Brief Psychotic Disorder is the sudden presence of psychotic symptoms such as hallucinations or delusions, lasting at least one day but less than one month, often brought on by trauma or stress. Typical treatment options include antipsychotic medications and psychotherapy. Diagnostic criteria (DSM-5) require that the individual's symptoms cannot be due to another psychosis, drug or alcohol abuse, or medication side effects. If the individual had symptoms lasting longer than one month, it would indicate the individual had a different psychiatric disorder. [1]

What is brief psychotic disorder?

According to DSM-5, Brief Psychotic Disorder (BPD) is a mental health condition lasting from one day to one month. Stressful and traumatic events are common triggers. The main symptoms of the disorder include hallucinations, delusions, disorganized speech and behavior, and catatonic behavior. Individuals with the condition often experience overwhelming emotional distress and confusion. [1]

Individuals with the disorder cannot function at their typical level. The following is likely:

  • Acting impulsively and illogically
  • Showing poor reasoning and judgment
  • Suicidal thoughts or behavior
  • Ceasing to eat, drink or follow daily hygiene routines

Types of brief psychotic disorder

There are three forms of brief psychotic disorder:

  • With marked stressor(s) (brief reactive psychosis): This typically occurs in response to a traumatic or stressful incident, such as death, an accident, an assault, or a natural disaster.
  • Without marked stressor(s): This type occurs when there is no apparent trauma or stressor.
  • With postpartum onset: Some women may experience this type either during pregnancy or four weeks after childbirth.

Symptoms of brief psychotic disorder

The Diagnostic and Statistical Manual, fifth edition (DSM-5), is the primary reference for psychiatric diagnoses. According to DSM-5, a diagnosis of brief psychotic disorder requires that an individual's symptoms are sudden, that they last no longer than one month, and that they are experiencing at least one of the following key symptoms:

  • Delusions: Someone who is delusional has a false sense of reality, firmly believing they are someone they are not, or something is true when there is strong evidence to the contrary.
  • Hallucinations: Someone may believe they hear, see, or feel something not there.
  • Disorganized speech: Speech that jumps from topic to topic that seems unrelated or doesn't make sense is one example of disorganized speech.
  • Grossly disorganized behavior: Responding to questions with answers unrelated to the question and drawing conclusions or using language or words that do not make sense. Acting differently than they typically would, dressing in an entirely uncommon way for someone, difficulty remembering things, and mood swings.
  • Catatonic behavior: When someone exhibits catatonic behavior, they show a diminished ability to react to their environment. This behavior can take on many forms, from refusing to comply with instructions to adopting an odd or unusual posture to being entirely non-verbal (mutism) and immobile (stupor). Someone may also exhibit excessive motor activity without cause (catatonic excitement).[4]

Diagnosing brief psychotic disorder

A medical or mental health professional, such as a physician or psychiatrist, references DSM-5 criteria to diagnose a patient exhibiting symptoms. In addition, a healthcare provider will interview the patient and those close to them to obtain a complete medical and psychiatric history.

No specific test diagnoses a patient with the disorder, so doctors may order diagnostic tests to rule out other psychiatric or medical causes for the patient's symptoms. Tests may include lab tests for electrolytes, pregnancy, glucose levels, liver, thyroid, urine toxicology, and bloodwork to check for possible drug overdose or withdrawal. [1]

The doctor may take blood and urine and order other diagnostic procedures, including brain imaging (MRI, CT) and heart monitoring (ECG). The provider assesses what level of care the patient requires. In some severe cases, the individual may require hospitalization. [1]

Causes of brief psychotic disorder

There is no known cause for brief psychotic disorder, but several theories exist:

  • Genetic link: Due to higher rates of the medical condition among patients with a family history of psychosis or major mood disorders such as schizophrenia or schizoaffective disorder, bipolar disorder, or depression, one theory is that genetics play a role. [9]
  • Poor coping skills: Another theory contends that the mental disorder develops due to a person's poor coping skills and serves as a protective mechanism for the person to escape a highly traumatic or stressful event. [9]
  • Coronaviruses: People with coronavirus infections (including SARS, MERS, or COVID-19) may exhibit psychiatric symptoms of psychosis. This may be due to how coronaviruses impact the nervous system through their ability to enter the brain, which triggers an inflammatory reaction and the release of [3]
  • Neurodevelopmental factors: Prenatal infections, drug toxicity, nutritional deficiencies, birth complications, and trauma after birth are associated with risk factors for psychotic disorders. [6]

Treatment for brief psychotic disorder

Standard treatment for brief psychotic disorder typically consists of medication to treat symptoms and psychotherapy (also referred to as therapy).

Medication: Although the FDA hasn't approved a specific medicine to treat the disorder, doctors may prescribe antipsychotic or antidepressant medications to help manage or eliminate symptoms. Doctors may prescribe benzodiazepines to help calm aggression, severe anxiety, or problems sleeping. [9]

These include second-generation or "atypical" antipsychotic medications, such as:

First-generation or "typical" antipsychotic drugs include:

Benzodiazepines may include:

Psychotherapy (Therapy):

This form of therapy uses different approaches to help the patient become aware of their thought patterns, how they interact with others and how they may communicate with others. It can help patients learn to find ways to improve coping skills and how they handle and approach emotional and traumatic stressors. [7]

Another essential element of therapy includes patient and family education about the disorder, education, medications, and the need to maintain a robust support system for the patient, as well as stressing the importance of adhering to medication, therapy, and treatment plan to help prevent recurrent psychotic episodes.[7]

According to the American Psychological Association, there are five different types of psychotherapies. These include the following:

  • Psychoanalysis and psychodynamic therapy: With this approach, the therapist works closely with the patient to gain more self-awareness and breaks harmful patterns of thoughts, ideas, and behaviors by helping explore underlying factors.
  • Behavior therapy: This method aims to inform the patient about how behaviors are learned and assists the patient in figuring out how to alter the patterns and responses that cause their physical, emotional, or mental suffering.
  • Cognitive therapy: This approach focuses on identifying negative thought patterns an individual has about themselves or the outside world to change harmful patterns of thoughts and behavior.
  • Humanistic therapy: This type of therapy emphasizes a person's ability to make sound decisions to reach their full potential.
  • Integrative or holistic therapy: This form incorporates various treatments and techniques tailored to the patient's needs [2].

Self-care for brief psychotic disorder

It is important to practice self-care as it affects our emotional, psychological, physical, and mental well-being. It helps to ease daily stress and gives the body and mind a chance to rest and re-set to a healthy state. In addition, self-care can boost mood, energy, happiness, and attention and decrease negative feelings such as sadness, frustration, and anger, which is vital for good physical health.

The following steps can help you feel better and get back on track:

  • Take your medicine and follow up with your physician or psychiatrist as directed
  • Refrain from alcohol or the use of illegal drugs
  • Exercise regularly
  • Manage your stress; practicing mindfulness and meditation may be helpful
  • Monitor your symptoms and be aware of signs you may need help
  • Pay attention to your feelings, any new anxiety or distress, challenges at work or school, a loss of interest in interacting with people close to you, and any indications that you are retreating and spending too much time alone [5]

Helping someone with brief psychotic disorder

Watching someone experience a trauma or stress-induced episode of psychosis can be scary, stressful, and emotional. It can be hard to know what to do, but some ways people can help a loved one include the following:

  • Show compassion and respect
  • Come from a non-judgmental place
  • Acknowledge their feelings and what they have experienced
  • Be watchful of signs that they might be relapsing
  • Be vigilant of any indication that they may pose a risk to themselves in terms of self-injury or suicide
  • Educate yourself and be prepared by researching what services and resources are available in your community for someone undergoing a mental health emergency

How common is brief dsychotic disorder?

Brief psychotic disorder is not common. According to the National Institute of Mental Health (NIMH), there are about 100,000 new instances of psychosis reported annually in the U.S. [8], with brief psychotic disorder accounting for about 9% of those first-onset U.S. cases. [1]

A World Health Organization (WHO) study reported that developing countries were ten times more likely to experience cases of BPD than industrialized countries. The disorder is more in women, individuals with a personality disorder, and in developing countries. [9]

Resources:

  1. Psychiatry Online. (n.d.-b). DSM Library. Retrieved October 5, 2022, from https://dsm.psychiatryonline.org/
  2. Different Approaches to Psychotherapy. (2009). American Psychological Association. Retrieved October 5, 2022, from https://www.apa.org/topics/psychotherapy/approaches
  3. Bakre, S., Chugh, K., Oke, O., & Kablinger, A. (2022, January 5). COVID-19 Induced Brief Psychotic Disorder: A Case Report and Review of Literature. Case Reports in Psychiatry, 2022, 1–3. https://doi.org/10.1155/2022/9405630
  4. Calabrese J, Al Khalili Y. Psychosis. [Updated 2022 Jul 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546579/
  5. Brief Psychotic Disorder. (n.d.). Drugs.com. Retrieved October 5, 2022, from https://www.drugs.com/cg/brief-psychotic-disorder-discharge-care.html
  6. Lieberman, J. A., & First, M. B. (2018, July 19). Psychotic Disorders. New England Journal of Medicine, 379(3), 270–280. https://doi.org/10.1056/nejmra1801490
  7. Psychotherapies. (n.d.). National Institute of Mental Health (NIMH). Retrieved October 5, 2022, from https://www.nimh.nih.gov/health/topics/psychotherapies
  8. Understanding Psychosis. (n.d.). National Institute of Mental Health (NIMH). Retrieved October 5, 2022, from https://www.nimh.nih.gov/health/publications/understanding-psychosis
  9. Stephen A, Lui F. Brief Psychotic Disorder. [Updated 2022 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539912/