Other Schizophrenia Spectrum and Psychotic Disorders

ByMatcheri S. Keshavan, MD, Harvard Medical School

Reviewed/Revised Modified Jul 2025

v102029836

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Significant episodes of psychotic symptoms that do not meet the criteria for schizophrenia or other related disorders fall under the heading of other schizophrenia spectrum and psychotic disorders.

Psychosis refers to symptoms such as delusions, hallucinations, disorganized thinking and speech, and bizarre and inappropriate body movements (including catatonia) that indicate loss of contact with reality.

According to the standard psychiatric diagnostic manual, other psychotic disorders are categorized as "specified," meaning they fall into a specific pattern, or "unspecified," meaning they do not fall into any known category.

These categories refer to symptoms that are typical of a schizophrenia spectrum or other psychotic disorder (for example, delusions, hallucinations, disorganized thinking and speech, catatonic behavior), that cause substantial social and occupational distress and impairment. However, the symptoms do not meet the full criteria for any specific disorder. These categories sometimes apply early in a schizophrenia spectrum disorder before it has fully developed.

A disorder is classified as other specified if a doctor chooses to specify how the characteristics of the symptoms do not meet the criteria for a specific disorder. For example, someone may have persistent auditory hallucinations with no other symptoms, and thus not meet criteria for schizophrenia. The Other specified disorders include the following:

Persistent auditory hallucinations ("hearing voices")
Delusions with overlapping episodes of depression or mania
Mild (attenuated) psychotic symptoms
Shared delusions

The unspecified category is used when the information needed to make a diagnosis is insufficient (for example, in an emergency department).

Antipsychotic medications and psychiatric referral may be used as needed.

Shared Delusions

Shared psychosis occurs when people acquire a delusion from someone with whom they have a close personal relationship.

Psychosis refers to symptoms such as delusions, hallucinations, disorganized thinking and speech, and bizarre and inappropriate body movements (including catatonia) that indicate loss of contact with reality. (See also Introduction to Schizophrenia and Related Disorders.)

Shared psychosis (previously termed folie à deux) was previously considered a subset of delusional disorder but is now classified under Other Schizophrenia Spectrum and Psychotic Disorders. It is a rare disorder that usually occurs in a person or group of people (usually a family) who are related to a person with a significant delusional disorder. The socially dominant member in the relationship has the primary disorder and imposes the delusion on or convinces the less dominant person (or people) in the relationship of the unusual beliefs.

Doctors try to identify the person in the relationship who has the primary psychosis, because the person with the secondary disorder typically does not maintain the delusional beliefs when separated from the person with the primary disorder. Counseling and therapy can usually help people who have a shared psychosis. Psychotic symptoms are treated with antipsychotic medications as needed.

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