When someone experiences a psychotic episode the initial diagnosis is of an unspecified psychotic illness - that is readily recognized in most cases. Later, as more information is obtained from medical history, family input, and from laboratory tests, etc., a more precise diagnosis of a particular psychotic disorder is usually made. A diagnosis is a name or label for the disorder the person is experiencing, and the diagnosis is made on the basis of the symptoms the person is experiencing, what brought on the disorder and how long the symptoms last. Some of the more common diagnoses relating to psychotic disorders are listed below. It should be realised that diagnosis, particularly in psychotic disorders, is not ‘clean’: that is, the expression of symptoms is different between individuals, and can even change over time in a particular individual. Below are descriptions of the broad distinctions of the types of psychosis:
Drug-induced psychosis
Sometimes using, 'coming down' from, or withdrawing from certain drugs such as LSD, cocaine, ecstasy, amphetamines, cannabis or alcohol can bring on or exacerbate psychotic symptoms such as delusions and hallucinations. For some people, these symptoms will disappear fairly quickly (in a few days) as the effects of the substances wear off, and they may not experience another episode unless they continue to use drugs. However, if someone has an underlying vulnerability to a psychotic disorder, such as schizophrenia, the psychotic episode can last much longer, and may even be triggered by this initial substance use. It is not known in this case whether the person would have developed psychosis if they hadn’t used the drug, but there is little doubt that they had a vulnerability to psychosis in the first place.Organic psychosis
Sometimes a psychosis can occur as a symptom of a physical injury or an illness that affects the brain, and this is known as an organic psychosis. Some physical conditions that can result in a psychotic episode include Alzheimer's disease and other causes of dementia, brain tumours, infections of the brain, long-term syphilitic infection, stroke, AIDS, and some vitamin deficiencies. When someone experiences an organic psychosis some of the symptoms might include a dazed expression, confusion, problems with vision or muscle weakness. The main treatment for this kind of psychosis involves dealing with the underlying physical problem.Brief reactive psychosis
Sometimes psychotic symptoms can come on quite quickly in response to a very traumatic or very stressful event in someone's life, such as the death of a loved one, a physical or sexual assault, or a natural disaster. When someone experiences a brief reactive psychosis the symptoms can be severe and come on quite quickly, but they can subside fairly rapidly, i.e. from 1 day to 1 month.Delusional disorder
Individuals who are experiencing delusional disorder have delusions as the most prominent symptom, and show a strong belief in something that is not true, with few if any hallucinations. Usually the delusions involve situations that could possibly occur in reality, but are in fact extremely unlikely, e.g. an individual may believe that they have been infected, have a disease, are being followed or are being poisoned. Other common delusions include the belief that a partner is being unfaithful, or that another person is in love with the individual. Often individuals who are experiencing a delusional disorder experience few other symptoms: they usually continue to manage their responsibilities and function fairly well, and their behaviour may not be very different to the way it usually is.Schizophrenia (see also the Schizophrenia brochures)
Schizophrenia refers to a disorder in which people always experience psychotic symptoms, and in which the changes in behaviour or symptoms associated with a psychosis have been present for at least six months. Schizophrenia normally has three phases.- Prodromal phase: people experience the 'early warning signs' described above.
- Acute phase: people experience the obvious symptoms of a psychosis as described above.
- Recovery phase: people return to their day to day lives, with the help of medication and other forms of therapy.
There are some unfortunate and unfair myths in society about schizophrenia. People with schizophrenia do not have multiple or split personalities and most people with schizophrenia are not violent, just as most people in society are not violent. The risk of violence is increased if the individual suffers from persecutory delusions (that someone or something is trying to harm them), substance use, prior history of violence, or stopping medication.
Schizophreniform disorder
The symptoms people experience with this disorder are the same as those experienced by people with schizophrenia, but the length of time that the symptoms are experienced for is more than one month, but less than six months. It is absolutely vital that a person receive prompt medical intervention, in an attempt to prevent full-blown schizophrenia.Bipolar (Manic-depressive) disorder (see also the Bipolar disorder brochures)
Bipolar disorder (or manic depression) is a condition in which individuals experience extreme shifts in their mood and energy. When individuals are experiencing these shifts, it can be difficult for them to manage their responsibilities such as work, finances and family commitments. Individuals who have this disorder experience episodes of mania (or hypomania) and episodes of depression that can last for a short time (days) or for a longer time (months). Some of the symptoms of mania include:- elated, happy mood or an angry, irritated mood;
- increased energy or activity;
- decreased sleep and less need for sleep;
- increased talking, and talking faster than usual;
- more thoughts, and faster thinking than usual;
- overly ambitious plans, and reckless behaviour such as spending too much money or engaging in careless or potentially dangerous sexual behaviour; and
- grandiose delusions.
- sadness or depressed mood;
- lack of motivation and energy;
- changes in sleep patterns - sleeping more or less than usual;
- changes in appetite - eating more or less than usual;
- hopeless and helpless feelings;
- less interest in, and less enjoyment from usually enjoyed activities;
- feelings of guilt and worthlessness; and
- depressive delusions.
