Psychotic Disorders

A psychosis is a serious mental disorder in which a person loses touch with reality and cannot tell whether he or she is having a real-life experience or an unreal one. The two most common types of psychosis are schizophrenia and delusional disorder.


Schizophrenia is a devastating brain disorder that can be extremely disabling. The first signs of the disorder are often confusing and shocking to family and friends. Schizophrenia is characterized by profound disruptions in thought and emotion that can affect language, perception, and a person's sense of self. It can produce a wide array of symptoms. Some symptoms, called positive symptoms, show an excess of or distortion in normal functioning. They include hearing voices or other hallucinations, delusions (such as the belief that radio or television programs are sending special messages directly to the affected person), disorganized or incoherent speech, unpredictable agitation, purposeless and bizarre behavior, and catatonia (unawareness and rigid or unusual postures). So called negative symptoms reflect a loss of normal functioning. They include a flat facial expression and tone of voice, a lack of speech fluency, apathy, and the inability to begin or maintain any type of goal-oriented behavior. No single symptom defines the disorder, but rather a pattern of symptoms that is accompanied by difficulty holding a job or functioning in society. Several subtypes of schizophrenia, defined by their predominant symptom, have been identified. For example, a person with paranoid schizophrenia is preoccupied by delusions or "hearing voices."

Schizophrenia is often misunderstood. Many people mistakenly think that the disorder causes multiple personalities. Some people may fear that a person with schizophrenia is violent and dangerous, although most people affected with schizophrenia are not violent. The best way to think of schizophrenia is to compare a normal brain to a functioning telephone switching system in which the calls (in the form of perceptions) come in and are routed to the proper destination. But in the brain of a person with schizophrenia, the switching system malfunctions. Incoming calls can be sent along the wrong pathway, leave the pathway, or arrive at the wrong destination. Incoming perceptions and outgoing messages become disorganized or blocked.




More than 2 million people in the United States have schizophrenia. It usually appears during young adulthood. Onset can be either sudden or gradual. Researchers have found that susceptibility to schizophrenia may be inherited, but there is also some evidence that impairment in fetal brain development may also have a role in the disorder. Many people with schizophrenia are severely disabled and stigmatized by the disorder, which affects their careers and relationships.

Antipsychotic medications (such as haloperidol, thioridazine, or fluphen-azine) are prescribed to treat the hallucinations and delusions that frequently occur and may also help improve emotional expression. Most of these medications are taken by mouth, but seriously affected people may have to take them by injection. Antipsychotic medications can produce side effects such as muscle spasms, drowsiness, faintness, dry mouth, blurred vision, sensitivity to sunlight, and constipation. Some men who take these medications have difficulty with sexual function.

Only one person in five fully recovers from schizophrenia, and about 10 percent of affected people remain severely ill over long periods, even with treatment. In another 50 percent, symptoms improve, sometimes significantly. Most people with schizophrenia will need treatment for the rest of their lives. Some people with schizophrenia may deny that they need medications and refuse to take them. Others forget to take their medications because of the disorganized thinking that is characteristic of the disease.

This behavior makes it difficult to help a friend or family member who may be showing signs of schizophrenia. If you know someone who may have schizophrenia, you may be more successful in getting him or her to seek treatment by focusing on one symptom, such as depression or difficulty sleeping. Above all, try to maintain a caring, helpful manner when approaching someone who may have this type of psychotic disorder, since they often are anxious and suspicious of others.

Delusional Disorder

Many people with schizophrenia have delusions (tenaciously held false beliefs), but not all people with delusions have schizophrenia. Doctors diagnose a person with a delusional disorder if he or she has a persistent delusion that involves a situation that could occur in daily life, such as being poisoned or followed, but shows no other signs of schizophrenia. Aside from the odd manifestations of the delusion, the person's behavior is not unusual, and his or her functioning at home and work is not impaired.

Delusions fall into a number of distinct categories. The most common type of delusion is that of persecution by others. People with this type of delusional disorder believe that their friends, family, or coworkers are conspiring to drug or spy on them or to ruin their reputations.

Another form of delusional disorder that is frequently encountered is delu- 361

sional jealousy, in which the person takes everyday occurrences, such as a part- Mental ner's returning home a bit late from work, as evidence of unfaithfulness. Erotic Dis°rders delusions compel the affected person to believe that he or she is loved by someone with high status, such as the president of the company he or she works for or a famous actor. People who have grandiose delusions believe that they have special powers that could save the world or cure a disease. Delusional disorder also can take the form of somatic delusions, in which the person thinks that there is something seriously wrong with his or her body—that it is misshapen, produces a foul odor, or has insects crawling on it.

The treatment of choice for a delusional disorder is drug therapy, but drugs are not always successful in treating the disorder. Delusions that persist for a long period can be difficult for doctors to treat. If the affected person is unable to function in daily life, or if he or she poses a threat to himself or herself or others, the person will have to be hospitalized.

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