Psychotic Disorders

  • Medical Author:
    Roxanne Dryden-Edwards, MD


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

    Melissa Conrad Stöppler, MD


How common are psychotic disorders?


What are causes and risk factors for psychotic disorders in children, teenagers, and adults? What does it mean to have psychotic tendencies?

Except for those psychotic disorders that are caused by a medical disease or the use of a substance, specific causes for most psychotic disorders are not known. However, the interplay of inherited (familial), biological, environmental, and psychological factors is thought to be involved. We do not yet understand all of the causes and other issues involved, but current research is making steady progress toward elucidating and defining causes of psychosis. Such risk factors can be thought of as psychotic tendencies. For example, schizophrenia and bipolar disorder are thought to have many risk factors in common.

In biological models of psychotic disorders, genetic predisposition, infectious agents, toxins, allergies, and disturbances in metabolism have all been investigated. Psychotic disorders are known to run in families. For example, the risk of the disease in an identical twin of a person with schizophrenia is 40%-60% and in other siblings is 5%-15%. A child of a parent suffering from schizophrenia has about a 10% chance of developing the illness, in contrast to the risk of schizophrenia in the general population being about 1%. Toxins like ketamine or marijuana increase the risk of developing acute (rapid onset) psychosis.

The current concept is that multiple genes are involved in the development of schizophrenia and that risk factors such as prenatal (intrauterine), perinatal (around the time of birth), and nonspecific stressors are involved in creating a disposition or vulnerability to develop the illness. Neurotransmitters (chemicals involved in the communication among nerve cells) have also been implicated in the development of psychotic disorders. The list of neurotransmitters under scrutiny is long, but special attention has been given to dopamine, serotonin, and glutamate.

Also, recent research studies have identified subtle changes in brain structure and function, indicating that, at least in part, schizophrenia could be a disease of the development of the brain. The fact that autism is a risk factor for developing psychosis during childhood seems to support that theory. Psychosis is more likely to occur in people who have poor medical health in a general sense or who suffer from another mental illness.

Environmental risk factors, like a history of problem drinking, using tobacco, marijuana, or other drugs, have been associated with the development of a psychotic disorder.

There are a number of medical risk factors for psychotic disorders. Steroid-induced psychosis is one example of the risk of certain medications causing this illness. Women who have recently delivered a baby (in the postpartum state) are at risk for a number of mental-health problems, including postpartum psychosis. More than 25% of mothers with bipolar I disorder (those who have ever suffered from a full-blown manic episode, with possible symptoms of racing or other unwanted thoughts, pressured speech, and decreased need for sleep) may develop postpartum psychosis, and more than half of those who have both a personal history of bipolar disorder and a family history of postpartum psychosis tend to develop the condition. Children of mothers with a psychotic disorder may experience more than the genetic risk of developing a psychotic illness if their birth mother's pregnancy with them was characterized by problems like malnutrition, infections, high blood pressure, or problems with the placenta.

Psychological risks for developing a psychotic disorder include a history of mood problems, like an anxiety disorder, major depression, or bipolar disorder and trouble functioning socially or generally. People who are at risk for developing a psychotic disorder as the result of having a close relative with such symptoms are also more likely to have symptoms of attention deficit hyperactivity disorder (ADHD). Individuals who have frequent nightmares, tend to be suspicious of others or who have unusual thoughts (for example feeling paranoid, believing that an ordinary event has special and personal meaning, having somatic symptom disorder) are also more likely to develop a psychotic disorder. Studies show that women with postpartum psychosis are frequently victims of domestic violence or abusive childhoods and often have histories of abandonment or substance abuse.

Conditions that are classified as neurocognitive disorders, like delirium and major neurocognitive disorders, formerly called dementia, can include psychotic symptoms. Delirium, a condition that is characterized by disruptions in attention and thinking (cognition), usually develops quickly, over a period of hours to days, and can include psychotic symptoms like hallucinations. Major neurocognitive disorder, formerly called dementia, can have identifiable or unidentifiable causes and is characterized by a marked decline in cognitive functioning that results in the sufferer's having trouble doing things (like cooking or driving) independently; the symptoms do not only occur in the context of delirium and are not better described by another mental disorder.

Children, teens, or adults who have endured more negative life events, have poor housing, are more ethnically isolated where they live, or otherwise have little in terms of a support group are at higher risk for developing a psychotic disorder.

Medically Reviewed by a Doctor on 3/14/2017

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