Brief psychotic disorder

Definition

Brief psychotic disorder is a short-term, time-limited disorder. An individual with brief psychotic disorder has experienced at least one of the major symptoms of psychosis for less than one month. Hallucinations, delusions, strange bodily movements or lack of movements

(catatonic behavior), peculiar speech and bizarre or markedly inappropriate behavior are all classic psychotic symptoms that may occur in brief psychotic disorder.

The cause of the symptoms helps to determine whether or not the sufferer is described as having brief psychotic disorder. If the psychotic symptoms appear as a result of a physical disease, a reaction to medication, or intoxication with drugs or alcohol, then the unusual behaviors are not classified as brief psychotic disorder. If hallucinations, delusions, or other psychotic symptoms occur at the same time that an individual is experiencing major clinical depression or bipolar (manic-depressive) disorder, then the brief psychotic disorder diagnosis is not given. The decision rules that allow the clinician to identify this cluster of symptoms as brief psychotic disorder are outlined in the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision, produced by the American Psychiatric Association. This manual is referred to by most mental health professionals as DSM-IV-TR.

Description

Positive symptoms

The person experiencing brief psychotic disorder always has one or more "positive" psychotic symptoms. The psychotic symptoms are not "positive" in the everyday sense of something being good or useful. Positive in this context is used with the medical meaning: a factor is present that is not normally expected, or a normal type of behavior is experienced in its most extreme form. Positive symptoms of psychosis include hallucinations, delusions, strange bodily movements or lack of movements (catatonic behavior), peculiar speech and bizarre or primitive behavior.

hallucinations. Hallucinations involve experiencing sensations that have no corresponding objective reality. Hallucinations can occur in various forms that parallel the human senses. Visual hallucinations involve the sense of sight, or "seeing things." Auditory hallucinations generally involve hearing voices, and are the most common of the hallucinations. Sometimes, a hallucination can include both voices and some visual experience; mental health professionals describe this as an "auditory-visual hallucination." Smelling non-existent smells or feeling things on or under one's skin that do not actually exist are forms of somatic hallucinations. Somatic comes from soma, the Greek word for body; thus, somatic hallucinations are bodily hallucinations.

delusions. Delusions are also a classic psychotic feature. Delusions are strongly held irrational and unrealistic beliefs that are extremely difficult to change, even when the person is exposed to evidence that contradicts the delusion. The layperson typically thinks of delusions as being "paranoid," or "persecutory" wherein the delusional person is excessively suspicious and continually feels at the mercy of conspirators who are "out to get" him or her. However, delusions can also be unjustified beliefs that are grandiose, involve elaborate love fantasies ("erotomanic" delusions), or extreme and irrational jealousy. Grandiose delusions are persistent irrational beliefs that somehow exaggerate the person's importance, such as believing oneself to be a famous person, or having an enviable position such as being the Prime Minister or President. Often grandiose delusions take on religious overtones; for instance, a person might become convinced that she is the Virgin Mary. Furthermore, delusions can be somatic. Somatic delusions are erroneous but strongly held beliefs about the characteristics or functioning of one's body; an example is a mental health consumer who refuses to eat because of a conviction that the throat muscles are completely paralyzed and that only liquids can be swallowed, when there is no actual physical reason to be unable to swallow.

other psychotic symptoms. Other psychotic symptoms that may occur in brief psychotic disorder are strange bodily movements or lack of movements (catatonic behavior), peculiar speech, and bizarre or child-like behavior. Catatonic behavior or catatonia involves both possible extremes related to movement. Catalepsy is the motionless aspect of catatonia—a person with catalepsy may remain fixed in the same position for hours on end. Rapid or persistently repeated movements, frequent grimacing and strange facial expressions, and unusual gestures are the opposite end of the catatonia phenomenon. Peculiar speech is also seen in some cases of brief psychotic disorder. Speech distortions can involve words mixed together in no coherent order, responses that are irrelevant and strange in the context of the conversation in which they occur, or echolalia, the repetition of another person's exact spoken words, repeated either immediately after the speaker or after a delay of minutes to hours. Bizarre behavior can range from child-like behaviors such as skipping, singing, or hopping in inappropriate circumstances to unusual practices such as hoarding food or covering one's head and clothing with aluminum foil wrappings.

Of course, not all of these psychotic symptoms will be observed simultaneously in the person with brief psychotic disorder. Any constellation of these positive psychotic symptoms that occurs for one entire day up to one month is considered to be brief psychotic disorder, unless there is some other syndrome or biological cause that caused the symptoms to appear.

Causes and symptoms i f

Causes p s

Brief psychotic disorder is not a simple or consistent h disorder with a single cause. Because many phenomena ti can prompt a short-term experience of psychotic symp- d toms, there are several ways of viewing the causes of the iso disorder. d r an early phase of schizophrenia. Because of "" the similarities between brief psychotic disorder, schizophreniform disorder and schizophrenia, many clinicians have come to think of brief psychotic disorder as being the precursor to a lengthier psychotic disorder. Although this can only be identified retrospectively, brief psychotic disorder is often the diagnosis that was originally used when an individual (who later develops schizophrenia) experiences a first "psychotic break" from more typical functioning.

a stress response. At times, under severe stress, temporary psychotic reactions may appear. The source of stress can be from typical events encountered by many people in the course of a lifetime, such as being widowed or divorced. The severe stress may be more unusual, such as being in combat, enduring a natural disaster, or being taken hostage. The person generally returns to a normal method of functioning when the stress decreases or more support is available, or better coping skills are learned.

postpartum psychosis. In some susceptible women, dramatic hormonal changes in childbirth and shortly afterward can result in a form of brief psychotic disorder often referred to as postpartum psychosis. Unfortunately, postpartum conditions are often misiden-tified and improperly treated. In many cases of a mother killing her infant or committing suicide, postpartum psychosis is involved.

defense mechanism in personality disorder.

Persons with personality disorders appear to be more susceptible to developing brief psychotic reactions in response to stress. Individuals with personality disorders have not developed effective adult mechanisms for coping with life. When life becomes more demanding and difficult than can be tolerated, the person may lapse into a brief psychotic state.

culturally defined disorder. Culture is a very important factor in understanding mental health and psychological disturbance, and brief psychotic disorder is an excellent example. The types of behavior that occur during brief psychotic disorder are very much shaped by the expectations and traditions of the individual's culture. Many cultures have some form of mental disorder that would meet criteria for brief psychotic disorder the features of which are unique to that culture, wherein most

£ Psychosis—Severe state that is characterized by 2 loss of contact with reality and deterioration in ^ normal social functioning; examples are schizo-^ phrenia and paranoia. Psychosis is usually one feature of an over-arching disorder, not a disorder in itself. (Plural: psychoses)

sufferers have similar behaviors that are attributed to causes that are localized to that community. The DSM-IV-TR calls disorders unique to certain societies or groups "culture-bound." An example of a culture-bound syndrome is koro, a syndrome observed in Japan and some other areas of Asia but not elsewhere. Koro is an obsession to the point of delusion with the possibility that the genitals will retract or shrink into the body and cause death.

Conversely, while culture shapes the form a psychotic reaction may take, culture also determines what is not to be considered psychotic. Behaviors that in one culture would be thought of as bizarre or psychotic, may be acceptable in another. For example, some cultural groups and religions view "speaking in tongues" as a valuable expression of the gifts of God, whereas viewed out of context, the unrecognizable speech patterns might be viewed as psychotic. If the behaviors shown are culturally acceptable in the person's society or religion, and happen in an approved setting such as a religious service, then brief psychotic disorder would not be diagnosed.

Symptoms

DSM-IV-TR provides three major criteria for brief psychotic disorder:

• At least one positive symptom of psychosis, from the following symptoms: delusions; hallucinations; disorganized speech which is strange, peculiar, difficult to comprehend; disorganized (bizarre or child-like) behavior; or catatonic behavior.

• Limited duration. The psychotic symptoms have occurred for at least one day but less than one month. There is an eventual return to normal level of functioning.

• The symptoms are not biologically influenced or attributable to another disorder. In other words, the symptoms cannot be occurring as part of a mood disorder, schizoaffective disorder, or schizophrenia, and they cannot be due to intoxication with drugs or alcohol. Further, the symptoms cannot be an adverse reaction to a medication, and they cannot be caused by a physical injury or medical illness.

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