FGBNU NTsPZ. ‹‹Exogenous mental disorders››

Brief psychotic disorder is a short-term, time-limited mental illness. A person with brief psychotic disorder has at least one of the core symptoms of psychosis for a period of less than one month. Hallucinations, delusions, strange or lack of body movements (catatonic behavior), peculiar speech, and strange or noticeably inappropriate behavior are classic symptoms of psychosis that can result from brief psychotic disorder.

Determining the causes of the disease

Determining the causes of symptoms helps determine whether the illness is truly a short-term mental disorder. If psychotic symptoms, for example, result from a physical illness, a reaction to medication, or drug or alcohol intoxication, then the unusual behavior is not classified as a brief psychotic disorder. If hallucinations, delusions, or other psychotic symptoms occur during major clinical depression or bipolar (manic-depressive) disorder, a diagnosis of brief psychotic disorder is not made. The decision rules that enable the clinician to identify this symptom cluster as a brief psychotic disorder are outlined in the Diagnostic and Statistical Manuals of Mental Disorders of the leading psychiatric associations.

Positive symptoms of brief psychotic disorder

A person experiences a brief psychotic disorder always in combination with one or more “positive” psychotic symptoms. These psychotic symptoms are not “positive” in the everyday sense, that is, good or useful. The term "positive" in this context is used with a medical meaning: a factor is present that would not normally be expected, or a normal type of behavior is exhibited in its most extreme form. Positive symptoms of psychosis include hallucinations, delusions, strange body movements or lack of movement (catatonic behavior), strange speech and primitive behavior.

Hallucinations

Hallucinations are sensations that do not have a corresponding objective reality. Hallucinations can occur in various forms, paralleling human senses. Visual hallucinations involve the sense of sight, or seeing something. Auditory hallucinations—when a person hears voices or sounds that do not exist—are the most common. Sometimes, a hallucination may include both voices and some visual experiences; psychiatrists describe this condition as "auditory-visual hallucinations." Smelling non-existent odors or sensations on/under the skin are forms of somatic hallucinations. Somatic hallucinations can be defined as hallucinations of the body.

Mania

Mania is also a classic psychotic feature. Manias are firmly held by irrational and unrealistic beliefs that are extremely difficult to change, even when the person is exposed to evidence that contradicts his beliefs. The average person usually thinks of mania as a "paranoid" or "persecutive" state in which the person is overly suspicious and constantly feels persecuted. However, delusions may be grandiose, unjustified beliefs, involve complex love fantasies (erotomania), or have extreme and irrational overtones. Grandiose delusions are often tinged with religious colours; for example, a woman with mania may firmly believe that she is the Virgin Mary. In addition, delusions can be somatic. A somatic delusion is a person's strong belief about some characteristic or functioning of their body. An example is the condition of a person who refuses to eat because of the belief that his throat muscles are completely paralyzed and that he can only drink liquids, when in fact there is no real physical reason for not eating normally.

Other psychotic symptoms

Other psychotic symptoms that may occur in brief psychotic disorder include inappropriate or absent body movements (catatonia), unclear speech, and erratic or childish behavior. Catatonic behavior or stupor includes possible symptoms related to movement (catalepsy). A person with catalepsy may remain fixed in the same position for several hours at a time. Rapid or constantly repeated movements, frequent and strange grimaces, as well as unusual gestures are the opposite expression of catatonia.

In some cases of brief psychotic disorder, speech distortions may include words mixed together in an incoherent order, responses that are irrelevant to the context of the conversation, or echolalia, repetitions of another person's spoken words, repeated either immediately or after a delay of several minutes. up to several hours. Eccentric behavior can range from childlike behavior (singing or jumping in inappropriate circumstances) to unusual practices such as hoarding food or covering one's head and clothing with aluminum foil.

Of course, not all of these psychotic symptoms occur simultaneously in a person with a short-term mental disorder. Any set of positive psychotic symptoms may occur over varying periods of time, ranging from one day to a month.

Acute symptomatic psychoses often occur with transient stupefaction. Disorders of consciousness vary in depth, structure and duration. The most common syndromes are: stupor, delirium, amentia, twilight stupefaction, oneiroid. These disorders are possible in psychoses that develop both from somatic diseases and infections, and from poisoning.

Symptomatic psychosis is usually preceded by a short-term prodromal period with headache, lethargy or motor restlessness, emotional disorders (anxiety, fear, depression), sleep disturbances, hyperesthesia, i.e. signs of asthenic syndrome. According to some researchers, the particular severity of asthenic phenomena indicates a severe course of the disease. In some cases, mental disorders are limited to asthenic disorders, and psychosis does not develop.

If acute psychotic disorders occur, they last from several hours to 2-3 days. Most often this is confusion with a picture of delirium or epileptiform agitation.

At the onset of many infectious diseases, delirium occurs only at night and often once. For children (especially young children), the most typical states of clouded consciousness are a combination of deafness with short-term episodes of delirious and pre-delirious disorders. In very severe underlying illnesses, delirium lasts for several days and in particularly unfavorable cases may give way to amentia.

In case of severe intoxication, the clinical picture is dominated by stunning, which, with increasing severity of the general condition, can turn into stupor and then into a coma.

A twilight state of consciousness with epileptiform agitation occurs suddenly and is accompanied by sudden excitement and fear. The patient rushes about, runs away from imaginary pursuers, screams; there is an expression of horror on his face. Such psychosis usually ends just as suddenly. It is replaced by deep sleep, often stupor. Sometimes psychosis can develop into a picture of amentia, which is prognostically unfavorable. The duration of the described psychotic state often ranges from 30 minutes to 2 hours. Epileptiform excitation can occur in the initial period of the disease, preceding the full picture of the infectious disease.

In somatic (infectious and non-infectious) diseases without pronounced toxicosis (malaria, rheumatism, etc.), oneiric conditions are more often observed, which are usually short-term, and when leaving oneiric, asthenia comes to the fore.

In a number of cases, it is possible to develop conditions that only superficially resemble oneiroid - oneiroid-like states with

involuntary fantasizing, lethargy and detachment from the environment. At the same time, patients are correctly oriented in place, time and their own personality. This state can be interrupted by external influence (call, touch).

of oneiric (dreaming) states in acute symptomatic psychoses

with a predominance in the clinical picture of dream experiences with ordinary, less often with fantastic themes, when patients become passive participants in events. The structure of dream states also includes visual hallucinations. At the same time, patients feel like spectators or victims of violence, experiencing anxiety, fear or horror. Excitement is accompanied by confusion and fussiness.

Amentia syndrome in the structure of symptomatic psychoses usually occurs when an acute somatic illness or intoxication develops against the background of preliminary weakening of the body (starvation, extreme physical and mental exhaustion, previous chronic disease). In this regard, some authors consider amentia as a variant of delirium (delirium on “altered soil”). Recently, amentia syndrome in its classical form has practically never been encountered. are more often observed .

The most successful designation for such conditions seems to be
asthenic confusion
[Mnukhin S.S., 1963; Isaev D.N., 1964]. They are defined by a combination of confusion with pronounced exhaustion and inconsistency of thinking. The depth of stupefaction constantly and quickly changes, becoming greater or lesser under the influence of fatigue or rest, respectively, and sometimes spontaneously. During a conversation, it is usually possible to obtain correct answers only to the first questions, then the answers become confusing and confused; After rest, the ability to respond to the interlocutor is restored for a short time. In amentia-like states, orientation in the environment is incomplete. Fragmentary ideas of relationship, persecution, hypochondriacal statements, and isolated hallucinations are noted. Emotions are characterized by extreme lability: the affect of fear, anxiety, melancholy, and confusion quickly replace each other. These conditions are most characterized by severe asthenia and exhaustion of mental processes at the slightest stress. Asthenic confusion differs from amentia not only in the shallower depth of clouding of consciousness, but also in the extreme variability of the state - rapid fluctuations from deep clouding of consciousness to almost complete clarification.

Many foreign authors note that the syndromes of the exogenous type of reactions described by K. Bonhoeffer are now almost never found in their “pure” form, and peculiar “alloys” (W. Scheid), transitions from one syndrome to another, predominate. Quite often, especially in elderly patients, there are states of confusion with symptoms characteristic of exogenous types of reactions. English psychiatrists designate such conditions as “confusal states,” American psychiatrists as “acute brain syndrome,” and German psychiatrists as “acute states of confusion” (acute Verwirrtheitszustande).

Acute symptomatic psychoses can occur without clouding of consciousness, in the form of acute verbal hallucinosis. Such psychosis develops suddenly, with the appearance of verbal hallucinations of a commentary nature (usually in the form of dialogue), accompanied by confusion, anxiety and fear. In the future, hallucinations may acquire imperative content. In this state, patients, under the influence of hallucinatory experiences, commit dangerous actions towards others and themselves. Verbal hallucinosis worsens at night. A rapid influx of verbal hallucinations can lead to the development of so-called hallucinatory confusion.

The picture of symptomatic psychoses in acute poisoning (acute intoxication psychoses) is usually limited to a profound change in consciousness and convulsive seizures. If death does not occur, then these disorders completely disappear or are significantly smoothed out.

Upon recovery from acute symptomatic psychosis, phenomena of asthenia or states of emotional-hyperesthetic weakness (according to K. Bonhoeffer) of varying severity are observed. Patients are tired, incapable of prolonged stress, and quickly become exhausted during work, especially mental work. At the same time, they are irritable, capricious, touchy, self-centered, and require special attention. The mood is extremely unstable, with a tendency to depression; the phenomena of hyperesthesia are expressed. In children and adolescents, along with asthenia, psychopathic-like behavioral disorders, a tendency to fear, hypochondriacal and other neurotic disorders occur [Sukhareva G. E., 1974].

Basic criteria for brief psychotic disorder

Brief psychotic disorder is not a simple or sequential disorder with a single cause. Many things can trigger short-term experiences of psychotic symptoms, and there are several ways to diagnose their causes.

Early phase of schizophrenia

Because of the similarities between brief psychotic disorder and schizophreniform illness or schizophrenia, many doctors consider brief disorder to be a precursor to longer-term psychotic illness. Although the condition can only be identified in retrospect, brief psychotic disorder is often diagnosed as the initial illness when a person (who later develops schizophrenia) experiences their first "psychotic break."

Stress reaction

From time to time, under conditions of acute stress, even a mentally healthy person may experience temporary psychotic reactions. Sources of stress can be quite common events that many people experience during their lives, such as the death of a spouse or divorce. Severe stress may be more unusual, such as the result of combat, a natural disaster, or a hostage situation. A person usually returns to normal when stress is reduced or psychological support is provided.

Postpartum psychosis

In some susceptible women, dramatic hormonal changes during and shortly after childbirth can lead to a form of short-term psychosis, often classified as postpartum psychosis. Unfortunately, this condition is often mistakenly and incorrectly treated during the postpartum period. In the most severe cases, a mother may kill her child and/or commit suicide.

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Personality disorder

Individuals with personality disorders appear to be more susceptible to developing brief psychotic reactions in response to stress. A person with a personality disorder does not have effective coping mechanisms. When life becomes more complex and difficult, he may fall into a brief psychotic state.

Cultural and social factors

Culture is a very important factor in understanding mental health and psychological disorders, including brief psychotic disorder. The types of behavior that occur during a short-term mental disorder are highly dependent on the expectations and traditions of the individual's culture. Many cultures have some form of mental behavior whose feature is unique to that culture, and where most sufferers share similar patterns of behavior, causes, and locations, that meet the criteria for brief psychotic disorder. The latter is often caused by disorders unique to certain societies or groups.

On the other hand, while culture shapes the form of psychotic reaction, it also determines that this behavior should not be considered psychotic. The behavior of people from one culture will be seen as eccentric or psychotic by another.

Causes of development and types of acute psychosis

Statistically, women are more likely to develop various forms of psychosis than men. Based on the causes of the disease, acute psychosis can be of the following types:

Endogenous psychosis. The causes of the disease in this case lie in the human body itself: endocrine or neurological disorders, genetic predisposition, schizophrenia. This group also includes senile psychosis - in this case, the cause of the disease is age-related changes in the human body after 60 years (hypertension, atherosclerosis).
Exogenous psychosis. Its cause is external factors - severe stress, infectious diseases (influenza, tuberculosis, syphilis, and others), drugs. Alcohol ranks first among external causes - alcohol abuse can undermine even the most stable psyche.
Organic psychosis. In this case, organic brain disorders due to traumatic brain injury or tumors lead to the onset of the disease.

Sometimes it can be quite difficult to determine the initial cause of the development of the disease: the impetus could have been an external (exogenous) factor, which later led to the emergence of an internal (endogenous) cause.

In addition, there are many forms of acute psychosis; each form can be identified by specific symptoms of the disease. Below are just some of the most common forms of the disease:

Acute manic-depressive psychosis (or bipolar disorder). It is considered one of the most severe forms of the disease, in which the patient alternates between periods of severe depression (depressive phase) with periods of excessive excitability, when the patient does not sleep for days and does something tirelessly (manic phase).
Acute manic psychosis. The patient is in a state of chronic overexcitation.
Acute reactive psychosis. It occurs as a reaction of the human body to super-stress that threatens its life and health (earthquake, fire, etc.). This form of acute psychosis has the most favorable prognosis, and is most often eliminated with the disappearance of the traumatic situation itself.
Acute polymorphic psychosis. Its symptoms usually appear during adolescence (around 10-15 years), and can be a sign of incipient schizophrenia.

Once again, it must be emphasized that only some forms of acute psychosis are listed here. Their detailed classification is the domain of psychiatrists. Medical diagnosis and timely treatment are necessary for any form of psychosis. If we talk about acute psychosis, any acute condition is always easier to eliminate than a chronic one. In the absence of timely measures, the psyche receives irreversible consequences: a distorted perception of the world becomes chronic and becomes, in fact, part of a person’s personality.

Symptoms of brief psychotic disorder

Psychiatrists define three main criteria for brief psychotic disorder:

At least one positive symptom of psychosis from the following: delusions, hallucinations, disorganized speech, disorganized and catatonic behavior.

Psychotic symptoms occur for at least one day but less than one month, during which time there is a possible return to normal levels of functioning.

The symptoms are not biological or their influence is not related to another disorder, in other words, they are not part of a mood disorder, schizoaffective disorder or schizophrenia, and they do not occur as a result of drug or alcohol intoxication. Additionally, symptoms must not be caused by an adverse reaction to medications, physical injury, or medical illness.

Diagnosis of brief psychotic disorder

Using the criteria listed above, the identification of short-term mental disorder is relatively clear. However, an unusual aspect of the diagnosis of the disease is the emphasis on the length of time its symptoms are evident. Most mental health disorder diagnoses do not include the duration of symptoms as part of their definitions. However, the length of time is one of the main differences between the three different psychotic illnesses. Brief psychotic disorder involves a short duration of psychotic symptoms, ranging from one day to one month. Schizophreniform disorder also includes individual features of psychosis, but over a longer period (one month or more, but less than six months). Schizophrenia is diagnosed in people whose psychotic symptoms are not associated with physical illness, mood disorders, or substance abuse for six months or longer. Another factor complicating the diagnosis is the cultural and social context of psychotic symptoms. If these behaviors are culturally or religiously acceptable, and these behaviors occur in traditionally expected settings, such as religious worship or meditation, then a diagnosis of brief psychotic disorder will likely not be made.

Brief psychotic disorder

As the name suggests, brief psychotic disorder is a short-term illness with psychotic symptoms. Symptoms often appear suddenly but last less than one month, after which the person often makes a full recovery. There are three main forms of brief psychotic disorder:

Brief psychotic disorder with an apparent stressor (also called brief reactive psychosis): This type, also called brief reactive psychosis, occurs immediately after and often in response to trauma or severe stress, such as the death of a loved one, an accident, or attack or natural disaster. In most cases, brief psychotic disorder occurs as a reaction to a very exciting event.
Brief psychotic disorder without an obvious stressor: In this type, there is no visible trauma or stress as a trigger for the disorder.
Postpartum short-term psychotic disorder: This type of disorder occurs in women, usually within 4 weeks of giving birth.

What are the symptoms of brief psychotic disorder?

The most obvious symptoms are:

Hallucinations: Hallucinations are the sensory perception of things that are not really there, such as hearing voices, seeing things that are not there, or feeling sensations on the skin even though nothing is touching the body.
Delusional Ideas: These are erroneous beliefs that a person does not want to give up even if he is presented with facts that contradict them.

Other symptoms of brief psychotic disorder include:

Disorganized thinking
Speech or language that has no meaning
Strange behavior and clothing
Memory problems
Disorientation or confusion
Changes in eating and sleeping habits, energy levels, or weight
Inability to make decisions

What causes brief psychotic disorder?

The exact cause of brief psychotic disorder is not known. One theory suggests a genetic link. It is based on the fact that the disorder is more common in people whose family members have mood disorders such as depression or bipolar disorder. Another theory suggests that the disorder is associated with poor adaptive skills and appears as a defense or escape from a particularly frightening or stressful situation. These factors may create susceptibility to the development of brief psychotic disorder. In most cases, the disorder is then triggered by a major stress or traumatic event. For some women, the trigger for the disorder may be the birth of a child.

How common is brief psychotic disorder?

Brief psychotic disorder is rare. It usually first occurs in young adulthood (in your 20s or 30s) and is more common among women than men. People with personality changes—such as antisocial personality disorder or paranoid personality disorder—are more likely to develop brief psychotic disorder.

How is brief psychotic disorder diagnosed?

If symptoms are present, the doctor will complete a patient history chart and perform a clinical examination to determine the cause of the symptoms. Because there are no laboratory tests to specifically diagnose brief psychotic disorder, your doctor may use various tests, such as x-rays and blood tests, to rule out physical illness as the cause of your symptoms.

If the doctor does not find any physical cause for the symptoms, he or she may refer the patient to a psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illness. Psychiatrists use specially designed interviews and assessment programs to assess whether a patient has a psychotic disorder. A diagnosis of brief psychotic disorder is made when a person exhibits psychotic symptoms such as delusions, hallucinations and disorganized thinking for less than one month, after which the symptoms completely resolve.

How is brief psychotic disorder treated?

Treatment for brief psychotic disorder usually includes psychotherapy (a type of counseling) and/or medications. Hospitalization may be necessary if the symptoms are severe or if the person is at risk of harming themselves or others.

Medications: Antipsychotic medications may be prescribed to reduce or eliminate symptoms and end a short-term psychotic disorder. Common antipsychotics include: Thorazine, Prolixin, Haldol, Navane, Stelazine, Trilafon and Mellaril. The newer generation drugs, called atypical antipsychotics, are: Risperdal, Clozaril, Seroquel, Geodon and Zyprexa. Tranquilizers such as Ativan or Valium may be used if a person has very high levels of anxiety (nervousness) and/or trouble sleeping.
Psychotherapy: Psychotherapy helps identify and adapt to the situation or event that triggered the disorder.

What is the outlook for people with brief psychotic disorder?

Brief psychotic disorder, by definition, lasts less than one month, after which most people make a full recovery. Some patients may have recurrent episodes of psychotic symptoms, but this is rare.

Can brief psychotic disorder be prevented?

There is no known way to prevent brief psychotic disorder. However, early diagnosis and treatment can help reduce disruption to a person's life, family and friendships.

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Treatment of brief psychotic disorder

Antipsychotic drugs are very effective for brief psychotic episodes. A number of different antipsychotic drugs are used to stop acute psychotic episodes. Haloperidol is most often used if psychotic symptoms are accompanied by a state of frantic activity, which is often combined with anger or sadness; in an excited state, when the patient may harm himself or other people. In some psychotic conditions, haloperidol is often combined with other drugs that reduce anxiety (lorazepam) and inhibit behavior (diphenhydramine). In certain situations, antipsychotics are used daily in tablet, capsule, or liquid form for a longer period of time.

The most commonly used antipsychotics are olanzapine, quetiapine or risperidone. Hormonal medications may be prescribed for postpartum psychosis. Maintenance therapy may also be helpful in some situations.

Preventing brief psychotic disorder

For women who have experienced brief postpartum psychosis, one prevention option is to abstain from conceiving more children. If you have had postpartum psychosis in the past, your doctor may prescribe an antipsychotic treatment regimen for subsequent pregnancies. Severe stressors can cause short-term psychotic disorder in many cases. Thus, in response to identifiable extreme stressors such as natural disasters or terrorist attacks, social support and post-crisis counseling could prevent the development of brief psychotic disorder in sensitive individuals.

Disclaimer: The information provided in this article about brief psychotic disorder is intended to inform the reader only. It is not intended to be a substitute for advice from a healthcare professional.