Psychotic Disorders: Types, Symptoms, Causes, and Treatment

What is a Psychotic Disorder?

A psychotic disorder is a severe mental health disorder characterized by a collection of psychotic symptoms that affect the mind, impacting a person’s thoughts and perceptions and making it difficult for them to distinguish what is real from what is not.^1,2 These psychotic symptoms include hallucinations, delusions, disorganized thinking, speech and behavior. There are several types of psychotic disorders–each with its own specific diagnostic criteria outlined in the Diagnostic and Statistical Manal of Mental Disorders, Fifith Edition (DSM-5)–and while individuals may have psychotic experiences in their life, the vast majority of people in the general population do not develop a psychotic disorder. In fact, only about 3% of individuals are diagnosed with a psychotic disorder sometime in their life.³ 

For those diagnosed with a psychotic disorder, symptoms can be debilitating and terrifying for them and their families.⁴

Types of Psychotic Disorders

Psychotic disorders occur with a range of severity and symptoms. Using the DSM-5, qualified mental health professionals can discern and diagnose the following schizophrenia spectrum and other psychotic disorders based on the presenting signs and symptoms:⁵

Delusional disorder: A disorder in which a person experiences persistent delusional thoughts for 1 month or more but does not meet the criteria for schizophrenia.

Brief psychotic disorder: A disorder in which a person experiences psychotic symptoms for a month or less and then returns to their previous mental state and level of functioning.

Schizophrenia: A mental disorder in which a person experiences chronic delusions, hallucinations, disorganized speech, or other symptoms for at least a month. These experiences can be extremely debilitating, significantly decreasing their ability to function at work, in relationships, at school, or with self-care.

Schizophreniform disorder: A mental disorder that resembles a milder form of schizophrenia. Many of the same symptoms are present over a similar timeline but do not typically impair daily functioning.

Schizoaffective disorder: A mental disorder that causes severe mood symptoms (major depressive or manic episodes) and psychotic symptoms at separate times.

Substance or medication-induced psychotic disorder: Some medications or substances may cause delusions, hallucinations, or other psychotic symptoms.

Psychotic disorder caused by another medical condition: As mentioned below, some medical conditions may cause delusions or hallucinations.

It is possible to have psychotic symptoms or episodes without being diagnosed with a psychotic disorder as psychotic disorders have specific diagnostic criteria.

Medical Conditions That Can Cause Psychotic Symptoms

Several medical disorders have been associated with psychosis and psychotic episodes, including (but not limited to):⁶

• Infections.
• Human immunodeficiency virus infection (HIV).
• Lyme disease.
• Malaria.
• Metabolic disturbances.
• Autoimmune disorders (such as multiple sclerosis).
• Endocrine disorders (such as Cushing’s disease and thyroid disease).
• Brain disorders (such as recurrent seizures).
• Vitamin deficiencies (such as Vitamin B deficiency).

What Causes a Psychotic Disorder?

Studies suggest that there are a complex combination of factors involved in the development of psychotic symptoms, which may include:^2,6,7  

• Genetics.
• Differences in brain development. 
• History of trauma or certain stress exposures.
• Certain substance or medication use. 
• Other existing mental illnesses.
• Medical illness or brain injury.

Research indicates a strong connection between genetics and heredity with the development of psychotic disorders.⁶ 

Plasticity of the developing brain and how it is affected by stress or traumatic experiences during childhood remains unpredictable in whether an individual develops a psychotic disorder. That being said, it is clear that brain changes, observable through imaging, are present in individuals diagnosed with psychotic disorders, but the manner in which those changes occur is still not fully understood.⁶

Signs and Symptoms of Psychotic Disorders

• Individuals who experience psychosis or psychotic episodes don’t always have the same symptoms each time. However, most psychotic symptoms include:^2,5
• Delusions (false beliefs), which can be persecutory (belief that someone is out to get them), referential (belief that the TV is communicating directly to them), grandiose (an over-the-top belief in their own abilities), or somatic (belief that something is medically wrong with them). 
• Hallucinations, or seeing, hearing, smelling, tasting, or feeling things that aren’t there.
• Incoherent or nonsensical speech; the inability to organize thoughts while speaking.
• Grossly disorganized or catatonic behavior. This may include poor impulse control or being unresponsive to external stimuli such as pain.
• Diminished emotional expression or avolition, which is a total lack of motivation that makes it hard to get anything done.
• Markedly low level of functioning in one or more major areas, such as work, interpersonal relations, or self-care.
• Memory problems.
• Difficulty thinking clearly or logically.
• Disturbed thoughts or perceptions.
• Struggling to decipher reality from imagination.
• Poor executive functioning, which is the ability to use information and make decisions.
• Unpredictable, inappropriate, or confusing behaviors, which may include violence or self-harm.

People with severe psychotic disorders could experience all of these symptoms at different times, but others may only experience some.⁵ Symptoms may vary with the type of disorder, the severity of the disorder, and other personal influences.

Risk Factors for Psychotic Disorders

As previously mentioned, every person who experiences psychosis or psychotic episodes does not necessarily develop a psychotic disorder. Research indicates that most psychotic disorders are an evolving pathology of the human brain, shaped by genetic factors and environmental stressors. Some factors that may increase your risk of developing a psychotic disorder include:^2,8,9

• Having a first-degree relative who has a psychotic disorder. For instance, if an identical twin is diagnosed with schizophrenia, the probability of the other twin developing schizophrenia is 50%. 
• Genetic mutations.
• Pregnancy and birth complications, including abnormal fetal development, which while not fully understood has been associated with exposure to drugs in utero, perintally, or postnatally.
• Abnormal cognitive development.
• Early drug use. For instance, there is some evidence suggesting that early cannabis use may increase the risk for schizophrenia.
• The emergence of brief, limited psychotic symptoms–though not all who experience these brief psychotic symptoms will ultimately be diagnosed with a psychotic disorder.
• Being diagnosed with another psychiatric condition.
• Being diagnosed with certain medical conditions.
• Other environmental factors such as exposure to trauma (especially during childhood), migration, social isolation, and substance misuse and addiction.

Is There a Link Between Psychotic Disorders and Substance Use Disorders?

Research indicates that there may be a link between psychotic disorders and substance use. Studies show that individuals with schizophrenia have higher rates of alcohol, tobacco, and substance use disorders than the general population. In fact, approximately 1 in 4 individuals with a serious mental illness, like schizophrenia, also have a substance use disorder.¹⁰

While there is a high prevalence of co-occurring substance use and mental health disorders, one does not necessarily cause the other. Instead, both disorders share common risk factors. Additionally mental illness may contribute to substance use and addiction and substance misuse or addiction may contribute to the development of a mental illness.¹¹

As previously mentioned, psychotic disorders may be caused by factors that include genetic and epigenetic vulnerabilities, issues in the brain, and environmental influences, such as trauma. This is also true for substance use disorders.¹¹ 

Furthermore, relative to the general population, individuals with severe psychotic disorders have increased risks for smoking, heavy alcohol and/or marijuana use, and recreational substance use.¹² 

Several epidemiological surveys have assessed the comorbidity of psychotic illness with substance use and found that alcohol and drug dependence were more than twice as common among individuals with certain mental health conditions, including psychotic disorders.¹²

How Are Psychotic Disorders Treated?

Studies indicate that individuals may experience psychotic symptoms for a year or more before seeking treatment. However, early intervention and early treatment often means better recovery. Treatment for psychotic disorders generally includes a combination of coordinated specialty care, which may involve:^2,13

• Antipsychotic and other medication management. These medications can reduce serious symptoms, including delusions, hallucinations, agitation, and disorganized thoughts and behaviors.
• Individual or group psychotherapy. Cognitive and behavioral therapies focus on teaching skills to help individuals build resilience and coping strategies.
• Family support or education programs. Teaching family members about psychotic symptoms, coping strategies, and problem-solving and communication skills can help them understand and support the recovery process.
• Employment support or education help. The focus here is to coach the individual and prepare them to return to work or school.
• Case management. A case manager can help individuals gain access to other resources and support services.

If you are dealing with psychotic symptoms not related to substance use, American Addiction Centers may be able to help. Later this year, AAC will offer primary mental health services at the River Oaks Treatment Center, not far from Tampa, Florida. The River Oaks Mental Health Services: A Center for Healing & Wellness provides programming and services to treat debilitating mental health issues—such as bipolar disorder, PTSD, major depression, and personality disorders—not related to substance use. Other mental health conditions are evaluated on a case-by-case basis. The goal of the inpatient/residential treatment program is to further stabilize your condition and enable you to develop the skills you need to manage it on your own in the future. Evidence-based therapies help you optimize day-to-day functioning and prevent future mental health crises. To learn more about this program, please call 640-202-9116.

Treatment For Co-Occurring Disorders

Integrated treatment for co-occurring substance use and psychotic disorders has been found to be consistently better compared to treating the disorders separately. Interventions used in this integrative approach include:¹⁴ 

Medications. Various medications may be used to treat the psychotic symptoms (as previously mentioned) as well as pharmacotherapies used to treat certain substance use disorders, including alcohol and opioid use disorders. These medications may be used during detoxification and maintenance to help ease withdrawal symptoms and prevent cravings and relapse.

Behavioral therapies. Various behavioral therapies may be utilized for the treatment of both substance use and mental health disorders, including: 

• Cognitive-behavioral therapy (CBT). CBT helps individuals modify maladaptive behaviors and is often used in the treatment of substance use disorders.
• Dialectical behavior therapy (DBT). DBT helps reduce self-harm behaviors, including suicidal attempts, thoughts, or urges.
• Assertive community treatment (ACT). ACT programs integrate behavioral treatments for severe mental illnesses, like schizophrenia, and co-occurring substance use disorders. ACT is differentiated from other case management programs in that there’s a team management approach, an emphasis on outreach, and a highly individualized approach.
• Therapeutic communities (TCs). TCs refer to long-term residential care for substance use disorders. They focus on the resocialization of individuals in the program, often utilizing community programs as treatment components.
• Contingency management (CM) or motivational incentives (MI). Typically used as an adjunct to treatment, CM or MI is used to promote healthy behaviors and reduce unhealthy behaviors typically relating to substance use. 

All AAC treatment centers offer co-occurring disorder treatment. If you or a loved one are struggling with a psychotic disorder and addiction, call AAC at to speak to a compassionate and knowledgeable admissions navigator, who will listen to your needs, answer your questions, explain your options, and help you begin your journey to recovery.

Frequently Asked Questions About Psychotic Disorders