Brief Psychotic Disorder
Short-Lived Reactive Psychotic Events
BY: T. Franklin Murphy | August 25, 2022
Sometimes, it appears, life outmatches the mind, and chaos reigns where a normal functioning mind once stood tall. Typically, these psychotic events are short lived, and normal cognitive functions return with a few days or weeks. These brief moments of psychosis are referred to by the DSM-V as Brief Psychotic Disorder (BPD). In Europe, similar symptoms are identified in the ICD-10 as Acute and Transient Psychotic Disorders (ATPD).
Patients diagnosed with brief psychotic disorder typically experience schizophrenia like symptoms (delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior).
Brief Psychotic Disorder (BPD) is a relatively brief psychotic episode lasting at least a day but not more than a month where the person experiences schizophrenia like symptoms (delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior). BPD typically has a sudden onset. Most patients diagnosed with Brief Psychotic Disorder make a full recovery.
Brief Psychotic Disorder and Trauma
Originally, DSM-III symptomology included precipitating stress as a mandatory criterion for a diagnosis of "brief reactive psychosis." DSM-IV and DSM-5 removed the stress criterion and renamed the condition "brief psychotic disorder" (Valdés-Florido et. al., 2022).
However, just because the stress criterion has been removed does not suggest it isn't a common instigator leading up to the brief psychotic events.
Brief psychotic disorder often fits well with the diathesis stress model. T. Franklin Murphy describes the diathesis stress model as "a psychological theory that disorders develop as a result of interactions between pre-dispositional vulnerabilities (the diathesis), and stress caused by life experiences" (2021).
Unfortunately, I have brought two family members to the emergency room over the last five years that were experiencing schizophrenia like symptoms, both were in the midst of extremely stressful situation preceding the onset of symptoms. Both completely recovered within a few weeks.
It is a little scary to see someone that was functioning normal one day and the next are hallucinating.
Because of the brief period of symptoms and fluctuating criteria to diagnose the disease, little is known about the epistemology. However, as much as 11% of all first time admissions for psychiatric events is due to brief psychotic disorder (Valdés-Florido et. al., 2022).
A Case Study
A 36 year old woman healthy woman with no personal or family history of mental illness, experienced prominent persecutory delusions and decreased sleep, four days after the onset of upper respiratory symptoms associated with a COVID-19 diagnosis. The delusions subsided shortly after recovering from the COVID-19 symptoms (Smith, et al., 2020).
Brief Psychotic Disorder and COVID-19
A sharp increase of people presenting brief psychotic symptoms emerged during the COVID-19 pandemic. Most of the cases involved people who did not contract the illness but were experiencing extreme anxiety because of the world wide epidemic.
A recent study identified 33 people that met the brief psychotic disorder according to the DSM-V criteria and their psychosis was believed to be triggered by the coronavirus outbreak. Of those 33, "almost half of the patients had first-rank symptoms of schizophrenia and high prevalence of suicide symptoms during the scute phase of psychosis" (Valdés-Florido et. al., 2022).
Suicidal tendencies are often heightened during brief psychotic disorder, not just those suffering from the disorder because of COVID-19. Several studies have found a significant higher incidence of suicide attempts and suicide ideation during brief psychotic disorder than occurs among the general population (Sher, 2015).
Possible Biological Correlates
If the diathesis stress model is an accurate model for brief psychotic disorder, one would expect in many of the cases the presence of a genetic or biological vulnerability would be associated. If a genetic marker was associated to the disorder, higher risk people could be identified and appropriate precautions taken to prevent the occurrence of a psychotic episode.
Scientist Hua Li and Szabolcs Kéri conducted brain scan research in search of any associated differences between those who have suffered brief psychotic disorder and a control group that have not.
To explore the possibility of structural brain abnormalities in brief psychotic disorder, the scientists recruited 30 patients with BPD in clinical remission and 30 matched healthy controls. they observed "a select volume reduction in the frontal cortex in BPD, including the caudal/rostral middle frontal, superior frontal, and frontal polar regions." They further noted that the "smaller frontal volumes were associated with one of the most important clinical features of BPD, that is, the number of recurrent episodes without conversion to schizophrenia or other long-lasting psychotic disorders" (2020).
The associated brain volume doesn't necessarily mean it causes the episodes but it does create a curiosity for continued research that may lead to a preventive treatment for those suffering from repeated, life disrupting psychotic episodes. When a person suffers intermittent psychotic episodes, the condition is often diagnosed as Brief Limited Intermittent Psychotic Symptoms or BLIPS. If the hypothesis of brain volume is correct, a brain scan would be able to differentiate from a one time event such as brief psychotic disorder and the higher risk state of brief limited intermittent psychotic symptoms.
A Few Closing Remarks
Because of this disorders transient state, it has not received much research attention. Hopefully, with increases in world tension, and a higher prevalence of those suffering from these disrupting episodes, more attention will be given to the disorder and helpful preventive care administered to those most vulnerable.
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Li, H., & Kéri, S. (2020). Regional brain volumes in brief psychotic disorder. Journal of Neural Transmission, 127(3), 371-378.
Murphy, T. Franklin (2021). Diathesis Stress Model. Flourishing Life Society. Published 9-7-2021. Retrieved 8-24-2022.
Sher, L. (2015). Brief psychotic disorder and suicidal behavior. Australian and New Zealand Journal of Psychiatry, 49(6), 578-578.
Smith, C., Komisar, J., Mourad, A., & Kincaid, B. (2020). COVID-19-associated brief psychotic disorder. BMJ Case Reports, 13(8),
Valdés-Florido, María José, Álvaro López-Díaz, Fernanda Jazmín Palermo-Zeballos, Nathalia Garrido-Torres, Paula Álvarez-Gil, Iván Martínez-Molina, Victoria Eugenia Martín-Gil, Elena Ruiz-Ruiz, Macarena Mota-Molina, María Paz Algarín-Moriana, Antonio Hipólito Guzmán-del Castillo, Ángela Ruiz-Arcos, Rafael Gómez-Coronado, Sara Galiano-Rus, Alfonso Rosa-Ruiz, Juan Luis Prados-Ojeda, Luis Gutierrez-Rojas, Benedicto Crespo-Facorro, and Miguel Ruiz-Veguilla. (2022). Clinical characterization of brief psychotic disorders triggered by the COVID-19 pandemic: a multicenter observational study. European Archives of Psychiatry and Clinical Neuroscience 272.1 5-15.