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Schizophrenia Spectrum & Other Psychotic Disorders

Individuals with psychotic disorders lose contact with reality and experience a range of extreme symptoms that may include hallucinations, delusions, disorganized thinking (speech), and/or grossly disorganized or abnormal behavior (including catatonia). Psychotic disorders include schizophrenia, schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, delusional disorder, shared psychotic disorder, substance-induced psychotic disorder, and paraphrenia. According to the National Institute of Mental Health, less than 1% of Americans have schizophrenia.

Schizophrenia is a complicated illness that is often misunderstood. It is a chronic illness that can be debilitating since people with schizophrenia often cannot distinguish between reality and their hallucinations and delusions. This can result in poor compliance with treatment including poor compliance with taking critical and effective medications as prescribed. Schizophrenia often first appears in men in their late teens or early twenties. Onset in women is typically twenties or early thirties. Schizophrenia has a strong genetic component and may run in families, but can be effectively treated with medication and therapy. 

There are five subtypes of schizophrenia based on the predominant symptoms:

  1. Catatonic schizophrenia

  2. Disorganized schizophrenia/hebephrenic schizophrenia

  3. Paranoid schizophrenia

  4. Residual schizophrenia

  5. Undifferentiated schizophrenia

However, a client's subtype can change throughout the course of his/her illness. Therefore, mental health professionals typically classify patients into one of three schizophrenia spectrum disorders:

  1. Schizoaffective disorder - similar to schizophrenia with major mood episodes (major depressive disorder or bipolar disorder)

  2. Schizophreniform disorder - identical to schizophrenia, but the duration of symptoms is less (longer than a month but less than six months)

  3. Schizotypal personality disorder - similar to schizophrenia, but episodes are not as frequent, prolonged or intense. Individuals can usually be made aware of the difference between their distorted ideas and experiences, and reality.

 

Other psychotic disorders include:

  • Brief psychotic disorder - classification used when psychotic symptoms come on suddenly and only last less than a month

  • Delusional disorder - an individual displays one or more delusions for at least a month. This is different from schizophrenia, as functioning is generally not impaired and behavior (other than the delusion) doesn't appear "odd". There are several different types of delusional disorder, including: grandiose, jealous, persecutory, somatic, erotomatic, and mixed. If an individual's delusions does not fall into one of these categories, or cannot be clearly defined, the disorder is classified as unspecified delusional disorder.

  • Shared psychotic disorder - one person in a relationship has a delusion, and the other person adopts the same false, fixed belief

  • Substance-induced psychotic disorder - characterized by hallucinations and/or delusions due to the direct effects of a substance, or withdrawal from a substance

  • Paraphrenia - similar to schizophrenia, but starts later in life (elderly)