Delusional disorder involves a person having false beliefs (delusions) that persist for at least one month. The delusions can be bizarre (about things that cannot possibly occur) or non-bizarre (things that are possible but not likely, such as a belief about being followed or poisoned).
Apart from the delusion(s), it does not involve other symptoms. The person may not appear to have any problems with functioning and behaviour except when they talk about or act on the delusion.
Delusional beliefs can lead to problems with relationships or at work and to legal troubles. Delusional disorder is rare: around 0.2% of people will have it in their lifetime. Delusional disorder is treated with individual psychotherapy, although people rarely seek treatment as they often do not feel they need treatment.
Brief psychotic disorder occurs when a person experiences a sudden short period of psychotic behavior. This episode lasts between one day and one month, and then the symptoms completely disappear, and the person returns to normal.
Brief psychotic disorder involves one (or more) of the following symptoms:
- Delusions,
- Hallucinations,
- Disorganized speech
- Grossly disorganized or catatonic behaviour.
Although the disturbance is short, individuals with brief psychotic disorder typically experience emotional turmoil or overwhelming confusion. Brief psychotic disorder can occur at any age. However, the average age at onset is the mid-30s. It is twice as common in females than in males.
It is important to distinguish symptoms of brief psychotic disorder from culturally appropriate responses. For example, in some religious ceremonies, an individual may report hearing voices. Still, these do not generally persist and are not perceived as abnormal by most members of the individual’s community.
The symptoms of schizophreniform disorder are similar to those of schizophrenia, but the symptoms only last a short time—at least one month but less than six months. If the symptoms last longer than six months, then the diagnosis changes to schizophrenia.
The schizophreniform disorder involves two or more of the following symptoms, each present for a significant portion of time during one month (or less if successfully treated):
- Delusions,
- Hallucinations
- Disorganized speech,
- Grossly disorganized behaviour or catatonic behaviour, and
- Negative symptoms.
A diagnosis of schizophreniform disorder does not require problems in functioning (as schizophrenia does). In the U.S., the schizophreniform disorder is significantly less common than schizophrenia. About one-third of individuals with an initial diagnosis of schizophreniform disorder recover within 6 months, and schizophreniform disorder is their final diagnosis. Most of the remaining two-thirds of individuals will eventually receive a diagnosis of schizophrenia or schizoaffective disorder.
People with schizoaffective disorder experience symptoms of a major mood episode of depression or bipolar disorder (major depression or mania) at the same time as symptoms of schizophrenia (delusions, hallucinations, disorganized speech, grossly disorganized behaviour, or negative symptoms). Symptoms of a major mood episode must be present for the majority of the duration of the active illness, and there must be at least two weeks when delusions or hallucinations are present in the absence of a mood episode.
Schizoaffective disorder is about one-third as common as schizophrenia, affecting about 0.3% of people at some time in their lives. The typical age at onset of schizoaffective disorder is early adulthood, although it can begin anywhere from adolescence to late in life. A significant number of individuals initially diagnosed with another psychotic illness later receive the diagnosis of schizoaffective disorder when the pattern of mood episodes becomes apparent.
FAQs
The earliest signs and symptoms come before a diagnosis can be certain. There is now a growing emphasis on identifying young people at high risk for a psychotic disorder and offering treatment and services in advance of a full psychotic experience. At this stage, symptoms and signs include:
- Problems with personal relationships and school or work performance.
- Experiencing odd phenomena such as hearing a voice or noise but being uncertain if it was really heard.
- Becoming excessively suspicious.
Also, some people may develop a “loner” lifestyle, a sense that something is wrong and that one’s mind is playing tricks, and other things that mark a change in life course. These are not always early schizophrenia symptoms, but it is a good time for clinical assessment and care in hopes of preventing a progression to a full first episode of psychosis.
In the first episode of schizophrenia, common symptoms include paranoia, hearing voices or seeing visions, disorganization of thoughts and behaviours, low motivation and reduced experience of pleasure, anxiety, fear, depression, sleep disturbance, social withdrawal, and sometimes poor emotional control seen as anger and hostility.
All the signs and symptoms can occur at a mild level in people who are not ill. A diagnosis must look at the severity of the symptoms, their impact on function, and resulting distress. It is critical to rule out other possible causes of these symptoms before a diagnosis of schizophrenia.
Substance abuse is a common problem in persons with schizophrenia, including tobacco, marijuana, alcohol, and other drugs. Abuse has all the usual health-related problems, but the presence of schizophrenia complicates this issue. Patients may stop their antipsychotic medications if they believe it interferes with the marijuana or alcohol effect. Disorganized thinking and behaviour may be made worse. Marijuana increases the risk of schizophrenia in vulnerable young people and may complicate the course of schizophrenia. Impaired cognition is common in schizophrenia, and misused drugs adversely affect cognition, such as attention, memory, task orientation, and the like. There are many good reasons to avoid substance misuse.
All persons with schizophrenia need drugs some of the time, and most will do better with continued use of medication to help control symptoms and prevent relapse. However, the drugs are not effective for all aspects of the illness. Cognitive behavioural therapy may help with certain symptoms, and supportive psychotherapy can support personal strengths and improve quality of life. Vocational programs increase the chances of successful employment. Family psychoeducation can give patients and family members a better understanding of the disorder and what will be helpful. A relationship with a case worker may help with the problems of daily living, and supportive psychotherapy may help. New treatments, such as neuromodulation, are being developed, and drugs with novel mechanisms of action are being tested.
So, yes, drug treatment is important, but many patients will not take medication continuously for long periods, and many experience side effects that have to be addressed. An integrated, comprehensive approach works best.
Negative symptoms refer to a decrease or absence of normal experiences/actions. Examples include reduced speech, low drive and motivation, little experience and expression of normal emotions, reduced pleasure in activities, failure to initiate activities, withdrawal from social interaction, and indifference to personal relations.
Warning signs include trouble sleeping, increased anxiety, agitation, increasing suspiciousness or hostility, lack of insight into symptoms, and an increase in severity of any of the person’s usual symptoms. Here, continuity of clinical care is essential to detection and rapid intervention.