Sometimes, it appears, life outmatches the mind, and chaos reigns where a normal functioning mind once stood tall. Typically, these psychotic events are short lived, and normal cognitive functions return with a few days or weeks. These brief moments of psychosis are referred to by the DSM-V as Brief Psychotic Disorder (BPD). In Europe, similar symptoms are identified in the ICD-10 as Acute and Transient Psychotic Disorders (ATPD).
Patients diagnosed with brief psychotic disorder typically experience schizophrenia like symptoms (delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior).
Brief Psychotic Disorder and Trauma
Originally, DSM-III symptomology included precipitating stress as a mandatory criterion for a diagnosis of “brief reactive psychosis.” DSM-IV and DSM-5 removed the stress criterion and renamed the condition “brief psychotic disorder” (Valdés-Florido et. al., 2022).
However, just because the stress criterion has been removed does not suggest it isn’t a common instigator. Stress still is a common factor leading up to the brief psychotic events.
Brief psychotic disorder often fits well with the diathesis stress model. T. Franklin Murphy describes the diathesis stress model as “a psychological theory that disorders develop as a result of interactions between pre-dispositional vulnerabilities (the diathesis), and stress caused by life experiences” (2021).
Unfortunately, I have brought two family members to the emergency room over the last five years who were experiencing schizophrenia like symptoms. Not surprizingly, both were in the midst of an extremely stressful situation preceding the onset of symptoms. Despite the frightening symptoms, both completely recovered within a few weeks.
It is a little scary to see someone who was functioning normal one day and the next is hallucinating. The amazing power of the brain fascinates and frightens.
Because of the brief period of symptoms and fluctuating criteria to diagnose the disease, little is known about the epistemology. However, as much as 11% of all first time admissions for psychiatric events is due to brief psychotic disorder (Valdés-Florido et. al., 2022).
A Case Study
A 36 year old woman healthy woman with no personal or family history of mental illness, experienced prominent persecutory delusions and decreased sleep, four days after the onset of upper respiratory symptoms associated with a COVID-19 diagnosis. The delusions subsided shortly after recovering from the COVID-19 symptoms (Smith, et al., 2020).
Brief Psychotic Disorder and COVID-19
A sharp increase of people presenting brief psychotic symptoms emerged during the COVID-19 pandemic. Most of the cases involved people who did not contract the illness but experienced extreme anxiety because of the epidemic.
A recent study identified 33 people that met the brief psychotic disorder according to the DSM-V criteria. Their psychosis was believed to be triggered by the coronavirus outbreak. Of those 33, “almost half of the patients had first-rank symptoms of schizophrenia and high prevalence of suicide symptoms during the scute phase of psychosis” (Valdés-Florido et. al., 2022).
Suicidal tendencies are often heightened during brief psychotic disorder, not just those suffering from the disorder because of COVID-19. Several studies have found a significant higher incidence of suicide attempts and suicide ideation during brief psychotic disorder than occurs among the general population (Sher, 2015).
Possible Biological Correlates
If the diathesis stress model is an accurate model for brief psychotic disorder, then one would expect in many of the cases the presence of a genetic or biological vulnerability would be associated. Identifying a genetic marker for the disorder could identify higher risk people. We can address mounting anxiety early when we know of a proneness to the illness.
Scientist Hua Li and Szabolcs Kéri conducted brain scan research in search of any associated differences between those who have suffered brief psychotic disorder and a control group that have not.
Scientists recruited 30 patients to explore the possibility of structural brain abnormalities in brief psychotic disorder. The study followed 30 patients with BPD in clinical remission and 30 matched healthy controls. They observed “a select volume reduction in the frontal cortex in BPD, including the caudal/rostral middle frontal, superior frontal, and frontal polar regions.” They further noted that the “smaller frontal volumes were associated with one of the most important clinical features of BPD, that is, the number of recurrent episodes without conversion to schizophrenia or other long-lasting psychotic disorders” (2020). Like most cognitive diseases, there is an organic componenet involved.
The associated brain volume doesn’t necessarily mean it causes the episodes. However, it does create a curiosity that motivates continued research. Regardless, hope remains that new discoveries may lead to a preventive treatment for these life disrupting psychotic episodes. When a person suffers intermittent psychotic episodes, the condition is often diagnosed as Brief Limited Intermittent Psychotic Symptoms or BLIPS. If the hypothesis of brain volume is correct, a brain scan would be able to differentiate from a one time event such as brief psychotic disorder and the higher risk state of brief limited intermittent psychotic symptoms.
A Few Closing Remarks
This disorder has not received much attention because of its transient state. Hopefully, with increases in world tension, and a higher prevalence of disrupting brief psychotic episodes, more attention will follow. Consequently, more attention leads to helpful preventive care for those most vulnerable.
Resources:
Li, H., & Kéri, S. (2020). Regional brain volumes in brief psychotic disorder. Journal of Neural Transmission, 127(3), 371-378.
Murphy, T. Franklin (2021). Diathesis Stress Model. Psychology Fanatic. Published 9-7-2021. Retrieved 8-24-2022.
Sher, L. (2015). Brief psychotic disorder and suicidal behavior. Australian and New Zealand Journal of Psychiatry, 49(6), 578-578.
Smith, C., Komisar, J., Mourad, A., & Kincaid, B. (2020). COVID-19-associated brief psychotic disorder. BMJ Case Reports, 13(8),
Valdés-Florido, María José, Álvaro López-Díaz, Fernanda Jazmín Palermo-Zeballos, Nathalia Garrido-Torres, Paula Álvarez-Gil, Iván Martínez-Molina, Victoria Eugenia Martín-Gil, Elena Ruiz-Ruiz, Macarena Mota-Molina, María Paz Algarín-Moriana, Antonio Hipólito Guzmán-del Castillo, Ángela Ruiz-Arcos, Rafael Gómez-Coronado, Sara Galiano-Rus, Alfonso Rosa-Ruiz, Juan Luis Prados-Ojeda, Luis Gutierrez-Rojas, Benedicto Crespo-Facorro, and Miguel Ruiz-Veguilla. (2022). Clinical characterization of brief psychotic disorders triggered by the COVID-19 pandemic: a multicenter observational study. European Archives of Psychiatry and Clinical Neuroscience 272.1 5-15.
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