Psychosis and schizophrenia are terms frequently used together, or sometimes interchangeably. However, while they’re related concepts, they represent distinct clinical phenomena.
Psychosis refers to a collection of symptoms. Schizophrenia, by contrast, is a specific mental health disorder. Although psychosis commonly occurs as a symptom of schizophrenia, an individual can experience a psychotic episode without meeting diagnostic criteria for schizophrenia. Drug-induced psychosis exemplifies this distinction.
For individuals struggling with schizophrenia and/or psychosis—and their loved ones—this resource provides detailed information about the differences between these two conditions and their interrelationship.
Psychosis describes a constellation of mental-emotional symptoms indicating a disconnection from reality, though not necessarily a complete break. When someone experiences these symptoms, they’re described as having a psychotic episode or psychotic break.
According to the National Institute of Mental Health, approximately 100,000 new cases of psychosis occur in the United States annually.
There’s often confusion between “psychosis” (a symptom cluster) and “psychotic disorders” (an official diagnostic category in the DSM-5). Schizophrenia is a mental illness classified as a subcategory of psychotic disorders. Substance-induced psychotic disorder represents another subcategory.
The term “psychosis” itself typically refers solely to a symptom group. The two primary symptoms of psychosis are hallucinations and delusions.
Hallucinations involve perceiving something that isn’t occurring in external reality. An individual experiences seeing, hearing, feeling, smelling, or tasting things that have no source outside their mind. During psychotic episodes, these hallucinations often feel as vivid and real as normal perceptions. Someone experiencing psychosis might hear voices when alone, see objects that aren’t present, or detect scents without an actual source in shared reality.
Delusions are firmly held beliefs or judgments not shared by others and highly unlikely to be true. These beliefs tend to be profoundly irrational: maintained despite compelling contradictory evidence. Although based on mistaken, strange, or unrealistic perspectives, delusions are held with complete conviction. The individual can be so convinced of their delusion’s reality that logical arguments cannot dissuade them.
A person experiencing delusions may:
Before a full psychotic episode develops, individuals often experience changes in thoughts, feelings, and/or behaviors. Warning signs of an impending psychotic break may include:
Mood fluctuations (unusual excitement or depression); feelings of detachment from the world; increased suspiciousness/paranoia or uneasiness; strange feelings or emotional numbness.
Atypical behavior patterns (extreme activity or lethargy); social withdrawal; inappropriate laughter or unprovoked anger/upset; significant performance decline at school or work; deterioration in self-care or personal hygiene.
Disorganized or confused thoughts; nonsensical or confused speech; concentration or memory difficulties; racing thoughts or seemingly slowed information processing; problems distinguishing reality from fantasy.
Conditions that may increase psychotic episode risk include:
Mental health professionals typically conceptualize psychosis in three distinct phases, corresponding to early warning signs, the acute psychotic episode, and recovery, according to research published in the Journal of Clinical Psychiatry.
Early signs of a psychotic break are often subtle and barely noticeable. While individual experiences vary, common prodromal phase indicators include:
The acute psychosis phase—also called the critical period—is when characteristic symptoms emerge. As mentioned previously, primary psychosis symptoms include hallucinations and delusions.
During this phase, individuals may experience extreme distress from their symptoms. They might behave so uncharacteristically that concerned friends and family members recognize the need for professional intervention.
It’s crucial to understand that psychosis is treatable. With effective intervention, most people fully recover from their first psychotic episode—and may never experience another.
Some acute phase symptoms may persist during recovery. However, with appropriate treatment under professional supervision, most individuals successfully recover and resume normal functioning.
Substance misuse or sudden withdrawal can trigger psychotic episodes. Drug-induced toxicity affects neurochemistry, so consuming large quantities of alcohol or drugs may produce psychosis resulting from such biochemical alterations. Recurring episodes may lead to diagnosis of substance/medication-induced psychotic disorder.
Like other psychosis forms, primary symptoms include hallucinations and delusions, though additional symptoms may occur. Early intervention is often essential for wellbeing and mental health.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), diagnosis of substance/medication-induced psychotic disorder requires:
No single substance invariably causes drug-induced psychosis. Understanding a drug’s potential side effects and addiction liability before consumption helps reduce risk. However, complete abstinence from drug use is the only definitive prevention method.
Alcohol represents one substance whose misuse can trigger psychosis. Acute intoxication, withdrawal, and chronic alcoholism can all precipitate alcohol-related psychosis, also termed alcohol hallucinosis, according to the National Center for Biotechnology Information.
In this condition, hallucinations, delusions, and other psychotic symptoms (e.g., paranoia, fear, confusion, aggression) emerge during or shortly after heavy alcohol consumption—or during withdrawal. While resembling schizophrenia, alcohol-related psychosis is considered a distinct condition.
Methamphetamines are potent psychostimulants that may induce psychotic episodes in recreational or chronic users. Research indicates that approximately 40% of methamphetamine users experience psychotic symptoms or syndromes.
Acute meth-induced psychosis symptoms may include agitation, violence, and delusions. For some users, psychotic episodes recur and become difficult to distinguish from primary psychotic disorders like schizophrenia.
Researchers have established correlations between cannabis consumption and various mental health disorders, including cannabis-induced psychosis. Cannabis use is considered an environmental stressor that increases psychotic episode risk, with long-term use associated with greater psychosis risk.
Delta 9-THC’s psychoactive effects include dreaminess, disinhibition, and heightened sensory awareness of sounds, colors, or tastes. These effects may induce psychotic symptoms such as visual hallucinations, paranoid ideation, and mood instability. Other potential marijuana-induced psychosis symptoms include isolation and agitation.
Acute cannabis-induced psychosis episodes may last from days to several months.
Films like “A Beautiful Mind” and “The Soloist” portray real-life stories of individuals (mathematician John Nash and musician Nathanial Ayers) affected by schizophrenia. But what exactly is this condition, and how does it relate to or differ from psychosis?
Schizophrenia is a severe, chronic mental illness affecting cognition, emotion, and behavior—creating the impression that those affected are disconnected from reality.
According to the National Institute of Mental Health, schizophrenia affects less than one percent of the U.S. population, with prevalence between 0.25 and 0.64 percent.
Men typically develop initial schizophrenia symptoms in late adolescence or early twenties, while women usually present in their late twenties or early thirties. Diagnosis before age 12 or after 40 is uncommon.
The precise etiology remains unknown. However, experts believe genetics, environmental factors, and neurotransmitter abnormalities—particularly involving dopamine—likely contribute.
As a formally diagnosed mental health disorder, schizophrenia belongs to the broader “psychotic disorders” category, which includes:
As previously noted, this diagnostic category should not be confused with the symptom cluster known as “psychosis.”
Individuals diagnosed with schizophrenia often experience psychosis as a symptom. However, not everyone experiencing psychosis has schizophrenia.
Schizophrenia encompasses several subtypes distinguished by predominant symptoms.
Characterized by impaired, rigid, or unusual movement, or unresponsiveness
Characterized by disorganized speech, thinking, or behavior
Characterized by auditory hallucinations and thoughts/feelings of persecution
The recovery phase when symptoms persist from previous schizophrenia episodes
A category for individuals not fitting other classifications
Mental health professionals utilize Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for schizophrenia diagnosis.
Schizophrenia symptoms fall into three major categories according to the American Psychiatric Association:
1. Positive symptoms
Also termed “psychotic symptoms,” these are abnormally present features in schizophrenia. They include hallucinations, delusions, paranoia, and exaggerated or distorted perceptions, beliefs, and behaviors.
2. Negative symptoms
These represent abnormally absent features in schizophrenia. They include diminished speech capacity, emotional expression, pleasure experience, or planning initiation.
The individual may withdraw socially, isolate themselves, show little interest in interactions or conversation, and display emotional flatness. In extreme cases, they might become completely immobile or nonverbal—a rare condition called catatonia.
3. Disorganized symptoms
Also called “cognitive symptoms,” these include confused thinking and speech, logical reasoning difficulties, information-processing problems, concentration or memory issues, and occasionally bizarre behavior or abnormal movements.
Schizophrenia symptoms can evolve over time. To reflect these variations—occurring along a spectrum—psychiatrists categorize symptoms into three schizophrenic spectrum disorders.
A combination of schizophrenia symptoms with mood disorder episodes (e.g., depression or mania).
A psychotic disorder with shorter symptom duration (1-6 months) than schizophrenia.
Similar to schizophrenia but with less frequent, prolonged, or intense episodes. Individuals can usually recognize the distinction between their distorted perceptions and reality.
Besides the schizophrenia spectrum disorders, five additional psychotic disorders exist:
One or more delusions (e.g., grandiose, jealous, persecutory, somatic, erotomatic) persisting at least one month
When one person adopts another’s delusional belief
Hallucinations and/or delusions resulting from substance use or withdrawal
Similar to schizophrenia but with later-life onset
Both psychosis and schizophrenia significantly impact mental health and wellbeing. Both involve reality disconnection—perceiving and experiencing the world dramatically differently from others.
The distinction, again, is that psychosis represents a symptom cluster indicating reality disconnection. Psychotic episodes can result from substance use, medical conditions, sleep deprivation, trauma, certain medications, or various mental health disorders.
Schizophrenia, conversely, is a specific mental health disorder often featuring psychosis among its symptoms. However, additional symptoms and diagnostic criteria apply to schizophrenia.
Individuals with schizophrenia may experience psychotic episodes featuring hallucinations and delusions—the “positive symptoms” of schizophrenia.
However, a person can experience psychosis without having schizophrenia or another mental health disorder.
Psychosis treatment proves most effective with early identification and intervention. Standard treatment typically includes:
Antipsychotic medications—administered orally or by injection—can reduce psychosis symptoms.
Cognitive behavioral therapy (CBT) effectively treats psychosis, as does CBTP—cognitive behavioral therapy specifically adapted for psychosis.
Family members learn effective, compassionate interaction with individuals recovering from psychotic episodes.
Vocational support and life skills training facilitate comfortable reintegration into work, educational, and social environments.
Schizophrenia represents a chronic condition without known cure. Treatment therefore focuses on symptom management and developing effective daily functioning strategies. Mental health professionals design treatment plans using evidence-based approaches, generally including:
Antipsychotic medications address schizophrenia’s psychotic symptoms and help prevent symptom recurrence.
Cognitive behavioral therapy (CBT) constitutes an important recovery component. Skilled therapists help develop coping strategies and positive thought/feeling reframing techniques.
Family education about schizophrenia improves support capabilities.
Vocational and life skills training enables educational or occupational reentry, social skill enhancement, and new approaches to everyday challenges.
Schizophrenia frequently co-occurs with other physical or mental health conditions including substance use disorders, depression, anxiety, OCD, cardiovascular disease, or diabetes. These significantly impact overall health and wellbeing. Therefore, managing such co-occurring conditions represents another crucial treatment aspect.
Sacramento Mental Health connects individuals seeking care with specialized treatment providers. Our expert mental health professionals combine scientific approaches and innovative therapy with compassion and understanding. We utilize therapeutic modalities including:
Complementary therapies enhancing healing include:
For more information about our treatment programs for various mental health disorders, including schizophrenia or psychotic disorders, contact us today at (916) 527-9606.
