Psychotic Disorders

A diagnostic term formerly used in a general way to designate the most severe psychological disorders; now used in a much narrower sense in connection with specific symptoms and conditions.

Formerly, all psychological disorders were considered either psychotic or neurotic. Psychotic disorders were those that rendered patients unable to function normally in their daily lives and left them "out of touch with reality." They were associated with impaired memory, language, and speech and an inability to think rationally. Neurotic disorders, by comparison, were characterized chiefly by anxiety; any impairment of functioning was primarily social. Psychotic conditions were attributed to physiological causes, neurotic conditions to psychosocial ones. Other distinguishing features associated primarily with psychotic disorders were hospitalization and treatment by biological methods—medication and electroconvulsive therapy. With the development of new types of psychoactive drugs in the 1950s and 1960s, medication became a common form of therapy for anxiety, depression, and other problems categorized as neurotic.

"Psychotic" and "neurotic" are no longer employed as major categories in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Instead, disorders that formerly belonged to either one category or the other appear side by side in Axis I of the manual under the heading "Clinical Syndromes." The term "psychotic" still appears in DSMIV, most prominently in the categorization "Schizophrenia and Other Psychotic Disorders." The disorders in this section have as their defining feature symptoms considered psychotic, which in this context can refer to delusions, hallucinations, and other positive symptoms of schizophrenia, such as confused speech and catatonia. In other parts of DSM-IV, "psychotic" is also used to describe aspects of a disorder even when they are not its defining feature, as in "Major Depressive Disorder with Psychotic Features."