Psychotic disorders


Psychotic disorders affect brain function by altering thoughts, beliefs or perceptions. People with a psychotic disorder may be convinced that someone is spying on them or following them, may hear voices or have the feeling that others are manipulating their thoughts. They have trouble differentiating between their perceptions and reality.

Symptoms of a psychotic disorder can appear gradually or suddenly. The period during which people shows these symptoms is called a “psychotic episode”. It is described as a loss of contact with reality. Psychosis affects thoughts, emotions, feelings and behaviour.

People with a psychotic disorder have considerable difficulty handling daily life.

Main types of psychotic disorders

The main types of psychotic disorders are the following:

  • Schizophrenia: Schizophrenia is defined as the manifestation of several symptoms of psychosis that lead to significant functional impairment. The symptoms (hallucinations, delusions, disorganized speech and behaviour, negative symptoms) last at least a month.
  • Schizoaffective disorder: People with schizoaffective disorder have symptoms of schizophrenia and a mood disorder (depression and bipolar disorder).
  • Delusional disorder: Delusional disorder primarily affects thoughts and ideas. People with a delusional disorder are convinced that their ideas are real, despite evidence to the contrary. For example, they may believe that:
    • a celebrity is in love with them
    • a group of people is out to get them
    • they have powers such as the ability to control other people’s thoughts
    • they are being followed or poisoned
  • Brief psychotic disorder: Symptoms of brief psychotic disorder are the same as those of schizophrenia (delusions, hallucinations, disorganized speech and behaviour). However, they appear suddenly and are often triggered by major stressor, such as a death in the family, violence, illness or a natural disaster. A psychotic episode lasts no more than a month. Afterwards, people return to their normal level of function.
  • Substance-induced psychotic disorder: People with this disorder lose touch with reality while using or shortly after using substances such as alcohol, drugs or medication.

Signs and symptoms

People with a psychotic disorder or their family members may notice certain signs:

  • Disturbed sleep and loss of appetite
  • Neglected personal hygiene and unkempt appearance
  • Lack of energy and motivation
  • Mood swings (for example, becoming abnormally excited and then depressed within minutes)
  • Difficulty concentrating or paying attention for long periods
  • Loss of interest in usual activities, work, studies or friends
  • Altered feelings (for example, appearing indifferent to loved ones, disconnected or cut off from the world). Bursting out laughing or getting angry for no reason
  • Delusions, that is, strange or false ideas, bizarre preoccupations or beliefs (for example, the feeling that their thoughts are being controlled by an outside force or their food is being poisoned)
  • Incoherent and confused thoughts (for example, difficulty following a conversation and speaking in a vague or illogical way)
  • Unusual behaviour (for example, self-isolating or taking up alcohol or drugs for the very first time or more alcohol or drugs than usual

Psychosis generally presents in three phases: the gradual onset of mild symptoms (the prodromal phase); the acute phase; and the recovery phase (following the start of treatment).

Symptoms vary from person to person and can change over time.

During a psychotic episode, people may have:

  • Hallucinations:
    • hearing one or more voices that nobody else hears
    • seeing things that nobody else sees
    • smelling odours that nobody else smells
    • experiencing unusual physical sensations, such as feeling that they are being touched by an invisible person)
  • Delusion, such as:
    • believing that they are able to control other people’s thoughts or that others are controlling their thoughts
    • feeling that they are being watched, followed or persecuted
    • feeling that they are unlike other human beings or that they have changed
  • Disorganized thinking, such as:
    • quickly skipping from topic to topic
    • giving answers that are barely or not at all connected to the topic at hand
  • Motor abnormalities, such as:
    • being agitated or, conversely, responding less to their environment
    • having difficulty with goal-directed behaviour
  • Negative symptoms, such as:
    • reduced emotional expression
    • decreased motivation
    • diminished ability to feel pleasure
    • loss of interest in social interaction

Their symptoms may cause people to experience anxiety and distress. For example, they may feel persistenly insecure.

Upon the onset of a psychotic disorder, many affected people pay little attention to their symptoms and think these will go away on their own. By doing so, they delay getting help and treatment.

When to seek help

Do not wait until you are unable to perform your usual activities before asking for help. See a health professional as soon as symptoms appear. According to recent studies, the earlier a psychotic disorder is diagnosed and treated as soon as symptoms appear, the greater the likelihood of a prompt recovery.

The health professional will assess whether you have a psychotic disorder and, if so, what type of disorder it is. They can also assess if you have another health problem with similar symptoms. For a proper assessment, it could be necessary to conduct a physical exam or prescribe laboratory tests. You will be offered a treatment plan that is adapted to your needs.

Consult the Help and resources section to find out about the support available to you.

People with a psychotic disorder and their families may experience significant distress and suffering.

If you are having suicidal thoughts and fear for your safety or that of the people around you, refer to the page Preventing suicide. You will find further information on available help and resources.

Care and services

Care and services that have proven effective are available to support people with psychotic disorders. Such support can help alleviate the symptoms associated with these disorders and enable people to to regain control over their lives and daily activities.

As a result, people are able to:

  • Maintain healthy and satisfying lives
  • Keep and improve their relationships with their family members and friends
  • Experience fewer psychotic relapses
  • Reduce the risks of aggressive or suicidal behaviour or behaviour that could endanger their life or that of others
  • Improve their memory and ability to concentrate

In most cases, psychotic disorders can be treated effectively with a combination of one or more treatments and rehabilitation activities, such as interventions based on the cognitive-behavioural approach and taking medication.

Psychosocial interventions

Experts generally recommend psychosocial follow-up care to help people with psychotic disorders get on with their lives despite the spychosis. This may include psycho-education or coping skills programs. Psychotherapy may be offered in some cases. This psychotherapy is designed to change the person’s problematic thoughts and behaviour and replace them with more realistic thoughts and reactions.

Additional help may also be necessary to enable people to continue or resume their studies or work.

Medication and medical care

Different medications can be used to treat symptoms and to prevent new psychotic episodes. These medications are called “antipsychotics” or “neuroleptics”.

Action of antipsychotics or neuroleptics

Antipsychotics or neuroleptics are designed to restore chemical balance in the brain. They therefore help people rebalance their:

  • Emotions
  • Thoughts
  • Perceptions
  • Memory
  • Concentration

These medications also lower anxiety, allow people to resume their activities of daily living and reduce the risk of their experiencing a new psychotic episode.

Recommendations regarding medication

If you and your doctor choose to start a medication, it is important you to carefully follow your doctor’s instructions.

Even if you feel better, continue the treatment as prescribed in order to prevent your symptoms from recurring. If you are thinking of stopping your treatment, talk to your doctor about this first. They will tell you if it is the right time to do so and, if so, they will explain exactly how to stop it safely.

If you experience undesirable effects due to medication, discuss the matter with your pharmacist or doctor as soon as possible. If necessary, your doctor may adjust your medication or recommend another one.

Related issues

Living with an untreated psychotic disorder can have many consequences for the affected person and their loved ones. This can:

  • Have a negative impact on the person’s self-esteem
  • Hurt their relationships with others, leading to self-isolation
  • Increase the distress of family and friends, who may not always understand their behaviour, possibly leading to conflicts
  • Increase certain risks for them, such as:
    • living in greater poverty or ending up homeless
    • drinking or using drugs excessively. People with a disorder often try to control their anxiety by drinking or doing drugs, which can result in addiction
    • suffering from depression and having suicidal thoughts
    • behaving in ways that could land them in trouble with the law or require in hospitalization

Stigma and prejudice

People with psychotic disorders sometimes fall prey both to their own prejudice and to that of society. This discourages them from asking for help or continuing their treatment. To learn more about stigma, its impact and how to fight against it, visit the page Fighting the stigma surrounding mental illness.

Impact on loved ones

Family members and close friends are well-placed to recognize the signs of a psychotic episode or a relapse in their loved one. They also provide indispensable support throughout the person’s recovery.

However, when someone is experiencing a psychotic episode, their family members and friends can be deeply affected. They may feel lost and powerless. They need help to understand the psychotic disorder affecting the person and to communicate better with them. For example, they may:

  • Learn to use effective communication techniques and coping strategies
  • Take part in supportive activities

Resources are available to help the loved ones of someone with a psychotic disorder. To learn more, refer to the Support for the family members and friends of people living with a mental disorder section or the page Living with a person suffering from mental disorder.

Mental health and prevention

If you are experiencing the symptoms associated with a psychotic disorder, there are means that can help you feel better or reduce your risk of experiencing another psychotic episode. Developing a healthy lifestyle, social skills, self-esteem and self-confidence, stress-management skills, and so forth, can help reduce the risk of developing a psychotic disorder (or having a relapse).

To learn more, read Maintaining good mental health.

Risk factors

The appearance of signs and symptoms is often caused by a combination of several factors linked to a person’s vulnerability or to the stress they are coping with. The more vulnerable a person is, even low-level stress can trigger a psychotic disorder. More and more studies have shown that the use of drugs such as marijuana, cocaine and amphetamines also increases the risk of experiencing a psychotic episode.

The following are a few contributing factors:

  • Vulnerability factors:
    • Heredity, that is, other people in the family have or had psychotic disorders
    • Alcohol abuse and the use of certain drugs
  • Stress factors:
    • Anxiety triggers present in the person’s life or environment

People at risk

Psychotic disorders affect slightly more men than women. These disorders generally appear between the ages of 15 and 35.

Psychotic disorders most often appear in adolescence, a period during which significant changes occur that affect various areas of young people’s lives:

  • Personal and sexual identity
  • Separation from parents
  • Intellectual maturation
  • Start of a career or post-secondary education
  • Search for personal and financial independence

Help and resources

To find information and support resources, or to receive care and services for psychotic disorders, see the page Mental health help and support resources.

Last update: May 2, 2022


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