Psychotic disorder facts

Psychotic disorders include schizophrenia and a number of lesser-known disorders.

The number of people who develop a psychotic disorder tends to vary depending on the country, age, and gender
of the sufferer, as well as on the specific kind of disorder.
There are genetic, biological, environmental, and psychological risk factors for developing a psychotic disorder.
Usually with any psychotic disorder, the person's inner world and behavior have notably changed.
When assessing a person suffering from psychotic symptoms, health-care professionals will take a careful history
of the symptoms from the person and loved ones as well as conduct a medical evaluation, including necessary
laboratory tests and a mental-health assessment.
Most effective treatments for psychotic disorders are comprehensive, involving appropriate medications, mental-
health education, andpsychotherapy for the sufferer of psychosis and his or her loved ones. It will also include the
involvement of community supportive services when needed.
Prevention of psychosis primarily involves preventing or decreasing the impact of factors that put the person at
risk for developing a psychotic disorder.
What are the different types of psychotic disorders?
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Psychotic disorders are now referred to as schizophrenia spectrum and other psychotic disorders. In addition to
the more commonly known mental disorders like schizophrenia, other mental disorders in this group include brief
psychotic disorder, schizotypal personality disorder, delusional disorder, schizophreniform
disorder,schizoaffective disorder, catatonia, substance/medication-induced psychotic disorder, psychosis due to a
medical condition, other specified schizophrenia spectrum, unspecified schizophrenia spectrum, and other
psychotic disorder. Besides catatonia, other catatonia-related disorders include catatonic disorder due to another
medical condition, as well as unspecified catatonia. Women who recently had a baby (are in the postpartum state)
may uncommonly develop postpartum psychosis. Also, mood disorders like major depressive disorder and bipolar
disorder can become severe enough to result in psychotic symptoms like hallucinating or having delusions, also
called psychotic features.
How common are psychotic disorders?
The percentage of people who suffer from any psychotic symptom at any one time (prevalence) varies greatly from
country to country, from as little as 0.66% in Vietnam to 45.84% in Nepal. While the figure of one out of 100 people
who qualify for the diagnosis of schizophrenia may sound low, that translates into about 3 million people in the
United States alone who have schizophrenia. The first time a person has psychotic symptoms is usually between
the ages of 18 and 24 years; related but less severe (prodromal) symptoms often start during the teenage years.
Statistics for postpartum psychosis include that it occurs in one or two out of 1,000 births but increases greatly, up
to one in seven mothers, in women who had postpartum psychosis in the past. Men are thought to develop
psychotic disorders more often and at younger ages than women.

What are causes and risk factors for psychotic disorders in children,
teenagers, and adults?
Except for those psychotic disorders that result from the use of a substance or a medical
condition, specific causes for most psychotic disorders are not known. However, the interplay
of genetic (familial), biological, environmental, and psychological factors is thought to be
involved. We do not yet understand all of the causes and other issues involved, but current
research is making steady progress toward elucidating and defining causes of psychosis. For
example, schizophrenia and bipolar disorder are thought to have many risk factors in
common.
In biological models of psychotic disorders, genetic predisposition, infectious agents, toxins,
allergies, and disturbances in metabolism have all been investigated. Psychotic disorders are
known to run in families. For example, the risk of the illness in an identical twin of a person
with schizophrenia is 40%-50%. A child of a parent suffering from schizophrenia has a 10%
chance of developing the illness, in contrast to the risk of schizophrenia in the general
population being about 1%. Toxins like ketamine or marijuana increase the risk of developing
psychosis.
The current concept is that multiple genes are involved in the development of schizophrenia
and that risk factors such as prenatal (intrauterine), perinatal (around the time of birth), and
nonspecific stressors are involved in creating a disposition or vulnerability to develop the
illness. Neurotransmitters (chemicals allowing the communication among nerve cells) have
also been implicated in the development of psychotic disorders. The list of neurotransmitters
under scrutiny is long, but special attention has been given to dopamine, serotonin, and
glutamate.
Also, recent research studies have identified subtle changes in brain structure and function,
indicating that, at least in part, schizophrenia could be a disorder of the development of the
brain. The fact that autism is a risk factor for developing psychosis during childhood seems to
support that theory. Psychosis is more likely to occur in people who have poor medical health
in a general sense or who suffer from another mental illness.
Environmental risk factors, like a history of problematic drinking, using tobacco, marijuana, or
other drugs, have been associated with the development of a psychotic disorder.
There are a number of genetic, medical, psychological, and social risk factors for psychotic
disorders. Women who have recently delivered a baby (in the postpartum state) are at risk for
a number of mental-health problems, including postpartum psychosis. More than 25% of
mothers with bipolar disorder may develop postpartum psychosis, and more than half of those
who have both a personal history of bipolar disorder and a family history of postpartum
psychosis may develop the condition. Children of mothers with a psychotic disorder may
experience more than the genetic risk of developing a psychotic disorder if their birth or
mother's pregnancy with them had problems like infections, high blood pressure, or problems
with the placenta.
Psychological risks for developing a psychotic disorder include a history of mood problems,
like an anxiety disorder, major depression, or bipolar disorder and trouble functioning socially
or generally. Individuals who tend to be suspicious of others or to have unusual thoughts are
also more likely to develop a psychotic disorder. Studies show that women with postpartum
psychosis are often victims of domestic violence or abusive childhoods and often have
histories of abandonment or substance abuse. Children, teens, or adults who have endured
more negative life events, have poor housing, are more ethnically isolated where they live, or
otherwise have little in terms of a support group are at higher risk for developing a psychotic
disorder.
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Psychotic Disorders (cont.)

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2. Take the Schizophrenia Quiz
Medical Author:
Roxanne Dryden-Edwards, MD
Medical Editor:
Melissa Conrad Stppler, MD
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IN THIS ARTICLE
Psychotic disorder facts
What are the different types of psychotic disorders?
How common are psychotic disorders?
What are causes and risk factors for psychotic disorders in children, teenagers, and adults?
What are psychotic disordersymptoms and signs?
How are psychotic disorders diagnosed?
What are the treatments for psychotic disorders?
What are potential complications of medications used to treat psychotic disorders?
Is it possible to treat psychotic disorders without medication?
What are complications of psychotic disorders?
What is the prognosis for people with a psychotic disorder?
Can psychotic disorders be prevented?
Where can people find additional information about psychotic disorders?
Patient Comments: Psychotic Disorders - Experience
Patient Comments: Psychotic Disorders - Treatments
Patient Comments: Psychotic Disorders - Symptoms
Find a local Psychiatrist in your town
Psychotic Disorders Index
What are the treatments for psychotic disorders?
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Antipsychotic medications are proven effective in treating acute psychosis and reducing the
risk of future psychotic episodes. For example, the treatment of schizophrenia or bipolar
disorder with psychotic features thus has two main phases: an acute phase, when higher
doses of medication might be necessary in order to treat psychotic symptoms, followed by a
maintenance phase, which could be lifelong. During the maintenance phase, the medication
dosage is gradually reduced to the minimum required to prevent further episodes. If
symptoms reappear on a lower dosage, a temporary increase in dosage may help prevent a
relapse.
Even with continued treatment of the more chronic or recurring psychotic disorders, some
patients experience relapses. By far, though, the highest relapse rates for such disorders are
seen when medication is discontinued. The large majority of patients experience substantial
improvement when treated with antipsychotic agents. Some patients, however, do not
respond to medications, and a few may seem not to need them.
Antipsychotic medications are the cornerstone in the management of psychosis. They have
been available since the mid-1950s, and although antipsychotics do not cure the illness, they
greatly reduce the symptoms and allow the patient to function better, have better quality of
life, and enjoy an improved outlook. The choice and dosage of medication is individualized
and is best done by a physician who is well trained and experienced in treating severe mental
illness.
The first antipsychotic was discovered by accident and then used for schizophrenia. This was
chlorpromazine (Thorazine), which was soon followed by medications such
as haloperidol (Haldol), fluphenazine (Prolixin),thiothixene (Navane), trifluoperazine
(Stelazine), perphenazine (Trilafon), and thioridazine (Mellaril). These medications have
become known as "neuroleptics" because, although effective in treating positive symptoms
(for example, acute symptoms such as hallucinations, delusions, thought disorders, loose
associations, ambivalence, or mood swings/emotional lability), they cause side effects, many
of which affect the neurologic (nervous) system. Examples of such neurologic side effects
include muscle stiffness or rigidity, painful spasms, restlessness, tremors, and muscle
twitches. These older medications are thought to be not as effective against so-called
negative symptoms such as decreased motivation and lack of emotional expressiveness.
Since 1989, a new class of antipsychotics (atypical antipsychotics) has been used. At
clinically effective doses, none (or very few) of these neurological side effects of traditional
antipsychotics, which often affect the extrapyramidal nerve tracts, are observed.
Clozapine (Clozaril), the first of the new class, is the only agent that has been shown to be
effective in situations where other antipsychotics have failed. Its use is not associated with
extrapyramidal side effects, but it does produce other side effects, including a possible
decrease in the number of white blood cells. Therefore, blood cell counts need to be
monitored every week during the first six months of treatment and then every two weeks to
detect this side effect early if it occurs.
Other atypical antipsychotics
include risperidone (Risperdal), olanzapine(Zyprexa), quetiapine (Seroquel), ziprasidone (Geo
don), aripiprazole(Abilify), paliperidone (Invega), asenapine (Saphris), iloperidone (Fanapt),
and lurasidone (Latuda). The use of these medications has allowed successful treatment and
release back to their homes and the community for many people suffering from
schizophrenia.
Although more effective and better tolerated, the use of these agents is also associated with
side effects, and current medical practice is developing better ways of understanding these
effects, identifying people at risk, and monitoring for the emergence of complications.
Most of these medications take two to four weeks to take effect. Patience is required if the
dose needs to be adjusted, the specific medication changed, or another medication added. In
order to be able to determine whether an antipsychotic is effective or not, it should be tried for
at least six to eight weeks (or even longer with clozapine).
Since people with a psychotic disorder are at increased risk of also developing depression,
medications that address that symptom may be of great benefit as well. Serotonergic
medications like fluoxetine (Prozac),sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa),
and escitalopram(Lexapro) are often prescribed because of their effectiveness and low
incidence of side effects. Other often-prescribed antidepressant medications for the
depression that can be associated with psychotic disorders
include venlafaxine (Effexor), duloxetine (Cymbalta),desvenlafaxine (Pristiq),
and buproprion (Wellbutrin).
Because the risk of relapse of illness is higher when antipsychotic medications are taken
irregularly or discontinued, it is important that people with a psychotic disorder follow a
treatment plan developed in collaboration with their doctors and with their families. The
treatment plan will involve taking the prescribed medication in the correct amount and at the
times recommended, attending follow-up appointments, and following other treatment
recommendations.
People with psychosis often do not believe that they are ill or that they need treatment. Other
possible things that may interfere with the treatment plan include side effects from
medications, substance abuse, negative attitudes toward treatment from families and friends,
or even unrealistic expectations. When present, these issues need to be acknowledged and
addressed for the treatment to be successful.
Medically Reviewed by a Doctor on 6/25/2014
What are potential complications of medications used to treat
psychotic disorders?
Many symptoms found in psychotic individuals are related to movement (motor symptoms).
Some of these can be side effects of prescribed medications. Medication side effects may, for
example, include dry mouth, constipation, drowsiness, stiffness on one side of the neck or
jaw, restlessness, tremors of the hands and feet, and slurred speech.
Tardive dyskinesia is one of the most serious, although quite uncommon, side effects of
medications used to treat schizophrenia and other psychotic disorders. It is usually seen in
older people and involves facial twitching, jerking, and twisting of the limbs or trunk of the
body, or both. It is a less common side effect with the newer generation of medications used
to treat schizophrenia. It does not always go away, even when the medicine that caused it is
discontinued.
A rare but life-threatening complication resulting from the use of neuroleptic (antipsychotic,
tranquilizing) medications is neuroleptic malignant syndrome (NMS). It involves extreme
muscle rigidity, sweatiness, salivation, and fever. If this complication is suspected, it should
be treated as an emergency.
Other potential complications of antipsychotic medications include significantweight gain and
sleepiness, depending on the medication. To address weight gain, prescribing physicians
often counsel their patients with a psychotic disorder onnutrition and exercise. Dose and
timing adjustments may alleviate sleepiness. For pregnant women, the potential risks of the
medication to a developing fetus must be balanced with the potential benefit to the mother
and fetus of treating the illness.
Medically Reviewed by a Doctor on 6/25/2014

s it possible to treat psychotic disorders without medication?
In spite of successful antipsychotic treatment, many patients with psychosis have difficulty
with motivation, activities of daily living, relationships, and communication skills. Also, since
an illness like schizophrenia typically begins during the years critical to education and
professional training, these patients lack social and work skills and experience. In these
cases, the psychosocial treatments help most, and many useful treatment approaches have
been developed to assist people suffering from a psychotic disorder.
Individual psychotherapy: This involves regular sessions between just the patient and
a therapist focused on past or current problems, thoughts, feelings, or relationships.
Thus, via contact with a trained professional, people with psychosis become able to
understand more about the illness, to learn about themselves, and to better handle the
problems of their daily lives. They can become better able to differentiate between what
is real and, by contrast, what is not and can acquire beneficial problem-solving skills.
Rehabilitation: Rehabilitation may include job and vocational counseling, problem
solving, social skills training, and education in money management. Thus, patients learn
skills required for successful reintegration into their community following discharge from
the hospital.
Family education: Research has consistently shown that people with a psychotic
disorder who have involved families have a better prognosis than those who battle the
condition alone. Insofar as possible, all family members should be involved in the care of
their loved one.
Self-help groups: Outside support for family members of those with any psychotic
disorder is necessary and desirable. The National Alliance for the Mentally Ill (NAMI) is
an in-depth resource. This outreach organization offers information on all treatments for
psychosis, including home care.