Brief Psychotic Disorder: Symptoms And Treatment
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Brief psychotic disorder can be considered a type of temporary psychosis that usually lasts between one day and one month. Individuals experiencing brief psychotic disorder may have symptoms like delusions, hallucinations, disorganized thinking and speech, and disordered or catatonic behavior. Temporary psychosis may also occur in schizophreniform disorder, bipolar disorder, depression with psychotic features, substance use disorder, and some medical conditions. Brief psychotic disorder can usually be treated with a combination of medication and therapy alongside psychosocial interventions and social support.
An overview of psychosis and psychotic disorders
Psychosis generally refers to a set of symptoms characterized by a loss of contact with external reality, typically affecting how one thinks, speaks, behaves, and perceives the world around them. There are several psychotic disorders recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), including:
- Schizophrenia
- Schizophreniform disorder
- Schizoaffective disorder (bipolar or depressive type)
- Delusional disorder
- Brief psychotic disorder
- Substance or medication-induced psychosis
- Psychotic disorder due to another medical condition
While it isn’t a diagnosable condition, temporary psychosis is sometimes used to describe conditions like brief psychotic disorder, in which psychotic symptoms have a shorter duration.
Most psychotic disorders emerge in the late teenage to early adult years. However, brief psychotic disorder’s median age of onset tends to be in the mid-30s. Psychosis associated with other factors, like physiological conditions, can emerge at different times.
It is estimated that roughly 1.5% to 3.5% of the population will experience symptoms of a primary psychotic disorder at some point in their lifetime. Reliable estimates on the prevalence of temporary psychosis aren’t readily available, primarily because it is highly variable and can exist within different conditions, which may or may not be psychological.
Recognizing psychotic symptoms: Potential signs of temporary psychosis
Psychotic symptoms often present differently between people and are typically influenced by a myriad of factors, such as age, background, culture, and life experiences. Individuals frequently experience profound changes in identity during psychosis, further affecting the nature of their symptoms.
It may be prudent to note that many early psychosis symptoms mirror those of other disorders. As such, early intervention is often vital for accurate diagnosis and treatment. Certain behavioral changes may indicate warning signs of psychosis.
Changes in thoughts and speech
Individuals with psychosis often have odd thought patterns and beliefs that don’t coincide with reality, such as:
- An uncharacteristic preoccupation with religion, the occult, or unseen entities
- Thoughts that others are in love with them or hate them without reason
- An uncharacteristic preoccupation with a celebrity, TV series, or media personality
Cognitive symptoms like memory problems and diminished focus can be signs of emerging psychosis, but they can also be symptoms of depression, anxiety, and other psychological conditions. Cognitive symptoms might be associated with psychosis when they are accompanied by strange speech patterns, such as:
- Irrational, impulsive, or inappropriate statements
- Racing or reduced speech
- Disorganized, incoherent sentence structure
- Using odd or nonsensical words (sometimes referred to as “word salad”)
Changes in behavior
Sometimes, individuals with psychosis exhibit changes in behavior that are uncharacteristic or seemingly random. Examples can include:
- Significant decrease in daily function
- Uncharacteristic high-risk or reckless behaviors
- Notable diminishment in activity or hyperactivity
- Unusual or inappropriate reactions to external stimuli
- Deterioration of self-care and personal hygiene
- Agitated, spontaneous movements
- Strange gesturing or posturing
- Significant disturbances in sleep
- Uncharacteristic substance or alcohol use
- Self-harm or threatening to harm others
Changes in social behavior
Changes in social behavior can be attributable to other conditions, like social anxiety disorder or depression, but they may also signal the beginning of a psychotic episode. Changes in social behavior that may be seen as a warning sign of psychosis include:
- The avoidance of social activities or situations in which one may be required to communicate with others
- Uncharacteristic, inappropriate aggression
- Reclusiveness and isolation
- Extreme mistrust of others without cause
- A diminished ability to interpret social cues or interactions
Changes in emotion and affect
Emotional dysfunction can be a common symptom associated with psychosis, although it can also be observed in conditions like bipolar disorder, certain personality disorders, and more. Emotional changes one may experience with psychosis include:
- Inability to feel pleasure
- Extreme euphoria or elation without cause
- Inability to express emotions
- Extreme, inappropriate displays of emotion
- Feelings of isolation and hopelessness
Brief psychotic disorder
Psychotic symptoms
- Hallucinations: Hallucinations generally involve seeing, hearing, feeling, smelling, or tasting stimuli that aren’t there. Auditory hallucinations, in which one hears nonexistent voices, tend to be the most common.
- Delusions: These typically refer to untrue beliefs that don’t align with reality. An individual with delusions usually maintains the validity of their beliefs despite clear evidence to the contrary. For example, one may think they’re being stalked or are receiving transmissions from outside entities. Individuals may also have delusions that they’re an important religious or historical figure or that they have special powers.
- Disordered thoughts and speech: A person with brief psychotic disorder may experience disorganized thought patterns that result in bizarre, incomprehensible speech.
- Disordered or catatonic behavior: Peculiar behavioral patterns in which one may appear agitated, move spontaneously, or seem to have no motor control can be categorized as disordered. Meanwhile, catatonia, typically characterized by an absence of movement and response to outside stimuli, can be another type of psychotic behavior.
People with brief psychotic disorder may also experience cognitive symptoms, such as impaired memory and problem-solving skills, as well as emotional symptoms, like diminished emotional expression and a limited ability to experience pleasure.
In general, to receive a diagnosis of brief psychotic disorder, one must present one or more of these symptoms, and they must not be better explained by an unrelated psychological or medical condition or the effects of a substance.
Brief psychotic disorder diagnostic criteria usually state that the duration of an episode must last for at least one day but less than one month, with a return to the previous level of function after the episode. Most other psychotic disorders must feature continuous signs of the disturbance for at least six months, with at least one month of core symptoms.
Brief psychotic disorder subtypes
There are several subtypes of brief psychotic disorder.
- Brief psychotic disorder with obvious stressor (formerly referred to as brief reactive psychosis): This generally refers to the sudden onset of psychotic symptoms occurring shortly after a severely stressful or traumatic event. Examples can include the sudden death of a loved one, abuse, assault, an accident, or a natural disaster.
- Brief psychotic disorder without obvious stressor: Psychotic symptoms tend to be brief but without an apparent trigger.
- Brief psychotic disorder with postpartum onset (postpartum psychotic disorder): The onset of symptoms usually occurs within four weeks after giving birth.
Other conditions associated with temporary psychosis
There are several examples of transient psychotic disorders and other conditions that may feature shorter-term psychosis symptoms.
Schizophreniform disorder
This can be described as a condition similar to schizophrenia, but with milder symptoms that don’t persist as long.
Bipolar disorder
Characterized by alternating manic and depressive episodes, bipolar disorder can feature mood-congruent psychosis, in which the symptoms reflect one’s moods, or mood-incongruent psychosis, in which symptoms are mismatched with one’s mood.
Psychotic depression
Also categorized as a mood disorder, psychotic depression or depression with psychotic features can be characterized by severe depression in which individuals experience depressive symptoms, plus core psychotic symptoms like hallucinations and delusions.
Substance use disorders
Substance-induced psychosis can be common in individuals with a predisposition for psychotic symptoms, and it can also occur in individuals who do not have this predisposition. Cannabis, psychedelics, and amphetamines may be associated with substance-induced psychotic episodes.
Medical conditions
Certain medical conditions may trigger psychotic episodes. For example, roughly up to half of patients with Alzheimer's disease (a type of dementia) may experience psychotic symptoms. Other medical conditions associated with an increased risk of psychosis include multiple sclerosis, head trauma, brain tumors, and certain infections.
Treatment and management for psychotic disorders
Psychosis and psychotic disorders can often be managed with appropriate interventions. Treatments are typically comprehensive and involve a combination of methods.
- Medication: Antipsychotics are normally the first line of treatment for psychosis, but doctors or psychiatrists may also prescribe mood stabilizers or antidepressants to manage secondary symptoms.
- Therapy: Cognitive behavioral therapy (CBT) tends to be the most common form of psychotherapy for psychosis. In CBT, individuals typically learn to identify and cope with triggers by adjusting unhelpful thought patterns.
- Support from friends and family: Family therapy is often recommended to teach family members communication and conflict resolution skills that may allow them to better support their loved one. Friends and family may benefit from psychoeducation about psychosis to cultivate empathy and understanding.
- Psychosocial intervention: Group therapy programs can help individuals with psychosis understand that they aren’t alone and that recovery is possible. In group therapy, peers often dicuss their experiences and support each other.
Seeking support during recovery from temporary psychosis or brief psychotic disorder
Psychotherapy can be a cornerstone of treatment. However, it isn’t always easy for individuals who have experienced psychosis to get the help they deserve. Difficulty finding care, scheduling issues, and affordability tend to be among the most commonly cited concerns, along with an aversion to interacting with others, such as staff or other patients in a traditional office environment.
Benefits of online therapy for managing psychotic symptoms
Online therapy can remove many of these obstacles, providing an effective alternative solution for individuals who have experienced psychosis. While in-person care may be warranted during periods of acute psychosis, online therapy may be appropriate for individuals in the recovery phase.
Effectiveness of online therapy for brief psychotic disorder and other psychotic disorders
Virtual treatment typically allows individuals to speak with their therapists from the comfort of their own homes on a convenient schedule. Because they can eliminate geographical barriers, online therapy platforms can make it easier to connect with a broader selection of mental health professionals, allowing individuals to choose a therapist with whom they feel comfortable.
Takeaway
What is an example of a brief psychotic disorder?
Brief psychotic disorder is classified by the diagnostic and statistical manual as a sudden onset of psychosis in which symptoms last for longer than 24 hours but less than a month. There are three categories: brief psychotic disorder with marked stressors, brief psychotic disorder without marked stressors, and brief psychotic disorder with postpartum onset.
Unlike schizophreniform disorder which can last 6 months, or schizoaffective disorder which often lasts up to five years, most individuals diagnosed with brief psychotic disorder go into complete remission after their first episode.
How long is a brief psychotic episode?
A brief psychotic episode generally lasts between a little over a day, and a little under a month.
How do you treat brief reactive psychosis?
People with brief reactive psychosis are typically treated with talk therapy such as cognitive behavioral therapy, and atypical antipsychotic medications. Doctors will also take a psychiatric history, complete a physical examination with laboratory testing to rule out physical illness, and make a decision whether the patient will require inpatient or outpatient care. In some cases, inpatient care is necessary to prevent patients from harming themselves, and to coordinate care.
What does a psychotic episode look like?
Psychosis refers to a break from reality, which can manifest in a number of ways. A psychotic episode may include delusions, hallucinations, grossly disorganized speech, frequent derailment from conversation, confusion, talking to self or people that others can’t see, or paranoia.
What are the 5 key symptoms of a psychotic disorder?
Five key symptoms of a psychotic disorder include:
- Delusions, or false beliefs
- Hallucinations (visual, auditory, or tactile)
- Disorganized speech
- Disorganized behavior
- Negative symptoms, or decrease of normal functioning
What triggers psychotic disorders?
Psychotic disorders are mental disorders that include psychotic features. Triggers and causes can be different depending on the disorder, and there may be several that contribute. Postpartum psychosis is triggered by childbirth primarily, although other things contribute, while the schizophrenia spectrum can be caused by environmental and biological factors, while researchers have also found a genetic link. In some cases, psychosis can be an early sign of illness, as in the case of small cell lung cancer. A serum pregnancy test has offered some insight to researchers that exposure to high levels of cytokine in early pregnancy may also contribute. Brief psychotic episodes may be triggered by major stress, trauma, or a particularly stressful situation. Sociocultural settings can also be at play; those living in developing countries are at significantly higher risk of developing psychosis than those in industrialized countries.
According to an article published in the Journal of Clinical Psychiatry (j clin psychiatry), researchers are currently attempting to classify a number of differential diagnosis psychoses into the category of nonaffective acute remitting psychosis. These cases are acute, and last no longer than six months, and are extremely rare.
Can stress trigger psychosis?
Yes, in certain cases extreme stress or a stressful event can trigger psychotic episodes. Psychodynamic theory suggests that psychosis is a response that occurs when the individual is exposed to unbearable aspects of reality and is unable to cope with them. According to a study published in JAMA (arch gen psychiatry) those with poor coping skills may be at greater risk of developing this type of psychosis.
Can you be aware of your own psychosis?
Some are aware of their psychosis, while others are not. It can depend on the individual as well as the severity of symptoms. For some, it can be difficult to recognize psychosis as they believe what is happening to be real. Others may understand that they are seeing or hearing things that others don’t, and that it is a problem.
How do psychotic episodes start?
Early manifestation of a psychotic episode can have a range of indicators. According to the American Psychiatric Association, some signs that you are experiencing the prodromal stage of psychosis are:
- Social withdrawal
- Difficulty focusing
- Sleep disturbances
What are the signs of recovery from psychosis?
While everyone’s experience can be different, there are some common features of recovery from psychosis. There may be lingering symptoms, but hallucinations and delusions will decrease, and the individual will have an increased awareness of their own psychosis. Emotions will begin to stabilize. This phase can take time, and the treatment plan will focus on preventing future episodes and on long term functional recovery.
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