Psychotic Disorders

Psychotic symptoms are a cross-sectional dimension that competes with multiple diagnostic categories and not necessarily identify schizophrenia; all cases of schizophrenia represent a psychotic disorder but not vice versa, as psychotic symptoms are a necessary but not a sufficient condition. Specific criteria are needed to diagnose schizophrenia which is characterized not only by the presence of persisting positive, negative, and cognitive symptoms but also by a significant functional impairment in daily life. Genetic and environmental factors contribute to the development of schizophrenia, which is associated with dysregulated neurotransmission as well as with structural and functional brain alterations. Delusional disorder, schizoaffective disorders, brief psychotic disorder, and substance-induced psychotic disorder represent other forms of psychosis, and the differential diagnosis is based on specific clinical features. Treatment of schizophrenia spectrum disorders is founded on the use of antipsychotic drugs, effective on positive symptoms such as delusions and hallucinations, but presenting only limited efficacy on cognitive and negative symptomatology. Therefore, nowadays adequate treatment of psychotic disorders, especially schizophrenia, needs an integrated approach including both pharmacotherapy and rehabilitative interventions aimed at symptomatic remission and patient’s functional recovery.