What are the types of psychoses?

Everyone's experience of a psychosis is different and attaching a name or label to the psychotic episode can be difficult, especially if it is the first time the person has experienced a psychotic episode. There is no medical test that can tell which type of psychoses a person is experiencing, and it can take some time for an exact diagnosis to be made.

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 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 be triggered by this initial substance use.

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 tumors, 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 usually 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 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.

When people with schizophrenia experience an acute psychotic episode they may show some or several of the obvious symptoms of a psychosis including thinking problems, delusions, hallucinations, changes in their behaviour and changes in their emotions. Some people with schizophrenia may experience only a few psychotic episodes, whereas others will experience more over the course of their lives. Schizophrenia is treatable and controllable and it is possible for people with schizophrenia to lead satisfying and productive lives.

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. If violence does occur it may be because the person has persecutory delusions; that someone or something is trying to harm them.

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

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 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.

Some of the symptoms of depression include:

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.

It is not common for individuals with bipolar disorder to experience a psychosis, but when they do, the psychosis usually occurs as a part of general difficulties with mood, and the symptoms experienced usually match the person's mood. For example, a person who is depressed who is also experiencing a psychosis might hear voices telling them that they are no good, or directing them to hurt themselves. A person who is manic who is also experiencing a psychosis might believe that they are very special and can do remarkable things.

Psychotic depression

(see also the Depression brochures)

People who are depressed experience the same symptoms that people with bipolar disorder experience when they are depressed. However, people who have such depression (known as unipolar affective disorder) do not experience any periods of mania. Sometimes a person who is severely depressed can experience a psychosis, although this is now uncommon. As in bipolar disorder, when people who are depressed experience a psychotic episode, they tend to experience symptoms that match their mood, e.g. persons who are very depressed might hear voices telling them to kill themselves, or might hear voices making fun of them, or experience depressive or nihilistic delusions.

Schizoaffective disorder

This disorder is relatively rare, and may be difficult to diagnose accurately. This is because the symptoms of schizoaffective disorder do not fit the usual picture of either schizophrenia, which has mainly psychotic symptoms, or a mood disorder such as bipolar disorder or depression, which mainly involve shifts in mood towards mania or depression. Instead, a person with schizoaffective disorder experiences both psychotic symptoms and shifts in mood at the same time.

Sometimes the psychotic symptoms and mood difficulties may occur within a few days of each other but still within the same episode of illness. Because of this, many people with schizoaffective disorder are originally diagnosed with bipolar disorder. However, unlike bipolar disorder, where psychotic symptoms usually match the person's mood, in schizoaffective disorder psychotic symptoms may not match the person's mood. For example, a person who is depressed might have a delusion that they are a very important or powerful person.

Sometimes, but not always, this can be a sign that the individual is experiencing schizoaffective disorder rather than bipolar disorder. Most authorities think that schizoaffective disorder is an atypical form of affective disorder (i.e. bipolar disorder or unipolar depression) occurring in a person who has some degree (small) of vulnerability to more schizophrenic types of illness.

Personality disorders

Sometimes, the way that people view and interact with the world (their personality style) makes them particularly sensitive to stress and prone to develop psychotic symptoms. These symptoms may develop at times of personal difficulty; times that would not necessarily be considered extreme or overwhelming by many other people. If psychotic symptoms do develop, they usually do not last very long.