There are two major psychotic disorders; mood disorders and schizophrenia.

When a person experiences a severe disruption in mood or emotional balance, we call the problem a mood disorder (formerly called an affective disorder). When emotions show an all time low and we lose interest in life, we experience depression. At the other extreme of mood is mania, which is a highly excitable, highly active, unrealistic, optimistic state. There are two major mood disorders. Major depression is characterized by a sad mood, filled with feelings of guilt and worthlessness. The bipolar disorder (which is sometimes referred to as manic-depression) is characterized by extreme mood swings from sad depression to joyful mania. Mania seldom occurs by itself.

Depression can vary widely in severity. In a mild form, it is normal for people to feel depressed when they have failed to achieve something or when they lose someone important to them. People become depressed when they have problems at work, marital problems, or find they are incompetent in something they want to do. Some research suggests that men become more depressed than women when their spouse dies. We may become mildly depressed when we have a fight with someone or receive a low grade on a test. Mild depression usually lasts briefly and is followed by recovery.

A more serious problem is dysthymia, in which the person has a depressed mood much of the time for at least two years. Symptoms of dysthymia include a major change in eating and sleeping habits (loss od appetite or overeating, insomnia, or hypersomnia), fatigue, low self esteem, poor concentration, and feelings of hopelessness. Dysthymia may be due to other non-mood disorders, such as anorexia or drug use. The individual with dysthymia usually experiences minor impairment in social interactions, and is rarely hospitalized unless a suicide attempt occurs. The depression in dysthymia is moderate, compared to major depression which is more severe and incapacitating.

Major depression occurs when an individual experiences one or more major depressive episodes, the chief symptom of which includes a depressed mood and loss of interest in normal activities. Other symptoms can include sleep disruption, weight loss, fatigue, feelings of worthlessness or inappropriate guilt, inability to concentrate, and thoughts of death or suicide. These symptoms occur most of the time for at least a two weak period. People who are severely depressed describe themselves as sad and hopeless. They may have no motivation to continue living and may attempt suicide.

Major depression usually begins in early adulthood, but a major depressive episode may occur at any age, including infancy. A major episode usually lasts at least six months, and some of the symptoms can persist for a year or more. Impairment of the depressed individual varies from moderate disruption of normal relationships and activities to complete inability to function as a person. The largest problem in depression is the possibility of suicide.

Depression is a common maladjustment problem, and there are a variety of theories that attempt to explain how it occurs. Psychoanalytic theory focuses on unconscious conflict, and suggests that feelings of anger and hostility are displaced, or turned inward, and the result is that the person becomes so miserable that life is no longer tolerable. Thus, he or she gives up and becomes depressed. Cognitive theory of depression emphasizes the negative and self defeating thoughts of the person who is depressed. It suggests that when a person dwells on the negative for too long, low self esteem and depression can result.

Learning theorists speculate that depression results from the reduction of social reinforcement and activity. For example, after the loss of a wife, a husband no longer has much intimate reinforcement or enjoyment, and other people do not expect much from him. Soon he learns a new role, and continues to remain depressed. Treatment would consist of changing activity levels, reinforcements, or control over his life.

Some research focuses on the role of psychosocial factors in depression, especially on the possibility that the environment might affect changes in the brain. Loss of a relationship (through death) often precedes depression. Children who lose a parent are more likely to become depressed as adults. In general, any major life event that significantly decreases an individual’s self esteem or increases his or her stress level might contribute to maladjustment.

The bipolar disorder, or manic-depression, is characterized by unpredictable extreme mood swing. Sometimes the manic depressive’s mood swings widely from great excitement to extreme melancholy. During the manic phase, the patient may become hyper excited, talkative, boastful, uninhibited, and perhaps destructive. In this energy and excitement phase, he or she may talk about highly unrealistic projects. Then, suddenly without warning, the patient with bipolar disorder becomes so gloomy and experiences such profound feelings of worthlessness that he or she will refuse to eat and have difficulty sleeping and moving. In the depressed state, the individual with bipolar disorder behave in exactly the same way as an individual with major depression. There are not nearly as many people with bipolar disorder (about 1% of the population) as with unipolar depression (from 10% to 20% of the population). The bipolar disorder occurs with equal frequency in men and women.

Some individuals experience a bipolar disorder called cyclothymia, which is a moderately severe problem with mood swings from hypomanic episodes to depression (but not as extreme as manic or major depressive episodes). A hypomanic episode is characterized by an elevated or irritable mood but is not severe enough to cause major disruption of normal functioning. It is also possible for an individual to have a seasonal pattern in a bipolar disorder, in which there is a relationship between an episode of bipolar disorder or depressive episode and the time of year.

Schizophrenia is the most common type of psychosis, and people with this disease tend to live in a world of their own imagining. Most hospitalized schizophrenics dress themselves, walk about, and indulge in such everyday activities as eating and smoking in much the same manner as everyone else. However, individuals with schizophrenia withdraw their interest in and concern for the events and people in the worlds around them. They are often preoccupied by fantasies, delusions, and hallucinations, which affect their speech and thoughts. Although there are several types of schizophrenia, most schizophrenics show some common symptoms.

Many individuals with schizophrenia have delusions, or belief not founded on reality. Some schizophrenics have delusions of persecution, and believe that someone is trying to kill or hurt them. They also have thoughts of agents controlling their thinking and behavior, as well as difficulty separating reality from fantasy. A common delusion in schizophrenia is thought broadcasting, in which people believe that their thoughts are broadcast so others can hear them. Thought insertion, in which people with schizophrenia believe thoughts from others are inserted into their heads, is another common delusion.

Individuals with schizophrenia often have problems with the form of their thoughts, called formal thought disorder. Often their thinking is unorganized and incoherent. They appear to have trouble associating current information with previous knowledge. In addition, they show confusion and lack of insight. Ideas shift from one topic to another, even though there is no relationship between topics of thought.

Individuals with schizophrenia often repeat having hallucinations, or sensory experiences with no sensory stimuli present. Often they are auditory hallucinations, such as hearing voices that talk to the patient or just make sounds. Tactile hallucinations may also be experienced, and usually involve a tingling or burning feeling. Sometimes visual or olfactory hallucinations occur, such as seeing snakes crawling around the room.

Many individuals with schizophrenia show abnormalities of emotional response. Sometimes they are emotionally flat, and do not show any emotional arousal. They tend to stare straight ahead and appear apathetic. When they speak, their voice is monotone without ant affective expression. Other individuals with schizophrenia show inappropriate emotional responses: for example, they laugh at sad news, or cry for no apparent reason; or they shift emotional moods quickly, and are not dependable in their reaction to a stimulus.

The sense of self is an important characteristic of the normal healthy person. As individuals with schizophrenia has difficulties in developing a personal identity, and may believe outside forces are directing his or her behavior.

A characteristic often observed in a person with schizophrenia is a disturbance in volition, or lack of goal directed activation. The person does not show adequate motivation to follow through on an action. Thus, of course, causes the person to be unable to function properly in society.

The individual with schizophrenia has great difficulty in relating to other people. Often he or she will withdraw from social relationships. Because the person experiences delusions and hallucinations, he or she is unable to properly relate to the external world.

Especially in severe forms of schizophrenia, disturbances in behavior are observed. For instance, the person with schizophrenia may maintain a rigid posture, or exhibit stereotypical spastic movements, or other bizarre mannerisms.

Schizophrenia usually begins during childhood or early adolescence. Diagnosis of schizophrenia requires that the symptoms be present for at least six months. Usually a prodromal phase occurs first, in which there is a definite deterioration in functioning. In this phase, the individual usually shows social withdrawal, neglect of personal hygiene, lack of motivation, and unusual perceptual experiences. During the active phase psychotic symptoms (such as hallucinations and delusions) are exhibited. Finally, after the active phase is a residual phase in which many of the prodromal phase characteristics are again evident.

There are five major types of schizophrenia: catatonic, disorganized, paranoid, undifferentiated, and residual.

Catatonic schizophrenia, most often characterized by complete immobility and the apparent absence of the will to move and speak. The individual with catatonic schizophrenia is able, without shifting, to maintain the same --- often quite uncomfortable – position for hours (called a catatonic stupor). Catatonics are sometimes suggestible, obeying the orders of others in a robot like way. More often, they are negativistic, resisting outside efforts to change their position or even to feed them. They may also show selective amnesia (forgetting) for some efforts along with an extraordinary memory for others.

The most severe personality disintegration occurs in disorganized schizophrenia. Previously, disorganized schizophrenia was called hebephrenia (from the Greek word “hebe” meaning childish or silly). Its onset most often occurs at an early age. It is characterized by flat or inappropriate emotions, including silliness and giggling, infantile reactions, bizarre behavior, incoherent speech and thought, hallucinations, and delusions.

Paranoid schizophrenia often has persecutory or grandiose delusions. With their often elaborately and logically constructed persecutory delusions, paranoids will often show great alertness, suspicion, and vigilance towards the “agents” who are “out to get them.” They may also believe they are Christ or the object of a pursuit by the CIA; and may project feelings they think are “bad” onto others. This ability to transfer the bad part of themselves to others may result in feelings of omnipotence or all powerfulness. Such grandiose delusions also provide paranoid schizophrenics with a rationale for why others are persecuting them. One of the common symptoms of schizophrenia is sensory hallucinations, paranoids may “hear voices: that confirm their supernatural powers. The individual with paranoid schizophrenia can be angry and at times violent. There is a chance the individual with paranoid schizophrenia can recover and function normally. The number of paranoid schizophrenics appears to be decreasing, whereas the number of individuals with undifferentiated schizophrenia is increasing.

The above three types of schizophrenia show specific psychotic symptoms. Sometimes the individuals with schizophrenia do not fit into any particular category, or shows symptoms of more than one type. This patient is labeled as having undifferentiated schizophrenia. This type, sometimes called simple schizophrenia, is characterized by a gradual loss of interest in the world, in social relationships, and in personal hygiene, as well as increased withdrawal, apathy, and emotional indifference. This person displays delusions, hallucinations, incoherence, or disorganized behavior, but because they do not meet all of the diagnostic criteria they cannot be categorized as a catatonic, disorganized, or paranoid type.

Residual schizophrenia are without major psychotic symptoms but have a schizophrenic episode in the past. They tend to exhibit symptoms such as social withdrawal, illogical thinking, and inappropriate emotions, although they can function fairly well. The individual who is classified as having residual schizophrenia is not quite “in remission” since the residual type still shows some signs of the disorder.