Psychotic Disorders

  • Medical Author:
    Roxanne Dryden-Edwards, MD

    Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Coping With Schizophrenia

How do health-care professionals diagnose psychotic disorders?

In order to determine whether the diagnosis of a psychotic disorder is warranted, the health-care professional has to first consider if a medical illness may be the cause of the behavioral changes. If a medical cause is identified or the psychosis is found to be the result of exposure to a medication or drug, the sufferer is assessed as having psychotic disorder due to a medical condition or psychotic disorder due to toxin exposure or withdrawal, respectively. On the other hand, if a medical cause and toxin exposure have been looked for and not found, a psychotic illness such as schizophrenia could be considered. The diagnosis will best be made by a licensed mental-health professional (like a psychiatrist or clinical psychologist), who can evaluate the patient and carefully sort through the diagnostic criteria for a variety of mental illnesses that might look alike at the initial examination, like schizotypal or schizoid personality disorder or a mood disorder with psychotic features like severe depression, or the manic phase of bipolar disorder.

  • The physician will examine someone in whom psychosis is suspected either in an office (for example, a primary-care doctor or neurologist), in an emergency department (by an emergency-room physician), or a hospital. The physician's role is to ensure that the psychosis sufferer doesn't have any medical (referred to as organic) problems, including active drug use, since these conditions can mimic the symptoms of a psychotic disorder. The medical doctor takes the patient's history and performs a physical examination. Laboratory and other tests, sometimes including a computerized tomography (CT) scan of the brain, are performed. Physical findings can relate to the symptoms associated with psychosis or to the medications or other substances the person may be taking.
    • People with a psychotic disorder can exhibit signs of mild confusion or clumsiness.
    • Subtle physical features, such as highly arched palate or wide or narrow set eyes, have been described in psychotic disorders, but none of these findings alone allow the physician to make the diagnosis.
  • Generally, results are normal for most psychotic disorders for the lab tests and imaging studies available to most doctors. If the person has a particular behavior as part of their mental disorder, such as drinking too much water, then this might show as a metabolic abnormality in the person's laboratory results.

Family members or friends of the person with psychosis can help by giving the doctor a detailed history and information about the patient, including recent life stressors, behavioral changes, previous level of social functioning, history of mental illness in the family, past medical and psychiatric problems, medications, and allergies (to foods and medications), as well as the person's previous psychiatrists and other physicians. A history of hospitalizations is also helpful so that prior records at these facilities might be obtained and reviewed.

The diagnosis of another psychotic disorder may be distinguished from schizophrenia based on the duration of symptoms (as with brief psychotic disorder), the specific kind of psychotic symptoms that occur with delusional disorder, the type of nonpsychotic symptoms that occur with it as with schizoaffective disorder, or what causes it, as with substance/medication-induced psychotic disorder and psychosis due to a medical condition. The diagnosis of other specified schizophrenia spectrum and other psychotic disorder is reserved for those individuals who have some psychotic symptoms but do not qualify for a specific psychotic diagnosis. Women who recently had a baby (are in the postpartum state) who develop psychotic symptoms may be diagnosed with postpartum psychosis. Also, a neurosis like major depressive disorder or bipolar disorder can become severe enough to result in psychosis symptoms, also called psychotic features.

Medically Reviewed by a Doctor on 2/19/2016

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