Schizophrenia & Psychosis

What are schizophrenia and psychosis?

Psychosis is a state in which a person loses some contact with reality. This can involve delusions (firmly held beliefs that are not based in reality), hallucinations (seeing, hearing, or sensing things that others cannot), disorganised thinking, or unusual behaviour. Psychosis is a symptom, not a diagnosis - it can occur in several different conditions.

Schizophrenia is a long-term mental health condition in which psychotic symptoms are a central feature. It typically emerges in late adolescence or early adulthood and involves a combination of positive symptoms (delusions, hallucinations), negative symptoms (reduced emotional expression, low motivation, social withdrawal), and cognitive symptoms (difficulties with memory, attention, and planning).

Schizophrenia affects approximately 1% of the general population.

The overlap with neurodivergence

Shared features

The overlap between autism and schizophrenia presents significant diagnostic challenges. Both can involve:

• Social withdrawal and reduced social engagement
• Restricted or blunted emotional expression
• Difficulties with eye contact and nonverbal communication
• Repetitive or unusual patterns of thought or behaviour
• Sensory differences

These surface similarities can lead to misdiagnosis in both directions - autistic people being incorrectly diagnosed with schizophrenia, and people with schizophrenia being incorrectly identified as autistic.

Shared genetics

Research has found that approximately 75% of the genes associated with autism in genome-wide studies are also associated with schizophrenia, suggesting significant shared genetic architecture. Having a parent or sibling with schizophrenia increases the risk of autism, and vice versa.¹

This does not mean the conditions are the same - but it does suggest they share some underlying neurodevelopmental mechanisms.

Psychosis in autistic people

Autistic people experience psychosis at significantly higher rates than the general population. One longitudinal study found that 23.5% of autistic individuals experienced psychosis, compared to 0.91% in non-autistic populations.¹

This may be because the conditions share neurodevelopmental pathways, because autistic people are more vulnerable to the social stressors that can trigger psychosis, or both.

Key differences

Despite the overlap, there are important differences:

• Developmental timing - autism is present from early childhood, even if not diagnosed until later. Schizophrenia typically emerges in late adolescence or early adulthood, often with a clear change from previous functioning.
• Nature of social difficulties - autistic social differences are qualitatively different from the social withdrawal seen in schizophrenia. Autistic people may struggle with social communication but often desire connection; schizophrenia-related withdrawal is more often linked to negative symptoms or paranoia.
• Restricted interests vs delusions - autistic special interests involve deep, genuine fascination with a topic. Psychotic delusions are fixed false beliefs that are not open to revision with evidence.
• Sensory experiences - autistic sensory sensitivities (finding certain sounds painful, textures intolerable) should not be confused with hallucinations.

Medication considerations

Stimulant medication and psychotic risk

ADHD stimulant medications (methylphenidate, amphetamines) can, in rare cases, trigger psychotic symptoms in vulnerable individuals. This requires careful psychiatric assessment before prescribing stimulants to neurodivergent people who have psychotic symptoms, a history of psychosis, or a strong family history of psychotic disorders.

This does not mean stimulants are unsafe for people with ADHD - for the vast majority, they are effective and well-tolerated. But the assessment needs to be thorough.

Antipsychotic medication

Antipsychotic medications are the primary treatment for psychotic symptoms and schizophrenia. When prescribing for neurodivergent people, clinicians should be aware of:

• Increased sensitivity to side effects in some autistic people
• The need to distinguish genuine psychotic symptoms from autism-related behaviours before prescribing
• Potential interactions with other medications (including ADHD medication)
• The importance of ongoing monitoring

Getting the right diagnosis

If you are neurodivergent and experiencing unusual thoughts, perceptions, or significant changes in how you relate to reality, it is important to seek assessment from a clinician who understands both neurodevelopmental and psychotic conditions.

Key points for assessment:

• Provide a developmental history - understanding whether features were present from childhood or emerged later is crucial for distinguishing autism from schizophrenia
• Describe changes - if something has changed in how you think, perceive, or relate to others, this is important diagnostic information
• Ask about differential diagnosis - ensure the clinician is considering both neurodevelopmental and psychotic explanations
• Consider trauma - autistic people have elevated trauma exposure, and trauma can contribute to psychotic experiences. A trauma-informed assessment is important.

Further reading on neurobetter

• Mental health conditions - overview
• Paranoia
• PTSD and complex trauma
• Co-occurrence of neurodivergent conditions

neurobetter services

• Local services directory - find mental health services near you
• Ask a Counsellor - get a confidential response from a registered counsellor