Abstract
Deaf and hard-of-hearing (DHH) individuals face unique challenges in psychiatric assessment, particularly in the diagnosis and treatment of psychotic disorders. Communication barriers, cultural misunderstandings, and clinician unfamiliarity with deaf language and norms may contribute to misdiagnosis, diagnostic uncertainty, and inadequate care. This narrative review synthesizes current literature on the prevalence, phenomenology, and diagnostic challenges of psychotic disorders in the deaf population, aiming to identify trends, gaps, and future research needs. A comprehensive search was conducted in three databases - PubMed, EBSCO Open Dissertations, and ScienceDirect - between April 1, 2025, and April 20, 2025. Keywords and MeSH terms related to psychosis, hallucinations, delusions, and deafness were used. Inclusion criteria encompassed peer-reviewed studies that investigated the prevalence, symptomatology, or diagnostic complexities of psychosis in DHH populations. Studies involving only hearing individuals, those without psychosis-related outcomes, or those lacking comparative or baseline data were excluded. Data were extracted independently by two reviewers and synthesized narratively. Nine studies were included, encompassing a total of 827 participants. The reported prevalence of psychotic disorders in deaf populations ranged from 28% to 58%. Schizoaffective disorder and schizophrenia were the most common diagnoses. Distinct phenomenological patterns emerged, with visual, tactile, and non-verbal auditory hallucinations frequently reported. High rates of diagnostic ambiguity, including overuse of psychotic disorder Not Otherwise Specified (NOS), were observed. Language dysfluency, cognitive impairment, and systemic barriers further complicated diagnostic accuracy. Psychotic disorders are prevalent in deaf psychiatric populations, yet cultural, linguistic, and systemic challenges often hinder assessment. Future research should focus on culturally adapted diagnostic tools, large-scale multisite prevalence studies, and qualitative investigations into deaf experiences of psychosis. Similar approaches should be extended to other sensory-impaired populations to uncover potential diagnostic disparities and inform equitable psychiatric care.