Psychosis is not psychopathy: differences in symptoms, diagnosis and treatment

Psychosis is a short-term acute condition which, if treated, leads in most cases to complete recovery

Psychopathy, on the other hand, consists of a personality disorder with antisocial characteristics, which include: lack of empathy, the ability to understand the emotions of others, manipulative character, disinterest in the consequences of one’s actions.

People with antisocial personalities can, at times, be a danger to others, as they can be violent.

Conversely, most people with psychosis are more likely to be a danger to themselves than to others. Having clarified this, let us return to psychosis.

The term “psychosis” was introduced in the 19th century with the meaning of mental illness or insanity.

The term psychosis defines a type of psychiatric disorder that causes alterations in the perception or interpretation of reality.

The disease manifests itself with serious disturbances of memory, attention, reasoning, affectivity and behaviour.

Psychosis can also cause hallucinatory crises and/or delirium (DSM 5).


The onset of symptoms of psychosis is often referred to as a psychotic episode.

Given that psychosis manifests itself in each person in a unique way, also in relation to the circumstances, it is still possible to highlight four main symptoms associated with the psychotic episode:

  • Hallucinations: of vision, seeing colors, shapes, or people; hearing, hearing voices or other sounds; touch, perceiving tactile sensations in the absence of real stimuli; smell, smelling a smell that no one else smells; of taste, feeling the taste of something even when the mouth is empty.
  • Delirium (delusion is when you firmly believe in something that is clearly false):
  • confused and disturbed thoughts; lack of awareness of being ill.
  • Confused and disturbed thoughts: (people with psychosis often have confused, twisted and disturbed thought patterns): speaking rapidly and continuously; switch from one topic to another in the middle of a sentence; losing track, making abrupt pauses in conversation or activities; lack of awareness of being ill.

When the psychotic episode occurs, the person is often unaware that their hallucinations are not real and may experience feelings of fear or stress.


Psychosis can be triggered by many different types of factors: psychological causes, physical illnesses, substance abuse, drugs, dopamine, changes in the brain.

Among the psychological causes we can identify the schizophrenia: mental illness causing hallucinations and delirium; bipolar disorder: abnormal swings (alternating euphoria with depression) in the affected person’s mood and functioning; severe forms of stress or anxiety; severe forms of depression: persistent sense of sadness; postpartum depression which can affect new mothers a few weeks after the birth of the child; sleep disturbances. The different type of psychological cause can often determine the type of psychotic episode that will occur.

Among the possible causes of the onset of psychotic episodes there may also be some physical diseases such as: HIV and AIDS, malaria, syphilis, Alzheimer’s disease, Parkinson’s disease, hypoglycemia (excessively low blood glucose level), lupus erythematosus, multiple sclerosis , brain tumor (WHO).

This is not the same as summing: physical illness equals psychotic episode, it could happen but it is not closely related.

Additionally, psychotic episodes may occur if there is an abrupt cessation of alcohol or drugs after prolonged use.

This phenomenon is known as withdrawal symptoms.


Therapy for psychosis requires the combination of antipsychotic drugs, useful for alleviating symptoms and psychological therapies (relational systemic, cognitive behavioral, family) which can be a valid aid in reducing the intensity of the crises and anxious states caused by psychosis .

Social support and intervention with family members who must be supported in the management of their loved one’s illness must not be lacking.

Furthermore, the person with psychosis can benefit from comparisons thanks to help groups with other individuals who have faced similar experiences.

In Italy, there are various associations of relatives of seriously psychiatric patients who can be of help such as, for example: Diapsigra, Aitsam, Unasam, Arap.

The psychotic experience frightens both the person experiencing it and those around them.

However, if we want to understand that malaise, it is necessary to listen to the person.

An attitude of acceptance and listening can open the doors to dialogue.

Furthermore, it is important that those who experience this experience, even as a family member, do not get stuck in seeking professional support due to a sense of guilt or shame towards the family member pervaded by psychosis.

Article written by Dr. Letizia Ciabattoni


Healthcare workers and rescuers in burnout: the symptoms, the way out

Anxiety, panic and fear: distinguish them even before managing them

Nurses in psychiatry, some guidelines: how are psychiatric emergencies divided?


Carcione, A., Nicolò, G., Procacci, M. (edited by) Manual of cognitive therapy of psychoses. Franco Angeli, 2012.

Cocchi, A., Meneghelli A., Early Intervention between Practice and Research. Handbook for the treatment of early psychosis. Publisher Scientific Center

WHO, Schizophrenia, information for families (Italian ed. edited by Dell’Acqua G. Vidoni D., Campiutti E.). Image Library Editions, Pordenone.1994


A Beautiful Mind, directed by Ron Howard, Great Britain 2001.

Diary of a schizophrenic, directed by Nelo Risi, Italy 1968.

The Bright Side, directed by David o.Russel, USA 2012.(original title: Silver Linings Playbook.)

Shine, directed by Scott Hiks, Australia/UK 1996.

Psychosis is not psychopathy: differences in symptoms, diagnosis and treatment