Psychotic disorders

Psychotic disorders or episodes arise when a person experiences a significantly altered or distorted perception of reality. Such distortions are often caused or triggered by hallucinations (false perceptions), delusions (false beliefs) and/or disrupted or disorganised thinking. Psychotic disorders are relatively common in young people, with around two in every 100 young adults experiencing some form of psychotic episode.

Signs this might be a problem:

  • withdrawal from family and friends

  • inability to maintain employment or engage in studies

  • confusion

  • confused speech

  • inappropriate or erratic behaviour and reactions

  • hearing voices when alone or that others cannot hear

  • mood swings.

Boy sitting on blue mat with sneakers holding arm

What is psychosis?

Psychosis is characterised by some sense of distorted reality. A psychotic episode may include many so-called 'positive symptoms; which include:

  • Hallucinations: seeing, hearing, feeling sensations that are not actually occurring

  • Delusions: believing in false realities, such as having superpowers. Delusions may be also paranoid beliefs, such as thinking you're being watched or followed

  • Thought disorder: characterized by jumbled or disorganised thoughts.

Negative symptoms include: Depressed or flattened mood. Difficulty engaging in conversation, such as difficulty following others or putting sentences together coherently, or engaging in unprompted or indirect speech.

Psychotic symptoms can be due to a psychotic disorder, but can also be caused by some drugs and prescription medications, or occasionally by medical conditions.

What are psychotic disorders?

Psychotic disorders cover a range of disorders and have a range of associated symptoms. Essentially psychotic disorders are those which involve some form of altered/distorted perception of reality that is persistent for a considerable period of time and interferes with daily functioning. As many as three in every 100 people will experience some form of a psychotic episode during their lifetime, and the first experience of psychosis most commonly occurs between the ages of 15-30 years.

Psychotic episodes can occur as an isolated event but are frequently an indication/symptom of an underlying psychotic disorder or mental health problem. Although psychotic disorders are not entirely understood, some risk factors associated include; a family history of psychotic disorders or episodes (especially schizophrenia) and drug use, specifically hallucinogenic drugs, amphetamines and cannabis. Stressful life events may trigger the onset of a psychotic episode. The most common psychotic disorders include:

Schizophrenia

Schizophrenia is a psychotic illness that is considered present when a person suffers psychiatric symptoms (such as hallucinations or delusions) for at least six months (with two or more symptoms present for much of the time over a one month period), with changes in behaviour and interference in daily functioning (e.g. work or education commitments) occurring as a result.

Diagnosis is often complicated because the symptoms experienced can be present in other disorders, and the extent of the symptoms may not be communicated (e.g. people may not want to confide in anyone that they are hearing voices for fear of stigmatisation, or due to paranoid delusions and mistrust of doctors etc).

Schizophreniform is similar to schizophrenia, only the symptoms have not persisted for six months. Schizoaffective disorder is diagnosed when a person is experiencing symptoms of psychosis and schizophrenia and another mood disorder.

Bipolar disorder

Bipolar is an affective disorder characterised by intense mood swings. People with bipolar often have intense highs (mania or hypomania) which are followed by intense lows (depression or major depressive episode). Not all people with bipolar will experience psychotic symptoms, but some will during the episodes of mania or depression. People in manic episodes may have extreme grandiose feelings, or believe they have unrealistic abilities (such as a guaranteed win in the lottery).

Major depression with psychotic features

Psychotic depression may be present when clinical depression presents with symptoms of psychosis. This is relatively uncommon and typically only occurs with severe depression.

What students can do about psychosis

For most people, psychosis can be treated and psychotic disorders can be managed to minimise the occurrence of psychotic episodes. Discussing the situation with a trusted teacher, parent, counsellor or local GP (who can refer to a psychiatrist, if necessary) is an important first step for students worried about psychosis, either for themselves or a friend or relative.

Early treatment for psychosis and psychotic disorders is associated with better treatment outcomes and recovery. Upon consultation with a psychiatrist or GP, medication may be considered the most appropriate course of action, especially if diagnosed with schizophrenia and major depression with psychotic features. Other treatments may involve counselling, education programs focusing on raising awareness about the signs and symptoms associated with psychotic disorders so that they can be recognised at their very onset.

Given stress may trigger a psychotic episode, minimising stress and enhancing coping strategies may be helpful. For people with bipolar, establishing regular sleeping patterns can minimise the onset and/or severity of mood swings and consequently psychotic features. Avoiding drugs, particularly hallucinogenic drugs, cannabis and amphetamines is especially important for people with a history of psychosis.

ReachOut.com resources on psychotic disorders

  • What is psychosis?

  • What is schizophrenia?

  • Bipolar disorder

  • How to call a helpline

  • What are mental health professionals?

  • Psychiatrists

  • Ben's experience with unwelcome voices

  • Jennifer talks about getting help for schizoaffective disorder

Orygen Youth Health has excellent resources for understanding young people with psychosis and how to help. We recommend:

What can I do now?

  • Try to be calm and supportive – psychosis can be frightening for the student experiencing it.

  • Support the student to get treatment as early as possible.

  • If a student is expressing thoughts of harming themselves then call your local specialist mental health service or hospital so that they receive urgent specialist support.

  • Read Orygen Youth Health's information on psychosis for more detailed guidance on helping.