Brief Psychotic Disorder: Symptoms And Treatment

When do we say that a person is “crazy”? How do we define “insanity”? There are many definitions that have been provided in this regard and many and varied different points of view on the phenomenon of madness. Here we are going to represent it by the brief psychotic disorder.

Traditionally, in psychiatry, it has been differentiated between two large groups of disorders: psychotic disorders and neurotic disorders. In general, we can define insanity as a psychotic state. 

Psychoses or psychotic states involve a loss of contact with reality manifested through delusions and / or hallucinations. On the contrary, neuroses or neurotic states do not entail a loss of contact with reality. Examples of neurotic disorders would be depression and anxiety and classic examples of psychosis would be schizophrenia and bipolar disorder.

Key defining characteristics of psychotic disorders: delusions and hallucinations

To speak of a psychotic disorder, such as Brief Psychotic Disorder, is to speak of its manifestations or symptoms. Thus, in brief psychotic disorder there are two types of alterations in the perception of reality: delusions and hallucinations.

When we speak of delusions, we refer to fixed beliefs that are not sensitive to reality, to the evidence against them . Etymologically the word delirium derives from the Latin term delirare , which means to get out of the carved furrow. Applied to thought, it would be something like “thinking out of the normal groove.”

In the lay sense, delirium means “to be delirious, to have reason disturbed.” In common language, delirium is practically synonymous with madness, unreason, delirium or loss of reality.

Characteristics of delusions

To identify a delusion as such, we should take into account the degree to which the experience conforms to the following points:

• They are maintained with absolute conviction.
• They are experienced as a self-evident truth, with great personal significance.
• They are not modified by reason or experience.
• Their content is often fantastic or at least intrinsically unlikely.
• Beliefs are not shared by other members of the social or cultural group.
• The person is preoccupied with the belief and finds it difficult to avoid thinking or talking about it.
• The belief is a source of subjective discomfort or interferes with the person’s social functioning and with their occupations.

In sum, delusions are characterized by being conceptually very complex, and perhaps that is why it is so difficult to “lock” them into a definition. A classic example of delusion would be that of a person who is convinced that he is being spied on or controlled through hidden cameras. Or the one who thinks he is Napoleon. Or the one who thinks she has a divine mission to save the world from its destruction.

What do we understand by hallucination?

Hallucinations are perceptions that take place without the presence of an external stimulus. They are vivid and clear, with all the force and impact of normal perceptions, and they are not subject to voluntary control.

Hallucinations can occur in any sensory modality, but auditory hallucinations are the most common in Brief Psychotic Disorder and in schizophrenia. These hallucinations are usually experienced in the form of voices, known or unknown, that are perceived as different from one’s own thinking.

Classic examples of hallucinations can be identified in those people who hear voices that tell them that they must carry out some mission. Or those that see small animals crawling up their arms.

Brief psychotic disorder

The essential feature of Brief Psychotic Disorder is a disturbance that involves the sudden onset of at least one of the following psychotic symptoms: delusions, hallucinations, disorganized speech or speech, or highly abnormal psychomotor behavior, including catatonia. Catatonia is defined as a neuropsychiatric syndrome characterized by motor abnormalities, which occur in association with alterations in consciousness, affect, and thinking.

Seizures may appear, but these are more frequent when the cause is organic. Ultimately (in both organic and psychiatric cases), catatonia is thought to be caused by dysfunction of the lateral orbitofrontal cortex.

Abrupt onset of Brief Psychotic Disorder is defined as a change from a non-psychotic to a clearly psychotic state within a period of 2 weeks. An episode of the disorder lasts at least 1 day, but less than 1 month, and the individual fully returns to the level of functioning that was present before the disorder.

Characteristics of brief psychotic disorder

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), for a person to be diagnosed with brief psychotic disorder, the following criteria must be met:

A. Presence of one (or more) of the following symptoms. At least one of them must be (1), (2) or (3):

• Delusions
• Hallucinations
• Disorganized speech (disorganized speech).
• Very disorganized or catatonic behavior.

B. The duration of an episode of the disorder is at least one day but less than one month, with a final total return to the degree of functioning prior to the disease.

C. The disorder is not better explained by a major depressive or bipolar disorder with psychotic features or another psychotic disorder such as schizophrenia or catatonia, and cannot be attributed to the physiological effects of a substance (eg, a drug or medication ) or another medical condition.

As we can see, a person with a brief psychotic disorder quickly goes from a state of “normality” to a psychotic state, almost without warning. This state of “madness” lasts between a day and a month (never more than that). Eventually, the person either makes a full recovery or returns to their baseline level.

The differences with schizophrenia are clear. In schizophrenia, the continuous signs of the disorder persist for a minimum of six months and the change from “normal” to “insanity” is usually not as rapid, but more gradual. The course of schizophrenia is usually chronic, whereas brief psychotic disorder usually resolves or “cured.”

Although the disorder is brief, it can become serious

People with Brief Psychotic Disorder typically experience emotional turmoil or great confusion. They can show rapid changes from one intense affect to another. Although the disorder is brief, the degree of dysfunction can be severe in the period in which the symptoms are present.

It may require supervision so that nutritional and hygiene needs are met and the person is protected from the consequences of poor judgment, cognitive dysfunction, and actions motivated by delusions. On the other hand, during brief psychotic disorder there appears to be an increased risk of suicidal behavior, especially during the acute episode. It is essential in this case to take security measures to prevent the affected person from self-harm.

Treatment of brief psychotic disorder

Pharmacological treatment is the main intervention for psychoses, but treatment during the initial phase should not be based exclusively on it. Both psychosocial interventions and conducting psychological therapy are very important in the recovery process.

These interventions encompass a series of measures aimed at minimizing the patient’s vulnerability to stressful situations, facilitating recovery processes, reinforcing their adaptation and family, social and educational-work functioning, as well as increasing their resources to deal with conflicts , interpersonal or biographical problems and tensions.

As we have seen, brief psychotic disorder can have significant consequences for the sufferer. It can also deteriorate family and personal relationships. This makes it essential to have it treated by a qualified professional.

Bibliographic references

American Psychiatry Association (2014). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th Ed. Madrid: Editorial Médica Panamericana.