Psychotic disorders encompass a range of severe mental illnesses marked by psychosis. Psychosis itself isn’t a disease, but rather a collection of symptoms often described as a detachment from reality. In essence, during a psychotic episode, an individual experiences disruptions in their thinking and interpretation of thoughts, making it challenging to discern what is real and what is not. A Psychotic Diagnosis is a critical step in understanding and addressing these experiences.
Psychosis is not rigidly defined due to its varied manifestations and subjective experiences. Psychiatrists rely on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), as a guide in determining a psychotic diagnosis. Psychosis is characterized by abnormalities in thoughts and perceptions across several key areas:
- Delusions: These are firmly held false beliefs that are not amenable to change in light of conflicting evidence. The individual is unable to recognize these beliefs as untrue.
- Hallucinations: These involve sensory experiences that occur without external stimulation and are not shared by others. Hallucinations can affect any of the five senses.
- Disorganized Thinking or Speech: This manifests as illogical, non-linear, or undirected patterns of thought, often reflected in incoherent or rambling speech.
- Disorganized Behavior: This includes unpredictable or inappropriate behavioral patterns that deviate from social norms and expectations.
- Negative Symptoms: These represent a reduction or absence of normal functioning. Examples include diminished emotional expression, limited speech, or a lack of motivation.
Types of Psychotic Disorders in Psychotic Diagnosis
The DSM-5 outlines several psychotic disorders, including:
Schizophrenia
Schizophrenia is a significant psychiatric illness. A psychotic diagnosis of schizophrenia requires specific criteria to be met. For a schizophrenia diagnosis, a person must exhibit two or more of the following active-phase symptoms for at least one month:
- Delusions
- Hallucinations
- Disorganized speech (frequent derailment or incoherence)
- Disorganized or catatonic behavior (ranging from abnormal movements to complete withdrawal)
- Negative symptoms (reduced emotional expression or lack of goal-directed motivation)
Crucially, at least one of these symptoms must be delusions, hallucinations, or disorganized speech for a psychotic diagnosis of schizophrenia. Furthermore, there must be a notable decline in functioning in areas like work or relationships since the onset of these symptoms. Continuous signs of schizophrenia must persist for a minimum of six months, which can include negative symptoms, although active-phase symptoms are only required for one month within this period. Finally, to ensure an accurate psychotic diagnosis, other conditions such as schizoaffective, depressive, or bipolar disorders, substance use, medication effects, or other medical conditions must be ruled out by a medical professional.
