American Medical Association Family Medical Guide - American Medical Association [467]
Psychotic Disorders
Psychotic disorders are mental disorders in which a person loses touch with reality, experiences unusual perceptions (hallucinations), and holds false beliefs called delusions. Psychotic disorders alter a person’s thought patterns and reactions to others so severely that he or she undergoes a dramatic change in personality and begins behaving irrationally. These disorders are characterized by the presence of two prominent symptoms: delusions and hallucinations. In most cases, the person does not realize that the hallucinations are not real.
Different types of medical conditions—including brain tumors (see page 682), stroke (see page 669), Huntington disease (see page 969), multiple sclerosis (see page 696), epilepsy (see page 686), migraine (see page 684), thyroid disorders (see page 901), and low blood sugar—can cause psychotic symptoms. Sometimes, psychotic symptoms result from drug abuse or exposure to a poison, or are side effects of a prescribed medication.
Schizophrenia
Schizophrenia is a disorder of the brain that causes alterations in a person’s perceptions (hallucinations) and fixed, false beliefs formed with no proof (delusions). A person with schizophrenia may have disorganized speech, catatonia (abnormal movements and posture or lack of movement), and limited emotional expressiveness. Schizophrenia is responsible for severe disruptions in personal relationships, work or school performance, and self-care. Symptoms usually appear between late adolescence and age 25 for men and between ages 25 and 35 for women. The disorder may be lifelong, but episodes tend to recur at times of emotional stress.
Doctors think that schizophrenia may to some extent be inherited. It also may result from brain damage that occurs during fetal development or in early childhood. An increased risk for schizophrenia has been linked to such factors as malnutrition or exposure to an infection such as influenza before birth, complications of birth, or a brain infection (such as encephalitis; see page 694) or neurological disorder early in life. For unknown reasons, schizophrenia is more common among people who live in the inner city than in people who live in rural areas.
Symptoms
For most people with schizophrenia, an episode begins with a gradual or, occasionally, sudden withdrawal from daily activities. The content of the person’s speech may become increasingly vague, and he or she may seem unable to follow a simple conversation. An acute episode can occur unexpectedly, but often the onset is so gradual that it is difficult to know exactly when psychotic symptoms appear. Initial symptoms may include disconnected remarks accompanied by blank looks. In early phases of schizophrenia, a person may have symptoms that mimic bipolar disorder (see page 715). However, as schizophrenia progresses, the person becomes unusually detached from other people.
People who have schizophrenia often believe that others can hear and “steal” their thoughts. They frequently have delusions, ranging from a single idea (such as believing that a family member is an impostor) to complex systems of related beliefs (such as believing that the CIA and FBI have been taken over by extraterrestrials, who are controlling everyone). Sometimes they fear they have lost control of their body movements and thoughts, as if they were puppets. They frequently hear voices, often hostile ones. Less often, they have hallucinations of unusual physical sensations, such as feeling that they have been poisoned or