What are psychotic disorders?

Psychotic disorders are a group of serious and complex mental illnesses that typically manifest during the transition from childhood to adulthood. They are characterized by the presence of psychotic symptoms as the core of the illness. These symptoms involve a disconnection from or distortion of reality, generating thoughts and perceptions that often do not align with the reality we all perceive.

In general, these symptoms cause alterations in thinking and perception (visual, auditory, olfactory, and/or tactile), as well as a range of emotional and behavioral difficulties that cause significant stress and suffering for the affected person. When a person exhibits these symptoms, it is said that they are experiencing a psychotic episode or a psychotic break.

Among psychotic disorders, the most well-known and studied illness is schizophrenia; this is, in general terms, the one that has the most severe presentation and generates the most difficulties in all spheres of a person's life.

All psychotic disorders have in common the presence of psychotic symptoms that lead to a distortion of reality.

However, psychotic symptoms can occur in isolation or briefly and occasionally in other mental disorders such as bipolar disorder or major depression, as well as in other medical conditions.

Psychotic symptoms

Psychotic symptoms are characterized by a misinterpretation or distortion of reality, as well as emotional and behavioral disturbances. Two main types of psychotic symptoms are distinguished.

Positive psychotic symptoms

These are symptoms that manifest as a distortion and/or disconnection from reality and a loss of judgment regarding reality as understood by most of the population. They consist of three main groups of symptoms:

• Delusions: These are fixed and erroneous beliefs that a person experiences as true and indisputable, even when there is evidence to the contrary. The content of these ideas can have diverse themes. The most frequent are usually persecutory delusions, in which the individual thinks they are being followed, watched in the street, etc.; or delusions of reference, which occur when the person thinks badly of themselves or that others are looking at them with suspicion, that a certain news report on television is directed at them, that other people can know what they are thinking, among other things.
• Perceptual disturbances or hallucinations: Hallucinations are paranormal sensory experiences that occur in the absence of a real external stimulus. The individual perceives them as vivid and clear, with the intensity of normal perception. They can occur in all sensory modalities, but the most common, especially during adolescence, are auditory hallucinations.
• Disorganization of thought and/or behavior: Disorganization is a symptom that can affect either thought or behavior. When thought disorganization manifests as incomprehensible speech, with disconnected ideas or where speech lacks semantic order and a coherent line of reasoning, the person's discourse becomes difficult to understand and incoherent. When disorganization affects behavior, the person may appear restless or even agitated and violent for no apparent reason.

Negative psychotic symptoms

Negative symptoms are the primary cause of decreased functioning in people with psychotic disorders. The most frequent symptoms are:

• Diminished or flattened emotional expression is observed when the patient shows no emotional expression and describes their emotionality as flat, as if they don't feel emotions as strongly as usual. This symptom is observable in facial expression, eye contact, tone of voice, and overall body movements.
• Abulia-apathy is characterized by a decrease in motivation to perform activities and a low interest in participating in social, academic or work activities.
• Anhedonia refers to the inability or diminished capacity to feel pleasure. It typically manifests first as a decrease in the performance of activities that were previously enjoyable and pleasurable.
• Alogia refers to an impoverishment of thought and cognition, which can be observed in the person suffering from it when their speech becomes simpler and poorer.

Other symptoms associated with psychotic disorders

• Mood changes: In addition to the symptoms already mentioned, mood changes may occur, such as low mood or depressive symptoms, or elevated mood or manic symptoms.
• Emotional disturbances: The presence of depressive symptoms, anxiety, or other associated symptoms is common. These symptoms are often the first manifestations of psychotic disorders and are therefore the first thing observed, especially in children and adolescents.
• Cognitive difficulties: These disorders often present with difficulties in cognitive functions. Cognitive functions are the mental processes that allow us to think and function in our daily lives. They enable us to receive, process, store, retrieve, and transform information from the world. This deficit is most evident in schizophrenia.

Types of psychotic disorders

Idiopathic psychoses

Those that occur spontaneously or without a known cause:

• Delusional disorder: characterized by the presence of delusions as the core of the illness.
• Brief psychotic disorder: This psychotic disorder is characterized by the presence of some of the aforementioned positive psychotic symptoms, but they are of short duration. The duration of the symptoms must be longer than one day, but does not exceed one month.
• Schizophrenia: This disorder is the most severe of the psychotic disorders. It is characterized by the presence of at least one of the positive psychotic symptoms described.
• Schizophrenic disorder: in this disorder, symptoms similar to schizophrenia are present, but unlike schizophrenia, in this case the symptoms last for less than six months.
• Schizoaffective disorder: This disorder is characterized by presenting positive psychotic symptoms, as well as other symptoms present in schizophrenia, but also by the presence of mood symptoms.

The importance of early intervention in psychosis

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Psychosis due to a medical condition

This subgroup includes patients who present with psychotic symptoms due to another illness. Some medical disorders, such as epilepsy, strokes, or neurodegenerative diseases like dementia, can include psychotic symptoms such as visual or olfactory hallucinations, delusions, and other symptoms among their symptoms.

Toxic psychoses

These are psychotic disorders that develop due to the consumption of toxic substances, whether illegal substances such as drugs, or other substances such as medications or some toxins.

In addition to these disorders, other mental illnesses can also exhibit psychotic symptoms. In this case, the disorders most closely associated with the presence of psychotic symptoms are bipolar disorder and major depressive disorder.

This is an original article from the School of Health at Sant Joan de Déu Hospital in Barcelona . For more information, please consult the   12th FAROS Report "A look at the mental health of adolescents - Keys to understanding and supporting them."