Psychotic Disorders
With steady, compassionate care, people with psychotic disorders build full, meaningful lives.
This information is educational and is not a diagnosis. Diagnosis requires a comprehensive psychiatric evaluation.
If you are in crisis, call or text 988 (Suicide & Crisis Lifeline) or call 911.
What it is
Psychosis describes experiences in which a person loses some contact with reality, such as hearing or seeing things others do not (hallucinations), holding strong beliefs that are not based in reality (delusions), or having disorganized thinking and speech.
Psychosis is a symptom that can occur in several conditions, including the schizophrenia spectrum disorders described here, mood disorders, substance use and some medical conditions. Early, consistent treatment makes a real difference in long-term outcomes.
Diagnostic features (DSM-5-TR)
A plain-language summary of key features described in the DSM-5-TR. This is not the official criteria text and is not a self-diagnosis tool.
Schizophrenia
- At least two of the following for a significant part of 1 month (less if successfully treated), with at least one being delusions, hallucinations or disorganized speech: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms such as reduced emotional expression or motivation.
- A clear decline in functioning at work, in relationships or in self-care.
- Continuous signs of the illness for at least 6 months, which can include milder early (prodromal) or lingering (residual) symptoms.
- Schizoaffective and mood disorders, substances and medical conditions are ruled out.
Schizoaffective Disorder
- A period of illness in which a major mood episode (depressive or manic) occurs together with the core symptoms of schizophrenia.
- Delusions or hallucinations for at least 2 weeks without a major mood episode at some point during the illness.
- Mood episode symptoms are present for the majority of the total illness. Types: bipolar type and depressive type.
Brief Psychotic Disorder
- Sudden onset of delusions, hallucinations or disorganized speech (possibly with disorganized or catatonic behavior).
- Lasts at least 1 day but less than 1 month, followed by a full return to the previous level of functioning.
- May occur with or without a major stressor, or within 4 weeks after childbirth (with postpartum onset).
Delusional Disorder
- One or more delusions lasting at least 1 month.
- The full criteria for schizophrenia have never been met; any hallucinations are not prominent and relate to the delusional theme.
- Apart from the impact of the delusions, functioning is not markedly impaired and behavior is not obviously odd. Types include persecutory, jealous, grandiose, erotomanic, somatic and mixed.
Common signs
- Hearing, seeing or sensing things others do not
- Strong beliefs others do not share, such as being watched or followed
- Confused or hard-to-follow speech or thinking
- Withdrawing from friends, family or activities
- Decline in self-care or school or work performance
- Reduced emotional expression or motivation
- Increased suspiciousness
- Trouble telling what is real
- Sleep changes during early warning periods
How it's evaluated
I complete a careful, unhurried evaluation that includes your history, current experiences, mood, substance use, safety and, with permission, input from family or people close to you.
Medical and substance-related causes are ruled out with lab work and coordination with primary care or neurology for brain imaging when indicated. Cannabis, stimulants and some medications can trigger psychosis, so these are reviewed. Before starting medication, I obtain baseline measures such as weight, blood sugar and lipids.
Evidence-based treatment options
Antipsychotic medication
Antipsychotic medication is the foundation of treatment for schizophrenia and related disorders, helping reduce symptoms and prevent relapse. Long-acting injectable forms are an option for many people.
Clozapine
Clozapine is recommended for treatment-resistant schizophrenia and for people with schizophrenia who have ongoing suicide risk. It requires regular blood monitoring.
Psychosocial treatments
Cognitive behavioral therapy for psychosis (CBTp), family education and support, supported employment and education, and skills training improve recovery.
Coordinated specialty care
For a first episode of psychosis, coordinated specialty care brings together medication, therapy, family support and work or school support, and is recommended by NIMH.
Physical health monitoring
Regular monitoring of weight, blood sugar, cholesterol and movement side effects keeps treatment safe over the long term.
How I can help
I provide steady, compassionate, long-term psychiatric care. I take time to listen, explain what is happening in clear language, and choose medication with you, balancing symptom relief with side effects that matter to you.
I monitor physical health closely, involve family when you want them involved, and help connect you with therapy, coordinated specialty care and community supports. My goal is stability and a life that reflects your goals.
Insight
Most people living with a psychotic disorder are not violent. Stigma is one of the biggest barriers to seeking care, and compassion and early treatment are part of recovery.
Sources
- American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).
- National Institute of Mental Health (NIMH): Schizophrenia
- National Institute of Mental Health (NIMH): Understanding Psychosis
- NIMH: Coordinated Specialty Care for First Episode Psychosis (RAISE)
- American Psychiatric Association: Practice Guideline for the Treatment of Patients With Schizophrenia (3rd ed., 2020)
- NICE guideline CG178: Psychosis and schizophrenia in adults
Heal • Grow • Thrive
Ready When You Are.
Putting your mental health first is a strength. It is okay to ask for help.