Most Psychotic disorders do not have clear etiology. Of course, the disorders related to medical conditions and substance withdrawal are more easily traced to a precipitating factor and are therefore more likely to be easily diagnosed.
Evaluation of persons suspected of having a psychotic disorder requires a good history and a physical examination by a physician. Generally, non-organic disorders present with disturbances in thought and emotion, while organic disorders tend to present with mental clouding, confusion, and disorientation because of some degree of delirium. This is not a hard and fast rule and in practice, there are many exceptions. The following are some characteristics that suggest the presence of an organic disorder:
1. No personal or family history of mental illness. Someone who presents with schizophrenia like psychotic symptoms will undoubtedly have some family or personal history of psychiatric treatment. This is particularly true if the subject is well into adulthood. First time psychotic breaks usually occur in early adulthood (early 20’s of men, late twenties for woman). The lack of history makes it more likely that there is some organic factor operating.
2. There is a history of serious medical illness with periodic relapses. This suggests organic etiology, especially if the subject is an elderly person.
3. There is very rapid onset. If the onset is in a few hours of days, this is a strong indicator of organic etiology. With symptoms that are not organically based, family members usually report some period of time that the client is acting “strange”.
4. The client presents with significant memory loss, confusion, disorientation, and clouding of consciousness (that may fluctuate rapidly- within hours).
Major Depression and Bipolar Disorder may have psychotic symptoms that are secondary to affective symptoms. Affective disturbance always precedes psychosis in these cases. Individuals with severe personality disorders may have brief periods of psychosis, especially at times of severe stress. Psychotic symptoms usually resolve when the environmental stressors are stabilized, either through direct psychosocial intervention or by removing the individual from the environment and placing them into a stable and safe environment such as a hospital setting. Both Pervasive Developmental Disorder NOS and Autistic Disorder may have psychotic symptoms. Again, these symptoms appear to be secondary to the developmental impairment.
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