Brief Psychotic Disorder

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). (See Clinician-Rated Dimensions of Psychosis Symptom Severity in the chapter “Assessment Measures.”)

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
What is psychosis?

Comparison

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