Psychoses

Psychoses is a broad term used in psychiatry to describe conditions characterized by a loss of contact with reality. The core symptoms include delusions, hallucinations, and disturbance of thinking and behavior. Psychosis is not a single diagnosis but a syndrome that can arise from primary psychiatric disorders, mood disorders with psychotic features, substance effects, or medical illness.

Delusions are fixed, false beliefs, often with paranoia or grandiosity. Hallucinations are perceptual experiences without external stimuli, most commonly auditory. Disorganized thinking may manifest as incoherent speech, disorganized or agitated behavior, and negative symptoms such as reduced motivation, affect, or social engagement.

Most commonly, psychoses occur in schizophrenia spectrum disorders, including schizophrenia, schizoaffective disorder, and delusional disorder, as well as brief psychotic disorder and schizophreniform disorder. Psychosis can also occur in bipolar or major depressive disorder with psychotic features, and in substance-induced psychosis or psychosis due to medical conditions.

Diagnosis relies on clinical assessment, with standardized criteria (such as DSM-5-TR or ICD-11). Important differentials include mood disorders without psychosis, personality disorders, delirium, and medical or substance-related causes. Investigations may include medical history, drug screen, and, when indicated, neuroimaging or cognitive testing.

Treatment combines antipsychotic medication, psychoeducation, psychotherapy, and social supports. Early intervention improves outcomes in first-episode psychosis. Management targets symptom reduction, functional recovery, and relapse prevention, with attention to substance use, suicide risk, and comorbid conditions.