What is Brief Psychotic Disorder?
Brief psychotic disorder (BPD) is a mental health condition where a person suddenly experiences abnormal behavior like delusions, hallucinations, or disorganized speech, less than a month, and recovers fully. Following recovery, they could experience these episodes again in the future. A key difference from similar disorders like schizophrenia is the short duration of the episode. The diagnosis usually happens after recovery, because one of the key characteristics is complete recovery within a month.
This condition is severe but temporary, and sufferers may experience one or more of the following characteristics:
* False beliefs or delusions
* Seeing or hearing things that aren’t there, known as hallucinations
* Confusing or disorganized speech
* Extreme or strange behavior
At a minimum, one of the symptoms experienced by sufferers should be hallucinations, delusions, or disorganized speech. These symptoms will appear for a period ranging from a single day to a month, and patients will regain their regular behavior patterns after this period with the help of antipsychotic medications. Importantly, these symptoms can’t be explained by schizophrenia, mood disorder with psychotic characteristics, or other mental health conditions. They also can’t be attributed directly to the use of drugs, medication, or a physical health issue like an overactive thyroid, sarcoidosis, or syphilis.
What Causes Brief Psychotic Disorder?
The cause of brief psychotic disorder (BPD) can be hard to pin down, but it often arises from a stressful event or trauma. It may also be influenced by genetic factors, changes in the brain, or the environment. However, the specific trigger, if there is one, can fall into one of several categories:
* BPD with notable stressors, also known as brief reactive psychosis, happens when psychotic symptoms start after a traumatic event. This event would be stressful for anyone in the same situation and cultural context.
* BPD without notable stressors occurs when psychotic symptoms begin, even without any traumatic event that would generally cause stress under similar circumstances and within the same culture.
There’s also a type of BPD called ‘postpartum onset’, in which the symptoms start within four weeks after childbirth.
Risk Factors and Frequency for Brief Psychotic Disorder
Brief Psychotic Disorder (BPD) is a mental health condition that isn’t common, so we don’t have a lot of data on how often it occurs. However, it’s seen more often in people who are under a lot of stress, like immigrants, refugees, and earthquake victims. Investigations in Finland found that BPD was present in 0.05% of the people they studied, while another study in rural Ireland found 10 cases of BPD among 196 individuals admitted for the first time with symptoms of psychosis.
Studies have shown that it is more common in developing countries compared to developed ones. In fact, the occurrence of BPD in developing countries is thought to be about 10 times higher than in industrialized nations, according to data presented by the World Health Organization. It’s also believed that BPD is more likely to affect women and individuals with certain types of personality disorders.
- Brief Psychotic Disorder is less common and widely varies in occurrence.
- It’s often seen in high-stress groups such as immigrants, refugees, and victims of natural disasters.
- A study in Finland found the condition in 0.05% of its population.
- In rural Ireland, 10 cases of BPD were found among 196 first-time psychosis patients.
- Developing countries report higher cases of BPD compared to developed countries.
- According to WHO, BPD’s occurrence is about 10 times higher in developing nations than in industrialized ones.
- BPD is believed to be more common in women and people with certain personality disorders.
Signs and Symptoms of Brief Psychotic Disorder
When diagnosing a brief psychotic disorder, there are three important factors to consider:
- Do they have any psychotic symptoms? This can include things like delusions, hallucinations, or disorganized speech and behavior.
- Have the symptoms been present for less than a day or more than a month? The length of symptoms can help confirm the diagnosis.
- Could the symptoms be explained by another condition? This could include a mood disorder, another medical condition, or the use of a substance or medication.
Further understanding of the disorder requires considering whether the symptoms were triggered by a stressful event or have happened after giving birth. Common triggers could include a death, environmental disaster, military activity, or recent immigration. It’s also crucial to observe if the patient has a personality disorder that may affect their ability to cope, making them more likely to develop disorders like brief psychotic disorder. Additionally, it’s important to note that the symptoms of this disorder can sometimes be very severe, resembling the symptoms of delirium.
Testing for Brief Psychotic Disorder
There aren’t specific lab tests or psychological evaluations that can definitively diagnose a brief psychotic disorder. The main goal of testing is to rule out other possible causes for the behavioral challenges. This includes ordering various tests based on the patient’s symptoms.
For instance, it’s appropriate to carry out a pregnancy test in women, since changes in hormones or stress associated with pregnancy can sometimes lead to behavioral changes. Different types of blood tests can also be useful, including ones that check electrolyte levels, glucose levels, liver function, and thyroid function. These tests can help to rule out physical health issues which may be causing the problems.
A urine test can be used to rule out the possibility that drug use is causing the behavioral changes. Brain scans, such as CT or MRI scans, might also be used to check for any physical abnormalities in the brain that could be causing the symptoms.
Treatment Options for Brief Psychotic Disorder
Determining the right care for a patient and whether they require in-patient or out-patient treatment depends on various factors. These include the patient’s symptoms, their social and financial situation, their support system, and also if they have thoughts of self-harm or violence against others. As there are quite few clinical trials on brief psychotic disorder (BPD), the treatment guidelines are derived from methods effective in other psychotic disorders and include medication and psychological therapy.
Pharmacotherapy – Medication
Second-generation antipsychotics are the first choice of treatment for BPD. Although BPD usually resolves itself within a month, the recommendation is to continue with the medication for one to three months after the symptoms disappear. While pills are preferred, there could be instances where immediate treatment is required and injectable versions are used, especially in emergencies.
Second-generation or atypical antipsychotics include certain medications that are favored due to fewer side effects related to movement disorders. Some of these are Quetiapine, Paliperidone, Olanzapine, Risperidone, Aripiprazole, Ziprasidone, and Clozapine. However, these drugs can cause weight gain, abnormal lipid levels, and high blood sugar, and periodic check-ups are required. Clozapine, used for resistant cases, mandates weekly blood tests as it may affect the white blood cells.
First-generation or typical antipsychotics include Trifluoperazine, Fluphenazine, Haloperidol, Chlorpromazine, and Thioridazine. These drugs are associated with movement disorders. To manage these side effects, other medications may be used. Benzodiazepines may be beneficial in managing symptoms in overly aggressive or restless patients.
Psychotherapy
Experiencing a brief psychotic episode can be very impactful and disrupt the daily lives of both the patient and their close ones. Therapeutic management includes educating the patient and their family about their condition and treatment options. It also focuses on reintegrating the patient into society and on improving their coping skills to deal with stress and any other related issues.
It’s important to monitor the patient long-term to check for any symptoms persisting or returning, which may warrant a specialist’s referral. Patients should be encouraged to take their medication consistently to prevent symptom relapse. The ideal treatment plan for BPD combines pharmacotherapy and psychosocial intervention, and needs to take into account the biological, psychological, and social aspects of the patient’s life.
What else can Brief Psychotic Disorder be?
Before finally diagnosing someone with brief psychotic disorder, numerous other possible conditions need to be ruled out. A diagnosis of short-term psychosis can only be confirmed after symptoms have subsided within a month since their appearance. Otherwise, these symptoms may instead indicate the early stages of another disorder that includes psychosis. So, until the symptoms resolve, the diagnosis might be marked as ‘psychotic disorder, not yet identified.’
Medical professionals have to consider several different disorders, including:
- Mood disorders with psychotic features, where major depression or mania happens along with psychosis.
- Schizophrenia-related disorders, where the symptoms persist for more than a month.
- Personality disorders, particularly borderline personality disorder, because they might cause brief periods of psychosis when under severe stress.
- Delusional disorder.
- Problems related to substance use, such as withdrawal, or induced due to substance-intake.
- A psychotic episode that could be a symptom of a physical illness.
Certain physical illnesses, like syphilis, neurosarcoidosis, brain spread from lung cancer, an overactive thyroid, or head injuries could also bring on symptoms that resemble brief psychotic disorder. Taking a thorough patient history, undertaking a complete physical examination, and ordering the appropriate lab tests and scans help doctors identify the root cause of the symptoms.
What to expect with Brief Psychotic Disorder
This particular condition typically has a good outcome, with all symptoms often disappearing within a month, according to the DSM-5 criteria, which is a manual mental health professionals use to diagnose mental conditions. However, stress can trigger a return of symptoms.
There are a few factors that might hint towards a better prognosis for brief psychotic disorder. These include not having any relatives with schizophrenia or brief psychotic disorder, sudden onset of symptoms, presence of a stressful trigger, and shorter duration of the symptoms.
Things could be more challenging for people diagnosed with Brief Psychotic Disorder (BPD) who can also meet the criteria for other disorders related to psychosis. A study done in Suffolk County, New York in 2000 showed that only 2% of patients who were admitted for the first time due to psychosis still fit the criteria for BPD six months later. From the Suffolk County study, out of 11 patients initially diagnosed with BPD, only three kept that diagnosis while the rest were diagnosed with mood disorder, schizophrenia, schizophreniform disorder, and other disorders related to psychosis.
Possible Complications When Diagnosed with Brief Psychotic Disorder
The most severe problem that comes with brief psychotic disorder is the sudden appearance of symptoms and a resulting decrease in normal functioning. It’s very important to identify any pre-existing stressors and accompanying disorders and manage them properly. These could have triggered the current episode and might cause similar episodes in the future. Even though medication can help control the symptoms of this disorder, therapy can teach the patient the tools and skills they need to handle this disorder both during and after the symptoms have eased off.
Preventing Brief Psychotic Disorder
It’s crucial to educate patients and their families about short-term psychotic disorders. This is a key part of the different therapies used to manage this condition. Experiencing symptoms like delusions, hallucinations, scrambled speech, or extremely disorganized behavior can be scary not just for the patient, but for their family as well.
Therefore, it’s really important that the patient and their family are fully informed about all the available treatment options and different forms of therapy. It’s also vital to ensure the patient has a strong support system around them. This can make dealing with the condition much more manageable.
