delirium, seizures/epilepsy, autoimmune or endocrine disorders, neurodegenerative disease, brain injury/tumor, stroke.
  • Psychotic symptoms can also appear in bipolar disorder, major depressive disorder (with psychotic features), OCD/BDD, PTSD, and neurodevelopmental disorders; these are diagnosed based on the full clinical picture.

Other Conditions

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Causes & Risk Factors for Psychosis

Psychotic disorders arise from a combination of genetic vulnerability, neurodevelopmental and neurochemical changes (including dopamine and glutamatergic circuit dysregulation), and environmental factors (stress, trauma, sleep deprivation, substance use). Medical and neurologic illnesses can directly cause psychosis, especially in older adults.

Common triggers of a psychotic episode include stress, mood episodes, substance use (e.g., cannabis, stimulants, hallucinogens), sleep loss, and certain medical conditions or medications.

Diagnosis: What the Evaluation Involves

  • A clinician will:
  • Take a comprehensive medical, psychiatric, and substance history, including collateral information when possible.
  • Perform a physical and neurologic exam; order labs and, when indicated, EEG and brain imaging to rule out medical causes.
  • Use structured interviews and rating scales to document symptoms, duration, and functional impact.
  • Assess safety (risk to self/others), co-occurring conditions, and social supports.
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Psychosis is when a person has trouble telling the difference between what's real and what's not.

  • There is no single cause. Contributing factors can include:
  • Genetics & brain circuitry/chemistry
  • Temperament (e.g., behavioral inhibition, high sensitivity)
  • Life stress & trauma (early or adult adversity)
  • Medical conditions (e.g., thyroid disease, arrhythmias) and certain medications/substances
  • Family history of anxiety or other mental disorders
  • Female sex (some anxiety disorders are more common in women)
  • Substance misuse can trigger or worsen anxiety. Depression commonly co-occurs with anxiety.

The most common and well known psychotic disorder is schizophrenia.

There are many other mental illnesses that can have psychosis as part of their symptoms.

Treatment for Psychotic Disorders

Early, coordinated care improves outcomes. Plans are individualized and typically combine medication, psychotherapy, family education, and practical supports.

1. Medications

  • Second-generation (atypical) antipsychotics are first-line for most people; some are available as long-acting injectables (LAIs) to reduce relapse.
  • First-generation (typical) antipsychotics remain options in selected cases.
  • Clozapine is indicated for treatment-resistant schizophrenia and can reduce suicidality; requires regular blood monitoring.
  • Treat co-occurring conditions (e.g., depression, anxiety, substance use). Benzodiazepines or ECT may be used for catatonia.

 

2. Psychosocial Interventions

  • Coordinated Specialty Care (CSC) / early-psychosis programs with shared decision-making.
  • CBT for psychosis (CBTp), family psychoeducation, social skills training, and supported employment/education (IPS).
  • Case management, peer support, and help with housing, benefits, and transportation.

 

3. Health Monitoring & Safety

  • Baseline and ongoing checks for metabolic effects (weight, lipids, glucose/A1c), movement side effects, prolactin as indicated, and ECG for QT-prolonging agents.
  • Crisis planning: when there’s risk of harm to self/others or inability to care for basic needs, brief hospitalization may be necessary for stabilization
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Vivabest Psychiatry PLLC: Our Approach

  • Thorough evaluation to identify primary vs. secondary causes of psychosis and assess safety.
  • Evidence-based medication management, including long-acting injectables and clozapine when appropriate, with systematic side-effect monitoring.
  • CBT for psychosis, family education, and linkage to supported education/employment and community resources.
  • Collaborative, measurement-based care with relapse-prevention planning and coordination across providers.

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