Brief Psychotic Disorder

Brief psychotic disorder is one of several mental illnesses that are referred to as schizophrenia spectrum and other psychotic disorders. Characteristics of this disorder may include hallucinations or delusions that last no more than one month.

• Studies show that a true brief psychotic episode that does not progress to another mental illness occurs in anywhere from one to four per 100,000 people, more commonly in women than in men.
• This illness usually develops in people 30-50 years of age, and an episode tends to last an average of 17 days.
• This differs somewhat from people who suffer from any first-time psychotic episode, which occurs in about 100,000 teens and young adults in the United States every year, has a peak onset between the ages of 15-25 years, and more commonly affects males versus females.

In addition to the more commonly known mental disorders like schizophrenia, other mental disorders in the schizophrenia spectrum and other psychotic disorders group include:

• Schizotypal personality disorder
• Delusional disorder
• Schizophreniform disorder
• Schizoaffective disorder
• Catatonia
• Substance/medication-induced psychotic disorder
• Psychosis due to a medical condition
• Other specified schizophrenia spectrum
• Other psychotic disorder

Besides catatonia, other catatonia-related disorders include catatonic disorder due to another medical condition, as well as unspecified catatonia.

Except for those psychotic disorders that result from the use of a substance or a medical condition, specific causes for most psychotic disorders are not known. However, the interplay of genetic (familial), biological, environmental, and psychological factors is thought to be involved. We do not yet understand all of the causes and other issues involved, but current research is making steady progress toward elucidating and defining the causes of brief psychotic disorders and other psychotic disorders.

In biological models of psychotic disorders, the following have all been researched:

• Genetic predisposition
• Infectious agents
• Toxins
• Allergies
• Differences in brain structure
• Disturbances in metabolism

Psychotic disorders like brief psychotic disorders are known to run in families. For example, people who have a close family member who has suffered from an episode of brief psychosis are more likely to develop the disorder than people with no such family history. Toxins like marijuana increase the risk of developing psychosis. Some medications are thought to be associated with developing, while not directly triggering, this illness in some people. Studies have not seemed to find ethnic differences in developing a brief psychotic disorder.

The current concept is that multiple genes are involved in the development of psychosis and that risk factors are involved in creating a disposition or vulnerability to develop the illness, such as:

• Prenatal (intrauterine)
• Perinatal (around the time of birth)
• Nonspecific stressors

Neurotransmitters (chemicals allowing communication among nerve cells) have also been implicated in the development of psychotic disorders like brief psychotic disorders. The list of neurotransmitters under scrutiny is long, but special attention has been given to dopamine, serotonin, and glutamate.

One form of brief psychotic disorder referred to as brief reactive psychosis is triggered by very stressful experiences, like placement in solitary confinement. People who have a low income, are unemployed, or are living alone are at higher risk for developing a brief psychotic disorder than those who do not have these experiences.

Signs and symptoms of brief psychotic disorder can include the following:

• Delusions (beliefs that have no basis in reality)
• Hallucinations (for example, hearing voices or other noises not based in reality; seeing or otherwise perceiving things not actually present in any way)
• Disorganized speech (frequently off-topic or nonsensical)
• Severely disorganized or catatonic behavior

Does psychosis turn into schizophrenia?

While most people who have an episode of a brief psychotic disorder tend to never experience another one, some will go on to develop a more chronic psychotic mental illness like schizophrenia or schizoaffective disorder. Some may evolve into having psychosis as part of a mood or personality disorder.

As such, individuals who have a brief psychotic disorder can be susceptible to the following:

• Unemployment
• Fractured relationships
• Medical illnesses
• Early mortality of these other psychotic disorders 

Since there is no specific test, like an X-ray, that can accurately diagnose a person with a brief psychotic disorder, people who are concerned that they may suffer from this illness might consider taking a self-test, either an online or printable, like the following:

• Yale PRIME Screen
• Youth Psychosis at-Risk Test
• Schizophrenia Test
• Early Psychosis Indicator

To determine if a person suffers from a brief psychotic disorder, healthcare professionals will conduct a mental health interview that looks for any history and the presence of symptoms, also called diagnostic criteria, that were previously described. As with any mental health evaluation, the practitioner will usually seek to rule out other mental health conditions, including:

• Mood problems like depression and anxiety disorders
• Panic attacks or generalized anxiety
• Psychotic disorders other than brief psychotic disorders (such as schizophrenia)
• Schizotypal personality disorder
• Delusional disorder
• Schizophreniform disorder
• Schizoaffective disorder
• Catatonia

In addition to guarding against having a brief psychotic disorder misdiagnosed as another psychotic disorder or delirium (sudden confusion due to a medical or mental illness), the mental health examiner may assess that while some symptoms (traits) of the disorder are present, the person does not fully qualify for the diagnosis. Since a brief psychotic disorder can co-occur with a life-threatening condition like delirium, the presence of those disorders will also likely be explored.

The process of determining the presence of a brief psychotic disorder will also likely include the professional trying to ensure that the person does not have a medical problem that may cause emotional symptoms that are similar to those of a brief psychotic disorder. The mental health professional will therefore often ask when the person has most recently had a physical examination, comprehensive blood testing, and any other tests that may be necessary to ensure that the individual is not suffering from a medical illness instead of or along with their emotional symptoms.

Since the mental health interview is used in making the diagnosis and the significant impact that having a brief psychotic disorder or a related diagnosis can have on the person's life, it is of great importance that the practitioner conducts a comprehensive assessment.

In assessing for brief psychotic disorder, the evaluator will likely inquire if the individual's symptoms occur for the required one-day to one-month period and are not better explained by a mood disorder (like major depression or bipolar disorder with psychotic features), another psychotic disorder, or occurs during the postpartum period (four weeks after a woman gives birth) is the result of the physical effects of a substance or other medical illness. The diagnosis should not be assigned if the person's symptoms are part of and sanctioned by the person's culture.

Formerly, the term brief reactive psychosis was used to describe the situation in which brief psychotic disorder occurs in reaction to events that most people would feel are very stressful (for example, trauma).

Given the brief duration of brief psychotic disorder, medications tend to be an important part of addressing many of its symptoms.

The first line of treatment includes atypical antipsychotics, for example:

• risperidone,
• olanzapine,
• quetiapine,
• ziprasidone,
• aripiprazole,
• paliperidone,
• asenapine,
• iloperidone,
• lurasidone, and
• clozapine.

The latter is rarely indicated specifically for the treatment of the brief psychotic disorder. This group of medications might cause weight gain, drowsiness, and changes in blood sugar and cholesterol.

The first generation or typical antipsychotic medication is also used for the treatment of schizophrenia and includes medications like:

• chlorpromazine,
• haloperidol,
• fluphenazine,
• thiothixene,
• trifluoperazine,
• perphenazine, and
• thioridazine.

These are now known as "neuroleptics" because, while they tend to be effective in treating positive symptoms of psychosis (for example, paranoia or other delusions, hallucinations), many of the side effects they can cause affect the neurologic (nervous) system. Examples of such side effects are muscle stiffness or rigidity, jitteriness, tremors, and muscle twitches. These older medications are thought to be not as effective against so-called negative symptoms like catatonia.

Since people with a brief psychotic disorder are at increased risk of also having depression, medications that address that symptom can be an important part of treatment. These include serotonergic medications like:

• fluoxetine,
• sertraline,
• paroxetine,
• citalopram, and
• escitalopram

They are often prescribed because of their effectiveness and infrequent occurrence of side effects. Other antidepressant medications used to treat depression that can be associated with the brief psychotic disorder include:

• venlafaxine,
• duloxetine,
• desvenlafaxine, and
• bupropion.

Cognitive behavioral psychotherapy (CBT) helps manage the symptoms of a brief psychotic disorder. CBT is a form of psychotherapy that focuses on helping the person understand and ultimately better manage how their thoughts and behaviors affect each other.

The prognosis of the brief psychotic disorder tends to be better than that of other psychotic disorders and comparable to the prognosis of mood disorders that have psychotic features. Women, as well as anyone who has a history of having a healthy level of functioning before developing the illness, tend to recover best after suffering from a brief psychotic disorder. Overall, women tend to recover and have no further recurrence of psychotic symptoms compared to men.

People who receive treatment for this illness are less likely to suffer a recurrence compared to people who do not get treatment.

Cognitive behavioral therapy (CBT) for the person who has multiple risk factors for developing psychosis but has yet to have such symptoms, or who has had an episode of brief psychotic disorder, is effective at helping prevent such symptoms. In individuals who have had a brief psychotic disorder, also providing his or her family with support and education about their loved one's condition is quite effective in the prevention of recurrent psychotic symptoms in the individual with the illness.

For women who have developed the brief psychotic disorder in the form of postpartum psychosis in the past, preterm delivery of subsequent pregnancy, and prevention of future pregnancies for extreme episodes have been found to help prevent further episodes of the disorder.

National Alliance on Mental Illness (NAMI)
Colonial Place Three
2107 Wilson Boulevard Suite 300
Arlington, VA 22201-3042
Phone: 1-800-950-NAMI 1-800-950-6264 hotline for help with depression
703-524-7600
Fax: 703-524-9094
TDD: 703-516-7227
Email: [email protected]
Web site: http://www.nami.org

National Institute of Mental Health (NIMH)
6001 Executive Boulevard
Room 8184, MSC 9663
Bethesda, MD 20892-9663
Phone: 866-615-6464 toll-free
301-443-4513
Fax: 301-443-4279
TDD: 866-415-8051 toll-free
Email: [email protected]
Web site: http://www.nimh.nih.gov