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What is Brief Psychotic Disorder?

A Brief Psychotic Disorder is a relatively rare psychotic condition which lasts from twenty-four hours to one month.  Sufferers experience delusions and hallucinations which cause them to act in bizarre ways,

Brief Psychotic Disorder: What Does It Mean?

A person suffering from this condition experiences transitory periods of severe hallucinations, delusions, confusion, and other symptoms which can often include violent or self-harming behavior. These periods of psychotic behavior can last from as little as 24-hours, and up to a maximum of one month. Some people only experience a single episode and then return to their normal comportment, while others have repeated relapses, although between them they function with normality,

What is a Psychotic Break?

A psychotic break is the name given to the rapid, unannounced onset of psychotic symptoms which last less than one month.

Stats: How Many Suffer from this Disorder?

A true Brief Psychotic Disorder occurs in between one and four people per 100,000 or 0.001-0.004 percent of the population. It is more common in women than in men and usually develops between the age of thirty and fifty years.  The average psychotic episode lasts for seventeen days.

What Causes Brief Psychotic Disorder?

A Brief Psychotic Disorder is frequently triggered by a traumatic event in a susceptible person’s life. The death of a close family member or friend, an accident, a natural disaster, or an assault, can all provoke an attack. However, this is probably not the cause of the condition, but a precipitating factor. There is evidence that suggests that Brief Psychotic Disorder may be genetically inherited, as it is quite common to find several members of the same family who have suffered at some time from the condition. There are also theories that environmental, biological, and neurological factors may cause the condition. A Brief Psychotic Disorder may also be the first symptom of a chronic psychiatric condition such as schizophrenia, bipolar disorder or psychotic depression.  The abuse of illegal drugs can provoke a Brief Psychotic Disorder although they are not considered as the cause.

Signs and Symptoms of Brief Psychotic Disorder

For a diagnosis of Brief Psychotic Disorder to be reached, the person must present one of the following symptoms

  • These are fixed erroneous beliefs. Often the person believes that they are being persecuted or plotted against. Less commonly, the person believes themselves to be rich, famous, powerful, or with supernatural powers.
  • These can be visual, auditory or tactile. They are false perceptions of a sound, sight, or sensation that does not exist. Hallucinations are frequently terrifying in nature and can evoke violent responses from the sufferer.
  • The sufferer does not know where they are, what date or time it is, and may not recognize people who are known to them.
  • Disorganized speech. Characterized by rambling disjointed sentences and a lack of fluid thought and rational thinking. Speech is often the response to the hallucinations and delusions and is incoherent and illogical.
  • At least one of these symptoms must be observed for more than one day, but less than one month. Psychotic symptoms which persist for longer periods do not meet the criteria of a Brief Psychotic Disorder. Other symptoms that are commonly observed in a person suffering from a Brief Psychotic Disorder include anxiety and agitation, immobility (catatonic behavior), intellectual impairment, hypochondria, insomnia, and constipation.

To reach a diagnosis of Brief Psychotic Disorder the psychiatrist must rule out other mental or physical health conditions which could be the cause of the symptoms or which could exist concurrently.

Some psychologists classify this type of event as a risk factor for future psychotic events and not as a disorder in itself. Statistics show that after one such event the person has a fifty percent chance that another will occur in the future.

What are the Common Behaviors/Characteristics?

Although the actual onset of the psychotic period may be rapid and without warning, it is quite common for mild symptoms to be developing over a period of years. These can include a general deterioration in intellectual abilities often revealed by lowering grades in studies or a decrease in efficiency at work. A reduction in self-esteem, often manifested in scruffy dress and an unkempt appearance, is also common.

During the psychotic period, the sufferer acts in a bizarre way usually in the response to their delusions and hallucinations, and extreme mood swings are common. Their actions depend on the nature of the irrational belief which they hold. Some may believe they are making a movie and that everyone around them is part of the filming. They may believe that they are a prophet and preach to their followers. They may believe that they have supernatural powers or that they are a dog. Whatever form the delusional thinking takes, the person perceives these thoughts as completely real and cannot be convinced that they are not. They misinterpret external information to fit into their delusional thought patterns.

Sufferers of Brief Psychotic Disorder exhibit bizarre and often violent behavior. They follow the instructions of their auditory hallucinations and are prone to self-harm, suicide, and unprovoked attacks on others. Sufferers may take off their clothes, run about on all fours, or remain immobile in one position for hours (catatonia). They are completely unaware that their behavior is inappropriate or strange. They are often disoriented and confused. They cannot recall the date or time, they don’t know where they are, and they don’t recognize people who should be familiar to them. Their speech is jumbled and illogical and they are completely detached from reality. Attempts to reason with them are impossible, and they can become aggressive if their delusional thoughts are questioned.

Testing: What are the Diagnostic Criteria Per the DSM 5?

According to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM–5), the standard used in the US for diagnosis and treatment of mental illnesses, Brief Psychotic Disorder is described as-

“A thought disorder in which a person will experience short-term, gross deficits in reality testing, manifested with at least one of the following symptoms:

  • Delusions- strange beliefs and ideas which are resistant to rational/logical dispute or contradiction from others.
  • Hallucinations- auditory, or visual.
  • Disorganized Speech- incoherence, or irrational content.
  • Disorganized or Catatonic behavior- repetitive, senseless movements, or adopting a pose which may be maintained for hours. The individual may be resistant to efforts to move them into a different posture or will assume a new posture they are placed in.

To fulfill the diagnostic criteria for Brief Psychotic Disorder, the symptoms must persist for at least one day but resolve in less than one month. The psychotic episode cannot be attributed to substance use (ethanol withdrawal, cocaine abuse) or a medical condition (fever and delirium) and the person does not fit the diagnostic criteria for Major Depressive disorder with psychotic features, Bipolar disorder with psychotic features, or Schizophrenia.

There are five specifiers that can be used to further describe the disorder:

  • With marked stressors- the psychotic episode appears following an acute stressor, or series of stressors, which would overtax the coping skills of most individuals.
  • Without marked stressors- there is no apparent stressor preceding the psychotic episode.
  • Post-partum- this disorder can appear during pregnancy or within one month following childbirth.
  • With catatonia.
  • Severity – The clinician can rate the severity of the psychotic episode during the last seven days using a five-point scale- Zero (Absent) to Four (Present and severe).

This disorder will manifest over a period of about two weeks or less, resolve in less than one month, and the person will return to their pre-morbid level of functioning prior to the psychotic state”.

Brief Psychotic Disorder and Other Conditions

Brief Psychotic Disorder vs Schizophrenia

Brief Psychotic Disorder displays basically the same symptoms as Schizophrenia, but, as the name indicates, Brief Psychotic Disorder, only lasts for a short period of time. For a diagnosis of Brief Psychotic Disorder, the person must exhibit psychotic symptoms for between one day and one month. After this time, they return to their normal behavior.  An episode of Brief Psychotic Disorder can repeat itself at intervals, but between attacks, the person maintains a normal life. A diagnosis of schizophrenia requires the presence of two psychotic symptoms, whereas a Brief Psychotic Disorder only requires the presence of one.

Brief Psychotic Disorder vs Schizoaffective

A person suffering from a Schizoaffective disorder manifests many of the same psychotic symptoms associated with schizophrenia and Brief Psychotic Disorder, but usually, the psychotic periods are interspersed with periods of depression or bipolar disorder. People with Brief Psychotic Disorder experience periods when they are free of symptoms, and they only display psychotic behavior for a maximum of one month.

Brief Psychotic Disorder in Adults/Children

Brief Psychotic Disorder usually occurs for the first time in early adulthood but can appear up the age of fifty. It is uncommon in children and teenagers. In most cases with repeated episodes of psychotic symptoms, these do not continue past the age of fifty.

Example Case of Brief Psychotic Disorder

Andrew was a grade A student throughout school and college. His teachers described him as disciplined and intelligent and his fellow pupils said he was just a regular nice guy. Andrew went on to graduate from a major law school and began practicing his profession in NYC.

Five years ago, at the age of 33, Andrew was arrested in a public park, half dressed and screaming obscenities. He was confused, disoriented and delusional. Interviews with a psychiatrist suggested that he was suffering from a psychotic episode. The doctors managed to contact his mother who revealed that she had been concerned about her son. He normally contacted her regularly, but in recent weeks had not been calling. One day when she had managed to reach him he had rambled on in a very disjointed and disconcerting manner. He had mentioned during the conversation that his beloved Doberman had been run over and killed in the street, in front of his eyes.

It would appear that this was the event that sparked Andrew’s Brief Psychotic Disorder. He was taken to a state mental hospital due to his delusional state and his inability to care for himself. While there, he received a course of antipsychotic medication. This helped to reduce his delusions and hallucinations, and ten days after his admission he was sent home.

Andrew has not had another psychotic episode. He is no longer on any medication, but he has been receiving therapy to help him to deal with his anxiety and to make him aware of any signs of a possible recurrence of his psychotic symptoms.

He has returned to his job and keeps in regular contact with his mother. He has expressed fear that another episode could occur but is hopeful that this was a once-off experience.

Brief Psychotic Disorder

How to Deal/Coping with Brief Psychotic Disorder

The person suffering from a Brief Psychotic Disorder is usually oblivious to their condition and their behavior during the acute phase of the attack. Afterward, they may retain some memory of the events, but this is usually fragmented. Those witnessing a person suffering from a Brief Psychotic Disorder may feel frightened and impotent. The vehemence with which the patient experiences their delusions and their reaction to the hallucinations can be a tough event to witness.

It is unwise to try and restrain a person in this delusional state and appropriate medical help should be sought immediately. It is also unwise to contradict them in their delusions as this can provoke intense anger. However, the delusion should not be reinforced either. Patients experiencing extreme delusions and hallucinations will require medication and sometimes restraint to prevent them from hurting themselves or others. It can be very distressing for family members to see a loved one in this condition, but their unconditional support is very important for the patient to achieve a complete recovery.

Look out for These Complications/Risk Factors

Early signs of the onset of a Brief Psychotic Disorder can be restlessness, agitation, anxiety, and insomnia. When the psychotic symptoms are at their peak the patient should be closely monitored at all times as there is a high risk of self-injury, suicide, and unprovoked attacks on others. After an incident, many people can feel ashamed or embarrassed by their behavior. Therapy can help them to understand their condition and to overcome any stigma which may be attached to it.

Brief Psychotic Disorder Treatment

Brief Psychotic Disorder is treated primarily with anti-psychotic medication. Short-term psychotherapy and Cognitive Behavioral Psychotherapy (CBP) are also employed.

Possible Medications for Brief Psychotic Disorder

Second-generation antipsychotic medications such as Aripiprazole, Asenapine, Closapine, Iloperidone, Olanzapine, Paliperidone, Quetiapine, Risperidone, Urasidone, Ziprasidone, are commonly used to treat this disorder.

First-generation antipsychotic medication such as Chlorpromazine, Fluphenazine, Haloperidol, Thioridazine, Thiothixene, Trifluoperazine and Perphenazine may also be employed.

Serotonergic and other anti-depressant medications are also used where depression is evident.

Home Remedies to Help Brief Psychotic Disorder

Vitamins and minerals such as B-vitamins, D-Alanine, D-Serine, Melatonin, N- Acetylcysteine (NAC) and Sarcosine may help sufferers of a Brief Psychotic Disorder.  Avoiding excessive alcohol consumption and recreational drugs, along with practicing ways in which to reduce and control stress, such as yoga, may help to prevent a Brief Psychotic Disorder.

Living with Brief Psychotic Disorder

Many people who have suffered through an experience of Brief Psychotic Disorder are fearful of a repeat attack. With therapy and support, most can overcome the condition and achieve a complete recovery, to continue with their lives as before.

Insurance Coverage for Brief Psychotic Disorder

Most insurance policies cover mental health conditions. You should consult with your provider to see if your policy covers you or if another would serve your needs better.

How to Find a Therapist

Ask your mental health care team to recommend therapists qualified to help with sufferers of Brief Psychotic Disorder.

What Should I be Looking for in an LMHP?

Ensure that the therapist has current relevant qualifications and that they are accustomed to treating people with Brief Psychotic Disorder.

Short-term psychotherapy can assist the sufferer of a Brief Psychotic Disorder to understand the condition and to guide them towards a complete recovery. Those who do not seek treatment are more likely to experience a repeat occurrence.

Cognitive behavioral psychotherapy can help to control some of the symptoms and assists the sufferer to understand his condition and the impact of his behavior on others. It may assist in preventing the development of an acute attack.

Questions to Ask a Potential Therapist

What type of therapies would you use?

How would these benefit the sufferer?

How long would the course of therapy last?

How often would sessions take place?

In many cases, a Brief Psychotic Disorder is an isolated event in the life of a person and they make a complete recovery. Even those who experience multiple events enjoy periods of normality in between, and the condition is not indicative of a chronic mental illness. With support, therapy, and medications, most people overcome this disorder and resume their lives as before.

Brief Psychotic Disorder Resources and Support Helpline

National Alliance on Mental Illness (NAMI) www.nami.org

Phone: 1-800-950-NAMI 1-800-950-6264 hotline for help with depression 703-524-7600 Fax: 703-524-9094

National Rehabilitation Information Center: https://www.naric.com/?q=en/content/resources-specific-disabilities

National Suicide Prevention Lifeline:  https://suicidepreventionlifeline.org/

1-800-273-8255 available 24 hrs a day

Crisis Text Line: Text “home” to 741741

Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline: 1-800-662-HELP (4357)

Resources

  1. https://www.psychologytoday.com/us/conditions/brief-psychotic-disorder
  2. https://www.merckmanuals.com/professional/psychiatric-disorders/schizophrenia-and-related-disorders/brief-psychotic-disorder
  3. https://www.livescience.com/53388-brief-psychotic-breaks-remain-a-mystery.html
  4. https://medlineplus.gov/ency/article/001529.htm
  5. https://www.nami.org/Blogs/NAMI-Blog/March-2017/Understanding-Psychotic-Breaks
  6. https://nypost.com/2017/09/20/this-is-what-a-psychotic-breakdown-actually-feels-like/
  7. https://www.theravive.com/therapedia/brief-psychotic-disorder-dsm–5-298.8-(f23)
  8. https://www.medicinenet.com/brief_psychotic_disorder/article.htm#where_can_people_get_more_information_on_brief_psychotic_disorder
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