Types of Psychotic Disorders

There are many psychiatric disorders that have psychosis as a feature or complication. Some of the most common ones are listed here:
Delusional Disorder: One or more delusions (false beliefs) lasting a month or longer but no hallucinations (false sensory experiences). Apart from the delusions, the person’s functioning is not seriously impaired and their behavior is not odd or peculiar.

Schizophrenia: Delusions, hallucinations, disorganized speech or behavior, and/or decreased emotional expression or initiative lasting a month or longer accompanied by significant impairment in work, social relationships, school, and/or self-care. The person has shown deterioration in functioning for at least six months. These symptoms are not due to drugs or alcohol or another mental disorder.

Schizoaffective Disorder: The presence of a major mood episode (depression or mania) occurring during the same time as the individual experiences delusions, hallucinations, disorganized speech or behavior, and/or decreased emotional expression or initiative lasting at least one month or longer. In addition, the person has experienced delusions or hallucinations for at least two weeks in the absence of a major mood episode at some time during the course of their illness, even though they have had symptoms of a major mood episode the majority of the time that they have been ill. The symptoms are not due to drugs or alcohol or another mental disorder.

Bipolar I Disorder with Psychotic Features: The person meets the diagnostic criteria for Bipolar I disorder and also experiences psychotic symptoms. These are typically paranoid or grandiose in nature.

Major Depression with Psychotic Features: The person meets the diagnostic criteria for major depressive disorder and also experiences psychotic symptoms. These typically consist of delusions or hallucinations that have depressing or morbid content.
Anxiety Disorders and OCD Spectrum Disorders: Extremely severe anxiety disorders and OCD spectrum disorders may be accompanied by brief psychotic symptoms at times.

Personality Disorders: Individuals with personality disorders, when under very acute stress, may experience transient psychotic symptoms at times.
Substance Use Disorders: Severe use of drugs and alcohol can induce severe psychotic states at times.

Psychotherapy for Psychotic Disorders

Because psychosis can be a complication of so many disorders, the treatment of psychosis requires a thorough understanding of the underlying psychiatric condition. In this section, we describe the psychotherapy of primary psychotic conditions such as schizoaffective disorder and schizophrenia.
Psychotherapy for a primary psychotic disorder requires a careful initial assessment of the appropriate level of care for the delivery of mental health services. The Arroyos team will conduct an initial assessment to determine if the psychotic patient is able to meaningfully participate in outpatient psychological and psychiatric care. If the patient is too unstable and local to the Pasadena area, the family may be able to bring the patient in for a crisis evaluation in which a determination is made whether to hospitalize the patient. Some of our staff are able to write 5150 holds for hospitalization if necessary. In some cases, we can provide treatment in local psychiatric hospitals and return the patient to our outpatient practice for continued care when they are stable.

For psychotic patients who are able to participate in outpatient treatment, we offer a combination of specialized evidence-based individual and family psychotherapy. The focus is on ensuring the patient’s safety, psychoeducation about their condition, making sure that they feel supported and understood, ensuring adherence to medications, and working on family communication patterns to reduce stressful interactions and increase supportive interactions.

Medications for Psychotic Disorders

Your psychiatrist will work closely with you and your psychologist to select the right medication program to treat your psychosis. We may suggest that one or more family members join you during some of your sessions. Pharmacogenomic testing through The Arroyos laboratory service may be recommended to better match your medications with your genetic profile. There are several classes of antipsychotic medications used to treat psychosis. The choice of which class of medication, brand, and dose is made between you and your psychiatrist. Psychopharmacology is a complex process, and you may have to try more than one type of medication before you find the right prescription plan to treat your condition. The best outcomes for the treatment of psychotic disorders are often achieved with a combination of medications and specialized evidence-based psychotherapies for psychosis. Your treatment team will regularly consult to maximize the coordination of your psychiatric and psychological care at The Arroyos.

How to Help a Loved One

If you have a loved one who is suffering from psychosis, it is important to talk with them right away about your concerns. They may be embarrassed about their condition, have difficulty putting their feelings into words, feel hopeless or worthless, or be preoccupied with delusions or hallucinations or even suicidal thoughts. Let them know that you care and that you are confident that they can feel better if they speak to a trained professional. Some people with psychosis are highly unpredictable and can be a danger to themselves or others, while other psychotic individuals may be very lethargic, uncommunicative, and disengaged from the world. Please call us if your loved one is willing to schedule an intake appointment. If they are unwilling or unable to get help, they may need to be hospitalized. If they are expressing thoughts of hurting themselves or someone else, this is an emergency. Call 911 or take them to the nearest emergency room.