ConditionMental health & sleep
Psychotic Disorders
A psychotic disorder is a mental health condition in which a person loses some contact with reality, experiencing hallucinations (hearing or seeing things others do not), delusions (fixed false beliefs) or disorganized thinking and speech. The group includes schizophrenia, schizoaffective disorder, delusional disorder, brief psychotic disorder and psychosis caused by substances or medical conditions. Psychosis often first appears in the late teens to mid-20s. Early treatment with medicine, therapy and family support leads to much better recovery.
Also called: Psychosis, schizophrenia spectrum disorder, psychotic episode, first-episode psychosis
At a glance
- What it is
- A group of conditions with hallucinations, delusions or disorganized thinking.
- How common
- About 3 in 100 people will have a psychotic episode in their lifetime.
- Types
- Schizophrenia, schizoaffective, schizophreniform, brief psychotic, delusional, substance- or medical-induced, mood disorders with psychosis.
- Early signs
- Withdrawal, falling performance, suspiciousness, unusual beliefs, poor sleep.
- Treatment
- Antipsychotic medicine, therapy, family support and coordinated specialty care.
When to get help
Call 911 or go to the ER
- Thoughts of suicide or harming others, or acting on voices telling them to: call or text 988 (US), or call 911 or your local emergency number
- Severe agitation, aggression, or being unable to eat, drink or care for themselves
- Psychosis with high fever, stiff muscles and confusion after starting an antipsychotic (possible neuroleptic malignant syndrome)
- Sudden confusion with hallucinations in someone who is medically ill, older or withdrawing from alcohol
See a doctor within a day or two
- A first episode of hallucinations, delusions or very disorganized speech
- Psychotic symptoms within weeks of giving birth (postpartum psychosis)
- Stopping medicine and symptoms returning
Book a routine appointment
- Gradual social withdrawal, decline at school or work, unusual beliefs or suspiciousness in a teen or young adult
- Side effects from antipsychotics such as weight gain, restlessness or stiffness
Symptoms of psychosis
Positive symptoms (added experiences)
- hallucinations: hearing voices is most common; also seeing, smelling, tasting or feeling things that are not there
- delusions: fixed beliefs not shared by others, such as being followed or poisoned (paranoia), having special powers, or that thoughts are being controlled
- disorganized thinking and speech: jumping between topics, hard-to-follow speech
- disorganized or unusual behavior
Negative symptoms (lost functions)
- reduced emotional expression
- reduced motivation and interest
- social withdrawal
- reduced speech
Cognitive symptoms
- trouble with attention, memory and planning
Early warning signs (prodrome)
Before a first episode, there is often a period of weeks to months with:
- a drop in grades or work performance
- withdrawal from friends and family
- suspiciousness or unusual ideas
- trouble thinking clearly
- poor sleep and neglect of self-care
- strong, unusual reactions or flat emotions
Types of psychotic disorders
| Disorder | Key features |
|---|---|
| Schizophrenia | Psychotic symptoms with decline in functioning lasting at least 6 months |
| Schizophreniform disorder | Like schizophrenia but lasting 1 to 6 months |
| Brief psychotic disorder | Sudden psychosis lasting at least 1 day but less than 1 month, then full recovery; often after severe stress |
| Schizoaffective disorder | Psychosis plus major mood episodes, with periods of psychosis without mood symptoms |
| Delusional disorder | Fixed delusions for 1 month or more, otherwise relatively normal functioning |
| Substance-induced psychosis | From cannabis, stimulants, hallucinogens, alcohol withdrawal or medicines |
| Psychosis due to a medical condition | From brain tumors, epilepsy, infections, autoimmune encephalitis, lupus, thyroid disease, dementia |
| Mood disorders with psychosis | Bipolar disorder or severe depression with psychotic features |
| Postpartum psychosis | Rapid onset within weeks of birth; a psychiatric emergency |
Causes and risk factors
There is no single cause. Contributing factors include:
- genetics: a family history raises risk, but most people with relatives affected never develop psychosis
- brain development and chemistry, including dopamine and glutamate signaling
- cannabis use, especially high-potency cannabis in adolescence
- stimulant and hallucinogen use
- trauma and adversity in childhood
- stress, migration and social isolation
- pregnancy and birth complications
- medical conditions and medicines (steroids, some Parkinson's drugs)
Diagnosis
A mental health professional assesses symptoms, their timeline and impact. Doctors also look for medical causes, especially in first episodes:
- physical exam and medication and substance review
- blood tests: blood count, thyroid, electrolytes, glucose, B12, syphilis and HIV tests
- drug screening
- brain MRI or EEG if neurological signs or atypical features are present
Treatment
Medicines
Antipsychotics reduce hallucinations and delusions. Options include risperidone, aripiprazole, olanzapine, quetiapine and others, chosen to balance benefit and side effects. Long-acting injectable forms help people who find daily pills hard to take. Clozapine is the most effective option for treatment-resistant schizophrenia.
Side effects can include weight gain, high blood sugar and cholesterol, sleepiness, restlessness, stiffness and hormone changes, so regular monitoring is needed.
Therapy and support
- coordinated specialty care for first-episode psychosis: a team approach combining medicine, therapy, family education, supported employment and education
- cognitive behavioral therapy for psychosis (CBTp)
- family psychoeducation, which reduces relapse
- social skills training and supported housing when needed
- treatment of substance use, depression and anxiety
Hospital care
Sometimes needed for safety or when someone cannot care for themselves.
Outlook
Recovery is possible. Many people recover fully from a first episode, especially with brief psychotic disorder or substance-induced psychosis once substances stop. Others have recurring episodes or long-term symptoms but live fulfilling lives with treatment. Early treatment, staying on medicine, avoiding cannabis and family support improve outcomes.
Frequently asked questions
What are the early signs of a psychotic disorder?
Early signs include social withdrawal, a drop in school or work performance, suspiciousness, unusual ideas, trouble thinking clearly, poor sleep and neglecting self-care. Seeking help at this stage, before full psychosis, improves outcomes.
What are the types of psychotic disorders?
Main types include schizophrenia, schizophreniform disorder, brief psychotic disorder, schizoaffective disorder, delusional disorder, substance-induced psychosis, psychosis due to medical conditions, and mood disorders with psychotic features such as bipolar disorder.
Can psychosis be cured?
Many people recover fully from a psychotic episode, especially if it is brief or substance-related. Conditions like schizophrenia are often long-term but treatable; with medicine, therapy and support, many people live independently and work.
Does cannabis cause psychosis?
Cannabis, particularly high-potency products used frequently in adolescence, increases the risk of psychosis and can trigger or worsen episodes in vulnerable people. Stopping cannabis use improves the outlook for people who have had psychosis.
How can I help someone with psychosis?
Stay calm, listen without arguing about their beliefs, and encourage them to see a doctor or mental health service. If they talk about harming themselves or others, call or text 988 or call 911. Family education programs offer support.
Sources
This guide was written from current patient and clinical guidance, including:
- National Institute of Mental Health: Understanding Psychosis
- American Psychiatric Association: Practice Guideline for the Treatment of Patients With Schizophrenia
- SAMHSA: Coordinated Specialty Care for First Episode Psychosis
- NICE: Psychosis and schizophrenia in adults (CG178)
- MedlinePlus: Psychotic Disorders