- Last edited on January 2, 2022
Brief Psychotic Disorder
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):
- Delusions
- Hallucinations
- Disorganized speech (e.g., frequent derailment or incoherence)
- Grossly disorganized or catatonic behaviour
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 DisordersComparison 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
- Endrocrine: hypothyroidism/Cushing disease
- Metabolic: Tay‐Sachs/Niemann‐Pick
- Autoimmune: Lupus/Hashimoto encephalopathy
- Infections: Neurosyphilis/HIV infection
- Seizures: Temporal lobe epilepsy
- Space occupying lesions
- Multiple sclerosis, Huntington's disease, nutritional deficiencies