Brief Psychotic Disorder

Primer

Brief Psychotic Disorder is a psychotic disorder that involves at least one positive psychotic symptom (delusions, hallucinations, disorganized speech), and/or grossly abnormal psychomotor behaviour, including catatonia. The symptoms must characteristically last for at least 1 day but no longer than 1 month. Individuals with brief psychotic disorder typically experience emotional turmoil or overwhelming confusion, and the although the duration can be brief, the symptoms may be severe (e.g., poor judgment, cognitive impairment, or acting on delusions). A diagnosis of brief psychotic disorder requires a full remission of all symptoms and a full return to the premorbid level of functioning within 1 month of the onset of the disturbance.

Epidemiology
  • Brief psychotic disorder may appear in adolescence or early adulthood, and onset can occur across the life span
    • The average age at onset is in the mid-30s.[1]
  • Brief psychotic disorder may account for up to 7% of cases of first-episode psychosis according to some epidemiological studies.[2]
    • Some of these cases are a prodrome, and evolve into a future diagnosis of schizophrenia.
Prognosis
  • About 50% of individuals with a brief episode of psychosis experience a relapse.[3]
    • Despite this, for most individuals, most individuals retain good social functioning and symptom control.
Comorbidity
  • There appears to be an increased risk of suicidal behaviour, particularly during the acute episode.

DSM-5 Diagnostic Criteria

Criterion A

Presence of at least 1 of the following symptoms. At least 1 of these must be (1), (2), or (3):

  1. Delusions
  2. Hallucinations
  3. Disorganized speech (e.g., frequent derailment or incoherence)
  4. Grossly disorganized or catatonic behaviour
Do not include a symptom if it is a culturally sanctioned response.
Criterion B

Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual full return to premorbid level of functioning.

Criterion C

The disturbance is not better explained by major depressive or bipolar disorder with psychotic features or another psychotic disorder such as schizophrenia or catatonia, and is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

Specifiers

Specifiers

Specify if:

  • With marked stressor(s) (brief reactive psychosis): If symptoms occur in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the individual’s culture.
  • Without marked stressor(s): If symptoms do not occur in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the individual’s culture.
  • With postpartum onset: If onset is during pregnancy or within 4 weeks postpartum.
  • With catatonia

Severity Specifier

Specify current severity:

  • Severity is rated by a quantitative assessment of the primary symptoms of psychosis, including delusions, hallucinations, disorganized speech, abnormal psychomotor behaviour, and negative symptoms.
  • Each of these symptoms may be rated for its current severity (most severe in the last 7 days) on a 5-point scale ranging from 0 (not present) to 4 (present and severe). (Refer to DSM-5 chapter “Assessment Measures”, and the Clinician-Rated Dimensions of Psychosis Symptom Severity)

Comparison of Psychotic Disorders

The term psychosis has been defined in various ways in the medical literature over time. The narrowest and current definition of psychosis is hallucinations and delusions, with the lack of reality testing or insight. A broader definition of psychosis would also include disorganized thought, emotions, and behaviour. This loose definition was more common in the past, and schizophrenia was often overdiagnosed as a result.

DSM-IV to DSM 5 Psychotic Disorder Criteria Changes

Substance Abuse and Mental Health Services Administration. Table 3.20, DSM-IV to DSM-5 Psychotic Disorders

Comparison of Psychotic Disorders

Type Onset Length Psychotic Symptoms Mood Symptoms Functional Decline?
Brief psychotic disorder Sudden 1 day to 1 month At least 1 of:
• Delusions
• Hallucinations
• Disorganized speech
• Grossly disorganized or catatonic behaviour 		No Full resolution of symptoms
Schizophreniform disorder Can be prodromal 1 month to 6 months At least 2 of:
• Delusions
• Hallucinations
• Disorganized speech
• Grossly disorganized or catatonic behaviour
• Negative symptoms 		No Not required
Schizophrenia Can be prodromal > 6 months At least 2 of:
• Delusions
• Hallucinations
• Disorganized speech
• Grossly disorganized or catatonic behaviour
• Negative symptoms 		No Required
Schizoaffective disorder Can be prodromal Major mood episode
+ 2 weeks of isolated psychotic symptoms + predominantly mood symptoms over course of illness 		• Delusions or hallucinations for 2 or more weeks, which must be in absence of a major mood episode (depressive or manic) during the lifetime duration of the illness Required Not required
Delusional disorder Can be prodromal > 1 month • One or more delusions, with no other psychotic symptoms. No Normal function aside from impact of delusions

Differential Diagnosis

References

1) American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
2) American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
3) American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.