PSYCHOTIC DISORDERS

Subject: Clinical Psychology

Submitted by: Asad Hussain

Class: PhD

Session: 2023

Semester: I
What is Psychosis?

Psychosis is a mental health condition characterized by a loss of touch with reality. Individual
experiencing psychosis may have difficulty distinguishing between what is real and what is not.
Patients suffering from psychotic disorders do not have insight into their condition. It involves
experiencing symptoms such as hallucinations (perceiving things that are not there) and
delusions (holding false beliefs). People with psychosis may also exhibit disorganized thinking,
speech, or behavior.

Historical Background:

The term "Psychosis" was first coined by the German psychiatrist Karl Friedrich Canstatt in
1845. However, the understanding and conceptualization of psychosis have evolved over time
within the field of clinical psychology.

Historically, the concept of psychosis has its roots in early psychiatric classifications. In the late
19th and early 20th centuries, Emil Kraepelin, a prominent German psychiatrist, made
significant contributions to the understanding of psychosis. Kraepelin classified mental disorders
based on observable symptoms and proposed a distinction between two major categories:
dementia praecox (which later became known as schizophrenia) and manic-depressive psychosis
(now called bipolar disorder). This differentiation was crucial in distinguishing psychotic
disorders from other mental health conditions. Kraepelin believed an early onset at the heart of
each disorder develops into “mental weakness.” In a second important contribution, Kraepelin
(1898) distinguished dementia praecox from manic-depressive illness (now called bipolar
disorder). For people with dementia praecox, an early age of onset and a poor outcome were
characteristic; in contrast, these patterns were not essential to manic depression (Lewis,
Escalona, & Keith, 2009). Kraepelin also noted the numerous symptoms in people with dementia
praecox, including hallucinations, delusions, negativism, and stereotyped behavior.

Later, the influential Swiss psychiatrist Eugen Bleuler expanded on Kraepelin's work and
introduced the term "schizophrenia" in 1911. Bleuler emphasized the importance of
understanding the underlying psychological processes and social factors contributing to
psychosis.
In the Diagnostic and Statistical Manual of Mental Disorders (DSM), one of the most widely
used diagnostic manuals in contemporary psychology; the concept of psychotic disorders has
been present since its earlier editions. The DSM-III, published in 1980, introduced a distinct
category called "Psychotic Disorders" that included conditions such as schizophrenia,
schizoaffective disorder, and delusional disorder. This category has been maintained and
expanded upon in subsequent editions of the DSM, including the DSM-IV (1994) and the current
version, DSM-5 (2013).

Similarly, the International Classification of Diseases (ICD), a global standard for classifying
diseases and disorders, has included the category of psychotic disorders. The ICD-10, which was
published in 1992, contains a section specifically dedicated to "Schizophrenia, schizotypal, and
delusional disorders." The ICD-11, released in 2018, continues to classify psychotic disorders
under a similar category.
Date Historical Figure Contribution
1809 John Haslam (1764–1844) Superintendent of a British hospital. In
Observations on Madness and Melancholy,
he outlined a description of the symptoms
1801/1809 Philippe Pinel (1745–1826) A French physician who described cases of
schizophrenia
1852 Benedict Morel (1809– 1873) Physician at a French institution who used the
term démence précoce (in Latin, dementia
praecox), meaning early or premature
(précoce) loss of mind (démence) to describe
schizophrenia.
1898/1899 Emil Kraepelin (1856– 1926) A German psychiatrist who unified the
distinct categories of schizophrenia
(hebephrenic, catatonic, and paranoid) under
the name dementia praecox
1908 Eugen Bleuler (1857–1939) A Swiss psychiatrist who introduced the term
schizophrenia, meaning splitting of the mind
(Book, Abnormal Psychology: Durand and Barlow, 2012)

Difference between Neurosis and Psychosis:

It's important to note that the distinction between neurosis and psychosis has become less
prominent in contemporary diagnostic systems like the Diagnostic and Statistical Manual of
Mental Disorders (DSM-5) and the International Classification of Diseases (ICD-11). These
systems now use broader categories, such as "anxiety disorders" and "schizophrenia spectrum
disorders," to capture the diverse range of symptoms and presentations observed in clinical
practice. Following are key differences between neurosis and psychosis:

 Reality testing: Individuals with neurosis generally have intact reality testing. They can
distinguish between what is real and what is not, even though they may experience
distressing symptoms. In contrast, individuals with psychosis may have impaired reality
testing, resulting in a distorted perception of reality.
  Severity of symptoms: Psychosis is typically associated with more severe symptoms,
such as hallucinations and delusions, which can significantly impact an individual's daily
functioning. Neurosis, on the other hand, tends to involve less severe symptoms, such as
anxiety, phobias, or obsessive-compulsive behaviors.
 Insight: People with neurosis often have insight into their condition and recognize that
their thoughts or behaviors are irrational or problematic. In contrast, individuals
experiencing psychosis may lack insight and genuinely believe in the reality of their
hallucinations or delusions.
 Underlying causes: Neurosis is thought to arise from psychological conflicts, unresolved
emotions, or maladaptive coping mechanisms. Psychosis, on the other hand, is believed
to result from complex interactions between genetic, biological, and environmental
factors.

Key Features of Psychotic Disorders:

The key symptoms that define psychosis include hallucinations, delusions, disorganized
thinking, disorganized speech, and grossly disorganized or catatonic behavior. Here are brief
definitions of each of these symptoms:

1. Hallucinations: Hallucinations are sensory experiences that occur without any external
stimuli. They can involve any of the senses, including hearing (auditory hallucinations),
seeing (visual hallucinations), feeling (tactile hallucinations), smelling (olfactory
hallucinations), or tasting (gustatory hallucinations). Individuals experiencing
hallucinations perceive things that are not actually present.

Types of Hallucinations:

a) Auditory Hallucinations: This is the most common type of hallucination in which

individuals hear voices or sounds that are not actually present. The voices may be
perceived as commenting on their actions, commanding them, or engaging in
conversation.
b) Visual Hallucinations: These involve seeing things that are not there. Individuals may see
people, objects, or distorted images that have no basis in reality.
c) Tactile Hallucinations: Tactile hallucinations involve false sensations of touch or feeling
on the skin, such as bugs crawling on the body or electric shocks.
d) Olfactory Hallucinations: These hallucinations involve perceiving smells that are not
present in the environment. Individuals may detect odors that are unpleasant, unusual, or
unfamiliar.
e) Gustatory Hallucinations: This type of hallucination relates to experiencing tastes that
have no external source. Individuals may perceive strange or unpleasant tastes in the
absence of any corresponding stimuli.

2. Delusions: Delusions are false beliefs that persist despite evidence to the contrary. These
beliefs are often irrational and not accepted by others in the person's culture or social
group. Delusions can take various forms, such as paranoid delusions (believing one is
being persecuted or conspired against), grandiose delusions (having an inflated sense of
self-importance or special abilities), or somatic delusions (believing one has a physical
illness or deformity despite evidence to the contrary).

Types of Delusions:

a) Paranoid Delusions: These involve beliefs of persecution, conspiracy, or being targeted

by others. Individuals may believe that they are being watched, followed, or that someone
is plotting against them.
b) Grandiose Delusions: In this type, individuals have an exaggerated sense of self-
importance and believe they possess exceptional abilities, wealth, or fame that is not
supported by evidence.
c) Delusions of Reference: This refers to the belief that neutral events or stimuli in the
environment have a personal significance directed towards the individual. For example, a
person may believe that TV broadcasts or newspaper articles contain hidden messages
meant specifically for them.
d) Somatic Delusions: These delusions involve false beliefs about the body or health.
Individuals may believe they have a serious illness, physical deformity, or that their body
is under the control of external forces.
3. Disorganized thinking: Disorganized thinking refers to the difficulty in organizing and
connecting thoughts coherently. It can manifest as a rapid or incoherent speech pattern,
making it challenging for others to follow the person's conversation. The individual may
jump from one topic to another unrelated topic or provide answers that are tangential or
irrelevant to the questions asked.
4. Disorganized speech: Disorganized speech, also known as formal thought disorder,
involves disruptions in the flow, structure, and organization of speech. This can manifest
as word salad (jumbled and incoherent speech), derailment (shifting from one topic to
another without logical connections), or neologisms (creating new words or using
existing words in unusual or idiosyncratic ways).
5. Grossly disorganized or catatonic behavior: Grossly disorganized behavior refers to
behaviors that are inappropriate or unusual in social or daily functioning. This can
include unpredictable or impulsive actions, inappropriate emotional responses, or
difficulty performing tasks of daily living. Catatonic behavior, on the other hand,
involves a range of motor abnormalities, such as immobility, excessive or purposeless
motor activity, rigid posture, or resistance to instructions or attempts to move.

(Note: Positive symptoms are characterized by an excess or distortion of normal

functions. These symptoms involve experiences or behaviors that are present in
individuals with schizophrenia but absent in healthy individuals. The term "positive" does
not imply that these symptoms are desirable, but rather that they represent an addition to
normal experiences. Positive symptoms include Delusions, Hallucinations, Disorganized
speech).

6. Negative Symptoms: Negative symptoms refer to a reduction or loss of normal functions

that are typically present in healthy individuals. These symptoms involve deficits in
emotional, cognitive, and behavioral functioning. Negative symptoms accounts for a
substantial portion of the morbidity associated with schizophrenia but are less prominent
in other psychotic disorders. Two negative symptoms are particularly prominent in
schizophrenia: diminished emotional expression and avolition (lack of motivation).
Diminished emotional expression includes reductions in the expression of emotions in the
face, eye contact, intonation of speech (prosody), and movements of the hand, head, and
 face that normally give an emotional emphasis to speech. Avolition is a decrease in
motivated self-initiated purposeful activities. The individual may sit for long periods of
time and show little interest in participating in work or social activities. Other negative
symptoms include alogia, anhedonia, and asociality. Alogia is manifested by diminished
speech output. Anhedonia is the decreased ability to experience pleasure from positive
stimuli or degradation in the recollection of pleasure previously experienced. Asociality
refers to the apparent lack of interest in social interactions and may be associated with
avolition, but it can also be a manifestation of limited opportunities for social
Interactions. Flat affect means marked lack of expressed emotions; a pattern of extreme
psychomotor symptoms (catatonia) also found in some forms of schizophrenia, which
may include catatonic stupor, rigidity, or posturing.

These symptoms are characteristic of psychosis, and their presence and severity are essential
criteria for diagnosing psychotic disorders. It's important to note that individuals may experience
a combination of these symptoms to varying degrees, and a comprehensive evaluation by a
mental health professional is necessary to make an accurate diagnosis and determine appropriate
treatment.

Brief Overview of Psychotic Disorders:

Schizotypal personality disorder is noted within this chapter as it is considered within the
schizophrenia spectrum, although it’s categorized under the umbrella of "Personality Disorders."
The diagnosis schizotypal personality disorder captures a pervasive pattern of social and
interpersonal deficits, including reduced capacity for close relationships; cognitive or perceptual
distortions; and eccentricities of behavior, usually beginning by early adulthood but in some
cases first becoming apparent in childhood and adolescence. Abnormalities of beliefs, thinking,
and perception are below the threshold for the diagnosis of a psychotic disorder. Two conditions
are defined by abnormalities limited to one domain of psychosis: delusions or catatonia.
Delusional disorder is characterized by at least 1 month of delusions but no other psychotic
symptoms. Brief psychotic disorder lasts more than 1 day and remits by 1 month.
Schizophreniform disorder is characterized by a symptomatic presentation equivalent to that of
schizophrenia except for its duration (less than 6 months) and the absence of a requirement for a
decline in functioning. Schizophrenia lasts for at least 6 months and includes at least 1 month of
active-phase symptoms. In schizoaffective disorder, a mood episode and the active-phase
symptoms of schizophrenia occur together and were preceded or are followed by at least 2 weeks
of delusions or hallucinations without prominent mood symptoms. Psychotic disorders may be
induced by another condition. In substance/medication induced psychotic disorder, the psychotic
symptoms are judged to be a physiological consequence of a drug of abuse, a medication, or
toxin exposure and cease after removal of the agent. In psychotic disorder due to another medical
condition, the psychotic symptoms are judged to be a direct physiological consequence of
another medical condition. Catatonia can occur in several disorders, including
neurodevelopmental, psychotic, bipolar, depressive, and other mental disorders.

Psychotic Disorders:

1. Delusional Disorder
2. Brief Psychotic Disorder
3. Schizophreniform Disorder
4. Schizophrenia
5. Schizoaffective Disorder
6. Schizotypal Disorder
7. Substance/Medication-Induced Psychotic Disorder
8. Psychotic Disorder Due to Another Medical Condition

1. Delusional Disorder

Diagnostic Criteria

A. The presence of one (or more) delusions with a duration of 1 month or longer.

B. Criterion A for schizophrenia has never been met. Note: Hallucinations, if present, are
not prominent and are related to the delusional theme (e.g., the sensation of being
infested with insects associated with delusions of infestation).
 C. Apart from the impact of the delusion(s) or its ramifications, functioning is not
markedly impaired, and behavior is not obviously bizarre or odd.

D. If manic or major depressive episodes have occurred, these have been brief relative to
the duration of the delusional periods.

E. The disturbance is not attributable to the physiological effects of a substance or

another medical condition and is not better explained by another mental disorder, such as
body dysmorphic disorder or obsessive-compulsive disorder.

2. Brief Psychotic Disorder

Diagnostic Criteria

A. Presence of one (or more) of the following symptoms. At least one of these must be (1), (2),
or (3):

1. Delusions.

2. Hallucinations.

3. Disorganized speech (e.g., frequent derailment or incoherence).

4. Grossly disorganized or catatonic behavior. Note: Do not include a symptom if it is a

culturally sanctioned response.

B. Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual
full return to premorbid level of functioning.

C. The disturbance is not better explained by major depressive or bipolar disorder with psychotic
features or another psychotic disorder such as schizophrenia or catatonia, and is not attributable
to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another
medical condition
3. Schizophreniform Disorder

Diagnostic Criteria

A. Two (or more) of the following, each present for a significant portion of time during a 1-
month period (or less if successfully treated). At least one of these must be (1), (2), or (3):

1. Delusions.

2. Hallucinations.

3. Disorganized speech (e.g., frequent derailment or incoherence).

4. Grossly disorganized or catatonic behavior.

5. Negative symptoms (i.e., diminished emotional expression or avolition).

B. An episode of the disorder lasts at least 1 month but less than 6 months. When the diagnosis
must be made without waiting for recovery, it should be qualified as “provisional.”

C. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been
ruled out because either 1 ) no major depressive or manic episodes have occurred concurrently
with the active-phase symptoms, or 2) if mood episodes have occurred during active-phase
symptoms, they have been present for a minority of the total duration of the active and residual
periods of the illness.

D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of
abuse, a medication) or another medical condition.

4. Schizophrenia

Diagnostic Criteria

A. Two (or more) of the following, each present for a significant portion of time during a 1 -
month period (or less if successfully treated). At least one of these must be (1 ), (2), or (3):
1. Delusions.

2. Hallucinations.

3. Disorganized speech (e.g., frequent derailment or incoherence).

4. Grossly disorganized or catatonic behavior.

5. Negative symptoms (i.e., diminished emotional expression or avolition).

B. For a significant portion of the time since the onset of the disturbance, level of functioning in
one or more major areas, such as work, interpersonal relations, or self-care, is markedly below
the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is
failure to achieve expected level of interpersonal, academic, or occupational functioning).

C. Continuous signs of the disturbance persist for at least 6 months. This 6-month period must
include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e.,
active-phase symptoms) and may include periods of prodromal or residual symptoms. During
these prodromal or residual periods, the signs of the disturbance may be manifested by only
negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated
form (e.g., odd beliefs, unusual perceptual experiences).

D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been
ruled out because either 1 ) no major depressive or manic episodes have occurred concurrently
with the active-phase symptoms, or 2) if mood episodes have occurred during active-phase
symptoms, they have been present for a minority of the total duration of the active and residual
periods of the illness.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of
abuse, a medication) or another medical condition.

F. If there is a history of autism spectrum disorder or a communication disorder of childhood

onset, the additional diagnosis of schizophrenia is made only if prominent delusions or
hallucinations, in addition to the other required symptoms of schizophrenia, are also present for
at least 1 month (or less if successfully treated).

5. Schizoaffective Disorder

Diagnostic Criteria

A. An uninterrupted period of illness during which there is a major mood episode (major
depressive or manic) concurrent with Criterion A of schizophrenia. Note: The major depressive
episode must include Criterion A1 : Depressed mood.

B. Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode
(depressive or manic) during the lifetime duration of the illness.

C. Symptoms that meet criteria for a major mood episode are present for the majority of the total
duration of the active and residual portions of the illness.

D. The disturbance is not attributable to the effects of a substance (e.g., a drug of abuse, a
medication) or another medical condition

6. Substance/Medication-Induced Psychotic Disorder

Diagnostic Criteria

A. Presence of one or both of the following symptoms:

1. Delusions.

2. Hallucinations.

B. There is evidence from the history, physical examination, or laboratory findings of both (1)
and (2):

1. The symptoms in Criterion A developed during or soon after substance intoxication or

withdrawal or after exposure to a medication.
2. The involved substance/medication is capable of producing the symptoms in Criterion A.

C. The disturbance is not better explained by a psychotic disorder that is not substance/
medication-induced. Such evidence of an independent psychotic disorder could include the
following: The symptoms preceded the onset of the substance/medication use; the symptoms
persist for a substantial period of time (e.g., about 1 month) after the cessation of acute
withdrawal or severe intoxication: or there is other evidence of an independent
non-substance/medication-induced psychotic disorder (e.g., a history of recurrent non-
substance/medication-related episodes).

D. The disturbance does not occur exclusively during the course of a delirium.

E. The disturbance causes clinically significant distress or impairment in social, occupational, or

other important areas of functioning.

7. Psychotic Disorder Due to another Medical Condition

Diagnostic Criteria

A. Prominent hallucinations or delusions.

B. There is evidence from the history, physical examination, or laboratory findings that the
disturbance is the direct pathophysiological consequence of another medical condition.

C. The disturbance is not better explained by another mental disorder.

D. The disturbance does not occur exclusively during the course of a delirium.

E. The disturbance causes clinically significant distress or impairment in social, occupational, or

other important areas of functioning.
8. Schizotypal Disorder (Personality)

Diagnostic Criteria

A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and
reduced capacity for, close relationships as well as by cognitive or perceptual distortions and
eccentricities of behavior, beginning by early adulthood and present in a variety of contexts, as
indicated by five (or more) of the following:

1. Ideas of reference (excluding delusions of reference).

2. Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural
norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”: in children and
adolescents, bizarre fantasies or preoccupations).

3. Unusual perceptual experiences, including bodily illusions.

4. Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or

stereotyped).

5. Suspiciousness or paranoid ideation.

6. Inappropriate or constricted affect.

7. Behavior or appearance that is odd, eccentric, or peculiar.

8. Lack of close friends or confidants other than first-degree relatives.

9. Excessive social anxiety that does not diminish with familiarity and tends to be associated
with paranoid fears rather than negative judgments about self.

B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or
depressive disorder with psychotic features, another psychotic disorder, or autism spectrum
disorder. Note: If criteria are met prior to the onset of schizophrenia, add “premorbid,” e.g.,
“schizotypal personality disorder (premorbid).”
Etiology of Psychotic Disorders

The etiological factors of psychotic disorders, such as schizophrenia, are complex and
multifaceted. They involve a combination of genetic, neurobiological, environmental, and
psychosocial factors. While the exact causes are still not fully understood, here are some
significant factors that have been implicated:

 Genetic Factors: There is evidence to suggest a genetic component in the development

of psychotic disorders. Family, twin, and adoption studies have shown a higher risk
among individuals who have close relatives with psychotic disorders. Various genes
related to brain development, neurotransmitter functioning, and immune system
regulation have been identified as potential contributors.
 Neurobiological Factors: Alterations in brain structure, neurotransmitter systems, and
neural circuitry have been observed in individuals with psychotic disorders.
Dysregulation of dopamine, glutamate, and serotonin neurotransmitter systems is
particularly implicated. Abnormalities in brain regions involved in cognition, emotion
regulation, and perception, such as the prefrontal cortex, hippocampus, and thalamus,
have also been associated with psychosis.
 Environmental Factors: Several environmental factors have been linked to an increased
risk of developing psychotic disorders, including:

o Prenatal and perinatal factors: Maternal infections during pregnancy,

complications during birth, fetal exposure to stress or trauma, and prenatal
malnutrition.
o Childhood adversity: Experiences of trauma, abuse, neglect, or early-life stress
have been associated with an increased vulnerability to psychosis later in life.
o Urban upbringing: Growing up in urban environments with high population
density, social stressors, and limited social support has been linked to a higher
risk of developing psychosis.
o Cannabis use: Heavy and prolonged cannabis use, especially during adolescence,
has been identified as a risk factor for psychosis, particularly in individuals who
are genetically predisposed.
  Psychosocial Factors: Psychological and social factors can contribute to the onset,
course, and severity of psychotic disorders. These include:
o Stressful life events: Major life stressors, such as loss of a loved one, relationship
difficulties, or financial problems, can trigger or exacerbate psychotic symptoms.
o Social isolation: Lack of social support, social withdrawal, and feelings of
loneliness can contribute to the development of psychotic disorders.
o Migration and minority status: Individuals from ethnic minority backgrounds or
those who have experienced migration may face additional stressors related to
cultural adaptation, discrimination, and social marginalization, which can impact
mental health.

It's important to note that the interplay between these factors is complex and varies for each
individual. Additionally, not everyone exposed to these factors will develop psychosis,
suggesting that additional factors or gene-environment interactions may also be involved. Further
research is needed to gain a deeper understanding of the etiology of psychotic disorders and to
develop more targeted and effective interventions.

Treatment options for Psychosis

The treatment of psychotic disorders, such as schizophrenia, typically involves a combination of

approaches, including medication, psychosocial interventions, and support services. The specific
treatment plan can vary based on the individual's symptoms, preferences, and the
recommendations of mental health professionals. In the context of clinical psychology, the
understanding and treatment of psychosis have advanced considerably. Psychologists have
played a significant role in assessing and diagnosing psychotic disorders, as well as developing
therapeutic interventions. Cognitive-behavioral therapies and family interventions are some of
the techniques commonly used to address psychosis in a clinical setting. However, antipsychotic
medicines are usually recommended as the first treatment for psychosis.

Here are some commonly used treatment options:

  Medication:

Antipsychotic Medications work by blocking the effect of dopamine, a chemical that transmits
messages in the brain. They help alleviate symptoms such as hallucinations, delusions, and
disorganized thinking. There are two main types of antipsychotics: typical (first-generation) and
atypical (second-generation) antipsychotics. Atypical antipsychotics are generally preferred due
to their reduced risk of certain side effects. The choice of medication depends on factors such as
symptom profile, side effect profile, and individual response. Antipsychotics can usually reduce
feelings of anxiety within a few hours of use, but they may take several days or weeks to reduce
psychotic symptoms, such as hallucinations or delusional thoughts.

Here are some common medication options:

1. First-Generation Antipsychotics (Typical Antipsychotics):

o Chlorpromazine (Thorazine)
o Haloperidol (Haldol)
o Fluphenazine (Prolixin)
o Perphenazine (Trilafon)
2. Second-Generation Antipsychotics (Atypical Antipsychotics):
o Risperidone (Risperdal)
o Olanzapine (Zyprexa)
o Aripiprazole (Abilify)
o Paliperidone (Invega)
o Clozapine (Clozaril)

It's crucial to work closely with a psychiatrist or healthcare provider to determine the most
suitable medication and dosage for an individual's specific needs. Regular monitoring,
assessment of side effects and adherence to the prescribed medication regimen are essential for
optimizing treatment outcomes.

Side effects can include: drowsiness, shaking and trembling, weight gain. Restlessness, muscle
twitches and spasms – where your muscles shorten tightly and painfully, blurred vision etc.
Cognitive-Behavioral Therapy for Psychosis (CBT): Cognitive Behavioral Therapy (CBT)
can be beneficial for individuals with psychotic disorders by helping them better understand and
manage their symptoms, reduce distress, and improve overall functioning. Here are some ways in
which CBT can help psychotic patients:

1. Challenging and Modifying Distorted Beliefs: Psychotic disorders often involve the
presence of delusions and distorted beliefs. CBT helps individuals identify and examine
these beliefs, encouraging them to critically evaluate the evidence supporting or
contradicting them. Through collaborative discussions, individuals can gain insight into
the irrationality of their beliefs and work towards modifying or replacing them with more
adaptive and realistic thoughts.
2. Coping with Hallucinations: CBT can help individuals develop coping strategies to
manage hallucinations. This may involve learning techniques to challenge the distressing
content of the hallucinations, such as reframing or reattributing their meaning.
Additionally, individuals can learn grounding techniques or distraction techniques to
redirect their attention away from the hallucinatory experiences and focus on the present
moment.
3. Enhancing Problem-Solving Skills: Psychotic disorders can impact an individual's
problem-solving abilities, leading to difficulties in managing daily challenges and
stressors. CBT helps individuals develop effective problem-solving skills by breaking
down problems into smaller, manageable steps, generating alternative solutions, and
evaluating the potential outcomes. This empowers individuals to approach difficulties in
a structured and adaptive manner.
4. Managing Emotional Distress: Psychotic disorders can be accompanied by emotional
distress, including anxiety, depression, and irritability. CBT techniques such as emotion
regulation and stress management can help individuals develop skills to identify and
regulate their emotions, reduce excessive worrying, and cope with distressing emotions in
a healthier way.
5. Relapse Prevention: CBT can be instrumental in preventing relapses by teaching
individuals early warning signs of worsening symptoms and providing strategies to
 manage stressors and maintain medication adherence. It helps individuals develop a
relapse prevention plan and recognize when to seek help from healthcare professionals.

Family Therapy:

After having an episode of psychosis, client may rely on family members for care and support.
Involving family members in therapy can be beneficial in improving communication, reducing
stress within the family, resolving conflicts and enhancing support networks for the individual
with psychosis. Family therapy can help reduce stress and relapse rates, improve medication
adherence, and promote overall recovery. Family therapy involves a series of meetings that take
place over a period of 3 months or more. Meetings may include:

 discussing client’s current condition and how it might progress, plus the available
treatments
 exploring ways of supporting someone with psychosis
 deciding how to solve practical problems caused by psychosis, such as planning how to
manage future psychotic episodes

Psychosocial Interventions:

o Supported Employment and Education: Assisting individuals with finding and

maintaining employment or educational opportunities can improve their quality of life
and enhance social integration.

o Social Skills Training: People with psychotic disorders often experience difficulties in
social interactions. Social skills training helps individuals develop and improve their
social skills, such as communication, problem-solving, assertiveness, and conflict
resolution. This intervention enhances social functioning and fosters greater community
integration.
o Milieu therapy: A humanistic approach to institutional treatment based on the belief that
institutions can help patients recover by creating a climate that promotes self-respect,
responsible behavior, and meaningful activity.
 o Token economy program: A behavioral program in which a person’s desirable behaviors
are reinforced systematically throughout the day by the awarding of tokens that can be
exchanged for goods or privileges.
o Rehabilitation and Recovery Programs: These programs focus on promoting recovery,
improving functional abilities, and supporting individuals in their journey towards
personal goals and meaningful lives.
o Peer Support and Self-Help Groups: Peer support and self-help groups can provide
valuable support, encouragement, and shared experiences for individuals with psychotic
disorders. These groups often consist of individuals who have similar experiences and
can offer understanding and practical guidance in managing symptoms and daily
challenges.

o Group Therapy: Group therapy provides a supportive and structured environment for
individuals with psychotic disorders to share their experiences, learn from others, and
practice social skills. It can enhance social support, reduce isolation, and improve coping
strategies. Group therapy may focus on specific topics, such as medication management,
stress management, or illness education.
o Hospitalization: In severe cases or during acute episodes, hospitalization may be
necessary to ensure the safety of the individual and provide intensive treatment and
stabilization. Hospitalization provides a structured environment and access to various
treatments, including medication management, therapy, and monitoring.

o Cognitive Remediation: Cognitive remediation programs target cognitive impairments

commonly associated with psychotic disorders, such as attention, memory, and executive
functioning deficits. These programs use exercises and strategies to improve cognitive
abilities and functional outcomes, such as work or school performance.

It's important to note that these therapeutic interventions are often integrated into a
comprehensive treatment approach that may also include antipsychotic medications, psycho-
education, case management, and other supportive services. The choice and combination of
interventions depend on the individual's specific needs and preferences, and treatment is
typically tailored to the unique circumstances of each person.
Islamic perspective

In spiritually modified cognitive therapy while following the cognitive restructuring model,
where the therapist identifies the patient automatic thoughts and core beliefs is generally used.
The process would then involve an evaluation and modification of automatic thoughts, followed
by modification of core beliefs and assumptions. Modification occurs mainly through examining
the evidence and looking for alternative explanation. Therapist can use cognitions from the
Islamic faith and offer it as alternative explanations to dysfunctional thoughts associated with a
variety of conditions or disorders.

Islam plays an important role in helping Muslims to cope with negative life events, which helps
them in both prevention and treatment of psychiatric disorders. if one experiences negative
feelings, he is encouraged to resist them with positive thoughts and actions if possible, or to seek
professional help if the case is clinical, exactly like any other form of illness.

“So, verily, with every difficulty, there is relief: Verily, with every difficulty there is relief .”
(Quran, 94: 5-6)

Islam encourages people to stay hopeful, even if someone has committed the worst sin or faced
with most troublesome life event as there is always God's mercy.

“And never give up hope of Allah's soothing Mercy: truly no one despairs of Allah's soothing
Mercy, except those who have no faith.” (Quran, 12:87)

To counter maladaptive thoughts related to hopelessness and feeling overwhelmed with life, as
there is no place for despair because Muslims believe that it is God Himself who is in charge of
everything, the all Seeing, All Knowing, and All Fair and Wise God.

God says: “And for those who fear Allah, He always prepares a way out, and He provides for
him from sources he never could imagine. And if anyone puts his trust in Allah, sufficient is
Allah for him. For Allah will surely accomplish His purpose: verily, for all things has Allah
appointed a due proportion.”(Quran, 65: 2-3)
When it comes to Islamic treatment options for psychotic disorders, it's important to note that
Islam does not provide specific medical treatments or therapies for psychiatric conditions.
However, Islamic principles and practices can complement the overall treatment approach and
provide spiritual support for individuals experiencing mental health issues. Here are some
aspects to consider:

1. Holistic Approach: Islamic teachings emphasize the interconnectedness of the mind,

body, and soul. This holistic approach aligns with contemporary notions of mental health
that emphasize a biopsychosocial-spiritual perspective. The integration of Islamic
teachings into treatment interventions acknowledges the importance of addressing
psychological, social, and spiritual aspects of a person's well-being.
2. Spiritual Healing: Throughout history, various forms of spiritual healing have been
employed within Islamic traditions. For example, the recitation of specific verses from
the Quran, known as Ruqyah, has been used to alleviate distress and promote spiritual
healing. This approach recognizes the potential role of spirituality in supporting
individuals with psychotic disorders.
3. Tawakkul (Reliance on God): Islamic teachings encourage believers to place their trust
and reliance on God. Incorporating the concept of Tawakkul into treatment interventions
can help individuals with psychotic disorders develop a sense of trust, hope, and
acceptance during their healing journey.
4. Community Support: Islamic communities have historically provided a support system
for individuals facing mental health challenges. Mosque-based counseling services,
community outreach programs, and informal support networks offer emotional and social
support to individuals and their families. Collaborating with these community resources
can enhance the effectiveness of treatment interventions.

While there may not be specific references from Islamic sources regarding the treatment of
psychotic disorders, Islamic principles can be applied to support individuals experiencing mental
health challenges. It's important to consult with knowledgeable religious scholars or imams for
guidance on specific spiritual practices within the context of mental health.
 References

American Psychiatric Association. (1968). Diagnostic and statistical manual of mental disorders
(2nd ed.). Washington, DC: American Psychiatric Association.

American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders
(3rd ed.). Washington, DC: American Psychiatric Association.

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders
(4th ed.). Washington, DC: American Psychiatric Association.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: American Psychiatric Association.

Barker, S., Lavender, T., & Morant N. (2001). Client and family narratives on schizophrenia.
Journal of Mental Health, 10 (2), 199–212.

Bürgy, M. (2008). The concept of psychosis: Historical and phenomenological aspects.

Schizophrenia Bulletin, 34 (6), 1200–1210.

Comer, R. J. (2019). Abnormal Psychology (8th ed.).

Durand, V. M., & Barlow, D. H. (2012). Abnormal Psychology.

Fischer BA, Buchanan RW. Schizophrenia: Clinical Manifestations, Course, Assessment, and
Diagnosis; 2017.

Hyde, P. (2001). Support groups for people who have experienced psychosis. British Journal of
Occupational Therapy, 64, 169–174.

McCarthy-Jones, S., Marriott, M., Knowles, R. E., Rowse, G., & Thompson, A. R. (2013). What
is psychosis? A meta-synthesis of inductive qualitative studies exploring the experience of
psychosis. Psychosis, 5, 1–16.

McGowan, J. F., Lavender, T., & Garety P. A. (2005). Factors in outcome of cognitive-
behavioural therapy for psychosis: Users’ and clinicians’ views. Psychology and Psychotherapy.