What Are The Psychotic Disorders Acute And Transient Psychosis?

Some psychotic disorders, such as schizophrenia, involve prolonged and repeated episodes of delusions, hallucinations, or confused thinking. However, in some cases, people can undergo short periods of psychosis and recover with no lingering symptoms or further relapses. The origins of this type of transient psychosis may not be clear, and their treatment and prognosis can vary considerably from other psychotic disorders. 

Transient psychosis, sometimes called brief psychotic disorder or acute and transient psychotic disorder, appears to be more common in middle-aged people, and women may be at higher risk. The disorder often appears as a response to severe stress, though there are cases where there’s no apparent cause present. The outlook for this condition is often more favorable than for other psychotic disorders. Still, those affected may remain at a higher risk of future psychosis or mental illness than the general population.

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What is psychosis?

Psychosis is a category of mental illness symptoms involving impairments in a person’s awareness of what is real and what isn’t. While specific manifestations can vary from person to person, every psychotic disorder includes at least one of the following symptoms:

• Delusions: Delusions are highly improbable or false beliefs that persist even without evidence or in the face of evidence contradicting them. 
• Hallucinations: Hallucinations are sensory perceptions that others do not perceive and don’t have a source in reality, such as hearing voices or seeing shadows that are not truly there. 
• Disorganized speech, thinking, and behavior: Disorganization can cause thoughts and actions that don’t appear to follow ordinary logic and may not be explainable in terms another person can understand. 

Psychotic symptoms are often understood as deficiencies in “reality testing” — the ability to accurately evaluate whether a situation or stimulus is real or imaginary. 

How psychologists define transient psychosis

Some people experience recurring episodes where the above symptoms occur frequently and for long periods. Schizophrenia spectrum disorders, including schizophreniform disorder and schizoaffective disorder, cause these long-term episodes. 

However, in some cases, an individual may exhibit severe psychosis for a short period without further relapse. Clinicians and researchers often consider this type of episode a distinctive psychotic disorder. They argue that these short-lived psychotic episodes have different risk factors and a different course of illness from other conditions with psychotic symptoms.

In both diagnostic frameworks, what separates transient psychosis from other types of psychotic disorders is their brief duration. This condition lasts less than one month in the DSM-5 and less than three months in the ICD-10. 

Acute psychosis versus schizophrenia 

The criteria for ATPD also specify an acute onset, with psychotic symptoms developing over two weeks or less. This criterion is another point of departure from conditions like schizophrenia, which are often preceded by a lengthy prodromal period involving symptoms like mood disruptions, diminished social functioning, and atypical patterns of thought and behavior.

Another significant difference can be found in prognosis. A 2016 meta-analysis reported that individuals who experienced brief psychotic episodes had a lower risk of future psychosis than those diagnosed with first-episode schizophrenia. 

What causes transient psychosis?

The causes of short-term psychosis aren’t yet fully understood. Current evidence suggests this condition may arise from several contributing factors, including the following. 

Acute and transient psychosis as a response to life stress

Acute and transient psychosis may occur in response to stressful life events, such as a divorce, a career upheaval, a life-threatening accident, or the death of a loved one. This type of immediate cause appears more common for ATPD than in schizophrenia spectrum disorders. 

Some evidence indicates that stressful and frightening world events can contribute to the risk of a temporary psychotic episode. For instance, during the COVID-19 pandemic, clinicians reported multiple patients experiencing brief psychotic disorder with delusions and hallucinations related to the disease, even though they were not infected. When transient psychosis occurs in response to a specific stressor, this may be referred to as “brief reactive psychosis.” 

Brief psychotic disorder with postpartum onset

The period immediately after childbirth, which can involve a variety of intense emotions, hormonal changes, and physical difficulties, is known as a high-risk period for short-term psychosis. The DSM-5 describes a subtype of this condition called “brief psychotic disorder with postpartum onset,” defined as non-recurring psychosis that appears within four weeks of delivery. Some clinicians believe this timeframe should be expanded, arguing that the acute risk of psychosis remains elevated for up to six months after giving birth.

Genetics

Some stressors may be more likely to cause ATPD in people who have a pre-existing genetic vulnerability. Researchers have identified a wide range of genes that appear to contribute to a person’s risk for psychotic disorders, including brief psychotic episodes. 

Some risk factors for transient psychosis could also overlap with non-psychotic illnesses. A 2019 study identified several genetic markers that predicted a higher likelihood of psychotic experiences like hallucinations but were also linked with mood disorders such as bipolar disorder and major depressive disorder. 

Both depression and bipolar disorder can involve psychotic symptoms during times of severe distress and emotional upheaval. This response might result from some of the same psychological and neurological mechanisms responsible for ATPD.

Immune response and psychotic symptoms

Some contemporary theories of psychosis suggest that brief psychosis may result in part from immune-mediated inflammation in the nervous system. The swelling, heat, and tissue destruction from inflammation can be protective in the case of illness, but they can also cause cell damage if they continue for too long. 

Both mental and physiological stress can cause prolonged inflammation, which might explain why they can both increase psychosis risk. Researchers have observed higher levels of specific immune biomarkers in patients with first-episode psychosis relative to healthy individuals.

There’s also evidence that immune responses may differ between people with acute and transient psychotic disorder and those with longer-lasting psychosis. A 2022 paper reported that the levels of certain inflammatory cytokines varied between individuals with ATPD, individuals with schizophrenia, and healthy controls. These differences might be related to the better prognosis for ATPD.

Who is at risk for transient psychosis?

Unlike schizophrenia, which may be more common in late adolescence and early adulthood, studies indicate that the average age of onset for transient psychotic disorders is 31 to 32 years old. Brief episodes of psychosis can appear across many different socioeconomic strata. However, they may be more common in developing nations.

Risk factor for women

There are also indications that women may be at a higher risk of short-term psychosis than men. A 2016 cross-sectional study reported that there was a higher incidence of ATPD among female patients. Women were also more likely to display polymorphic psychotic symptoms, meaning that their delusions and hallucinations were more varied and likely to shift rapidly instead of remaining stable over time. 

Incidence of personality disorders among acute and transient psychotic disorders

At least one older study indicated a high incidence of personality disorders among patients with transient psychosis, suggesting that being diagnosed with one of these conditions could be a potential risk factor. However, there’s little up-to-date research on this topic, so more recent studies are recommended. 

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Managing transient psychosis and its aftermath

The first-line treatment for a brief psychotic disorder is antipsychotic medication to suppress symptoms like hallucinations and delusions. Second-generation antipsychotics like clozapine or risperidone are often recommended first because their side effects may be milder and better tolerated.

After a patient’s psychotic symptoms have abated, they may benefit from psychotherapy. Regular contact with a therapist may help the individual maintain mental and emotional stability while ensuring that they have a trained mental health professional assessing them for warning signs of a relapse. Although people with ATPD may be less likely to experience further psychotic episodes than those with schizophrenia spectrum disorders, research suggests that their long-term risk of relapse may be as high as 36%.

Online therapy for acute and transient psychosis

If you’re seeking therapy following a short psychotic episode, you may have difficulty locating a care provider who suits your needs and preferences. Since brief psychotic disorders are relatively rare, there may be few clinicians experienced in working with them. Online therapy through a platform like BetterHelp may be a helpful option since online therapy can connect you with a broader pool of potential therapists than you’d be able to find locally. In addition, an online platform may allow you to use resources like support groups and worksheets throughout the week. 

Effectiveness of online therapy for mental health

Recent research has found evidence that people with psychosis can benefit from Internet-based therapy. One clinical trial published in 2017 found that an online cognitive-behavioral therapy program reduced the incidence and severity of hallucinations while improving social functioning in individuals with psychosis.