A brief overview of Psychotic Disorders.
Barron's Dictionary of Medical Terms defines Psychosis as a major mental disorder in which the person is usually detached from reality and has impaired perceptions, thinking, responses, and interpersonal relationships.The DSM-IV-TR lists nine different psychotic disorders. These disorders are Brief Psychotic Disorder, Delusional Disorder, Schizophrenia, Schizophreniform Disorder, Schizoaffective Disorder, Shared Psychotic Disorder, Psychotic Disorder due to a general medical condition, Substance-Induced Psychotic Disorder and Psychotic Disorder Not Otherwise Specified. These disorders are alike in some ways, but differ in other ways. The purpose of this article is to give a brief overview of each of the Psychotic Disorders.
Brief Psychotic Disorder
When and individual suffers from Brief Psychotic Disorder, he may have hallucinations, delusions, disorganized speech or end up in a catatonic state. These symptoms last one day or more, but they go away before a one month period. This disorder may affect individuals after a large stressful event. The individual may be overly confused and experience some major emotional turmoil. The risk of suicide during a brief psychotic episode is very high. This disorder is sometimes seen in teenagers, but onset usually occurs in the late 20s or early 30s. In order to be diagnosed with a Brief Psychotic Disorder other disorders such as; Mood Disorder with Psychotic Features, Schizoaffective Disorder and Schizophrenia must be ruled out. Also, the psychosis must not have occurred due to illegal substances, prescription medications or a medical condition.
A person with this disorder has one or more nonbizarre delusions in a one month period. These delusions are things that could be happening in the person's life, but usually aren't. Examples of nonbizarre delusions include; being followed by someone, having a disease, the persons spouse is having an affair, and many other delusions. Other than having the delusions, the person goes on with his normal life activities. He may make some odd decisions based on his delusions, but these usually aren't noticed by others. Onset of this disorder can occur anywhere from early adulthood to the time a person dies. The average age of onset is in the 40s. In order to be diagnosed with this disorder, the delusions must not have been caused by a medical condition or substances. This disorder has seven subtypes they are:
- Erotomanic Type- The person believes a person of a higher social status is in love with him.
- Grandiose Type- The person believes they are rich, powerful or have a relationship with a higher power.
- Jealous Type- The person believes his significant other is having an affair.
- Persecutory Type-The person believes that a loved one is being treated badly.
- Somatic Type- The person believes he has a medical condition, or physical defects and deformities.
- Mixed Type- The person believes that two or more of the other subtypes are happening.
- Unspecified Type
The main symptoms of Schizophrenia include; delusions, hallucinations, disorganized speech, disorganized or catatonic behaviors, and negative symptoms (affective flattening, alogia or avolition). In order to be diagnosed with Schizophrenia, the person must show two or more of these symptoms for a significant portion of a one month period. If the person has bizarre delusions, or the hallucinations are voices that are running the person's life, or there are two or more voices conversing in the persons head, only one of the main symptoms has to have occurred for the diagnosis. In order for an individual to be diagnosed with this disorder, Schizoaffective Disorder and Mood Disorder with Psychotic Features must be ruled out. The psychosis must not have been caused by medical conditions or substance use. The average age for the onset of this disorder in men is the mid-20s and for women it is the late 20s. There are five subtypes of Schizophrenia. These subtypes are:
- Paranoid Type- The person is preoccupied with one or more delusions or has frequent auditory hallucinations. Disorganized speech, flat affect, or disorganized or catatonic behaviors are not prominent.
- Disorganized Type- The person has disorganized speech patterns and behaviors. The person also has a flat or inappropriate affect.
- Catatonic Type- The person shows at least two of the following; motoric immobility, excessive motor activity, extreme negativism or mutism, or stereotyped movements, prominent mannerisms, or prominent grimacing, or echolalia or echopraxia.
- Residual Type- The person does not have prominent delusions, hallucinations, disorganized speech, or disorganized or catatonic behavior. This person usually shows negative symptoms or has two or more of the other symptoms present in an attenuated form.
- Undifferentiated Type- The person shows symptoms, but the symptoms do not meet the criteria for other subtypes.
The main symptoms of Schizophreniform Disorder include; delusions, hallucinations, disorganized speech, disorganized or catatonic behaviors, and negative symptoms. In order for an individual to be diagnosed with this disorder, the person must show two or more of these symptoms for at least one month, but less than six months. Schizoaffective and Mood Disorder with Psychotic Features must be ruled out, and the psychosis must not have been caused by a medical condition or substances. This disorder is usually seen in men and women in their late teen years to mid-30s.
The main symptoms for Schizoaffective Disorder are the same as the ones for the Schizophrenia and Schizophreniform Disorders. Again the person must show two or more of those symptoms. With this disorder the person also has to have a Manic Episode, Major Depressive Episode or a Mixed Episode. During the span of the episode, the person has to have had delusions or hallucinations for at least two weeks in the absence of mood symptoms. The disturbance cannot be the result of a medical condition or substances. There are two subtypes for this disorder, they are:
- Bipolar Type- This subtype is used when Manic or Mixed Episodes are part of the presentation. There is a chance that Major Depressive Episode may also occur. This subtype is usually more common in young adults.
- Depressive Type- This subtype is used when Major Depressive Episode is the only episode present during the presentation. This subtype is more common in older adults.
Shared Psychotic Disorder
According to the DSM-IV-TR, The essential feature of Shared Psychotic Disorder is a delusion that develops in an individual who is involved in a close relationship with another person who already has a Psychotic Disorder with prominent delusions. The delusion has to be similar to the one the already diagnosed person has. In order for a person to be diagnosed with this disorder other Psychotic Disorders need to be ruled out. Delusions must not be cause by a medical condition or substances.
Psychotic Disorder Due to a General Medical Condition
The main symptoms of this disorder are delusions and hallucinations. There has to be medical evidence that the symptoms are a direct physiological consequence of a medical condition. All other mental disorders have to be ruled out before this diagnosis is given. There are many medical conditions that can cause psychotic symptoms. These medical conditions include; epilepsy, multiple sclerosis, central nervous system infections and migraines. There are two subtypes of this disorder. The two subtypes are:
- With Delusions- The person has delusions.
- With Hallucinations- The person has Hallucinations.
Substance-Induced Psychotic Disorders
With this disorder the Psychosis is caused by the use of drugs and/or alcohol. The main symptoms include delusions and hallucinations. The symptoms are there as a direct result of the physiological effects of the substances. The subtypes of this disorder are; with delusions and with hallucinations.
Psychotic Disorder Not Otherwise Specified
With this disorder, the person shows many psychotic symptoms, but there is either not enough information to pinpoint the diagnosis. The person may also have symptoms that fall under many different psychotic disorders. When this happens, it is hard to decide on the correct diagnosis. If a person has auditory hallucinations, but no other symptoms, it is not best to diagnose them with Brief Psychotic Disorder. It is best to put them in the Psychotic Disorder (NOS) category until other information can be found or other symptoms show up.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.Mikel A. Rothenberg and Charles F. Chapman, Barron’s Dictionary of Medical Terms, 4th Edition (New York, Barron’s Educational Series, Inc,2000), 467.