Psychosis Vs. Schizophrenia: What Are The Main Differences?

Reviewed by Whitney White, MS CMHC, NCC., LPC

Published 12/28/2020

Psychosis and schizophrenia are often confused as being synonymous with one another; Theyare similar, but are not the same things, and in this article, you will learn the difference between schizophrenia and psychosis and how to distinguish them.

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Psychosis Is A Symptom Of Mental Illness

The first thing that people should be aware of when trying to tell the difference between psychosis and schizophrenia is that psychosis is a symptom and not a full-on mental health disorder.

When people have psychosis, it refers to smaller individual symptoms such as hallucinations and delusions.

During a psychotic episode, people can lose touch with reality and start hearing, seeing, or touching things that are not there. They can also start to believe things that may seem absurd to others, such as thinking that someone is out to get them, that someone or something is controlling them, or that they have unique special abilities, or even believe that they are a god.

These symptoms are a hallmark of schizophrenia, but psychosis can also be an indicator of different mental health issues.

For example, someone with bipolar disorder who is in a manic episode can also experience psychotic symptoms for a prolonged period.

It’s also possible to trigger psychosis with substances, like alcohol and drugs, especially powerful stimulants and hallucinogens, and even traumatic and stressful events and sleep deprivation can cause it.

Therefore, if someone is experiencing psychosis, it’s not necessarily a tell-tale sign they have schizophrenia; rather, other factors, such as causes and different symptoms, must be looked at to make a definitive answer.

Schizophrenia Is A Diagnosable Mental Disorder

Unlike psychosis, which can have many different causes, schizophrenia is a condition listed in the DSM-5 (Diagnostic and Statistical Manual 5th edition) by the American Psychiatric Association.

To be diagnosed with schizophrenia, patients must have psychotic symptoms like delusions and hallucinations, but this is just one part of the complete picture.

People with schizophrenia vs. psychosis will also often display a lack of emotional expression and motivation and disorganized thought and speech patterns. They may also have unusual motor behaviors.

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This interferes with a person’s ability to function normally. An important part of making a schizophrenia diagnosis is the amount of time the symptoms have interfered with their ability to work, maintain social relationships, and even practice self-care. In general, the signs and symptoms must have persisted for at least six months since their onset. [1]

To confirm that someone has schizophrenia, mental health professionals will also have to rule out other mental health concerns such as schizoaffective disorder and bipolar disorder that can mimic the signs at first glance.

For schizoaffective disorder, psychosis is an essential part of it. Still, there are also components of a mood disorder as well, and like bipolar disorder, this is another example of how psychotic symptoms don’t always point to schizophrenia.

Additionally, professionals will also need to be sure that the psychosis is not due to a substance, especially chronic abuse, to diagnose schizophrenia.

Psychosis can be caused by using different substances, hence why it’s important to ensure it’s not causing the issue. However, people with undiagnosed schizophrenia can also use substances to cope with their delusions and hallucinations, which can present some challenges in accurately diagnosing people.

Psychosis Can Be Temporary, But Schizophrenia Is Not

As mentioned before, psychosis can have several different causes, and in many cases, they will pass, whether through time or medication.

For example, there is a condition known as a brief psychotic disorder where people will have symptoms that last for less than a month, and it usually happens in response to trauma and extreme stress.

Additionally, for an individual with a substance-induced psychosis, the effects can be very limited and temporary and can start to fade away as the drug leaves the body.

On the other hand, schizophrenia is a chronic mental disorder that can last a lifetime, and the psychotic symptoms will not go away on their own.

There may be periods where some days are better than others, but in general, the condition gets worse the longer it goes untreated.

The primary way for people with schizophrenia to manage these symptoms is through medications, and in the next section, you will learn about what options are available.

Treating Psychosis

Conditions where a person is experiencing psychotic symptoms are treated with antipsychotic medications.

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There are several different antipsychotic drugs, and they can either be divided into first-generation antipsychotics and second-generation ones.

The first-generation ones have been around for nearly half a century. In contrast, the second generation ones were developed in the 1990s, and the main difference between them is the potential side-effects. [2] [3]

Some of these side effects include:

  • Fatigue
  • Restlessness
  • Blurry vision
  • Dry mouth
  • Weight gain
  • Diabetes
  • Nausea
  • Vomiting
  • Constipation
  • Sexual problems
  • Movement issues

The way that antipsychotics work is that it helps regulate the amount of dopamine in the brain. Dopamine is a neurotransmitter that all humans need. It has different roles; however, too much can be problematic and change how the brain functions. It’s believed this is the reason people experience psychosis.

Antipsychotic medication can be taken as an injection or taken orally as a tablet or syrup. Injections aren’t as commonly used but they can be useful if there is a tendency to forget to take medications daily.

Nonetheless, these options, including the various antipsychotics, will be discussed between you and your psychiatrist and what side effects you can expect.

If you have side-effects, it’s important not to discontinue the use of your current medication and instead consult with your doctor. A doctor can help safely adjust your dosage or can prescribe you a different antipsychotic entirely.Stopping abruptly can be dangerous, and it can cause the symptoms to return.

Upon starting antipsychotic treatment, you will also be instructed not to consume alcohol or any other substances. This can interfere with the medication and have adverse reactions, such as becoming more sedated.

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Antipsychotics can make people feel drowsy in general, and it can also reduce a person’s ability to concentrate. Therefore, you may also be asked not to operate a motor vehicle when taking antipsychotics to manage psychosis or schizophrenia.

Are You or A Loved One Experiencing Psychosis?

It’s very unlikely that an individual with psychosis can identify that they are having a psychotic episode because their perception of reality is distorted. Their delusions and hallucinations are real to them.

However, for those who may have had an episode of psychosis in the past and it has gone away temporarily, you can take this psychosis quiz to determine if the symptoms match your experiences.

This free and brief psychosis test is also useful for those who have concerns about a loved one who may be currently dealing with psychosis, which can help prompt individuals to seek help on behalf of those they care for.

Once a person has the first episode, and it’s been confirmed that it's psychosis, it’s best to get treated as early as possible and try to find out the reason why they have these symptoms.

A mental health professional will determine whether an individual’s psychosis is due to trauma and stress, a substance, or because of a much larger mental health issue such as bipolar disorder, schizoaffective disorder, or schizophrenia. Once an individual receives an accurate diagnosis, they can get started on the correct treatment protocol.

Conclusion

Although psychosis is a severe problem, it is manageable, and in many cases, temporary. However, even if it's chronic, as in schizophrenia, people can learn how to live healthier and productive lives by controlling these symptoms with antipsychotic medication.

References

  1. Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 3.22, DSM-IV to DSM-5 Schizophrenia Comparison. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t22/
  2. Rethink Mental Illness. (, 2020). Antipsychotics. Retrieved from https://www.rethink.org/advice-and-information/living-with-mental-illness/medications/antipsychotics/
  3. National Institute of Mental Health. (2016, October). Mental Health Medications. Retrieved from https://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml