Brief Psychotic Disorder 

  • Author: Mohammed A Memon, MD; Chief Editor: David Bienenfeld, MD   more...
 
Updated: Jan 17, 2012
 

Background

In 1913, Karl Jaspers described specific criteria for the diagnosis of reactive psychosis, including the presence of an identifiable and extremely traumatic stressor, a close relation between the stressor and the development of psychosis, and a generally benign course for the psychotic episode.

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) describes brief psychotic disorder based primarily on duration of symptoms. DSM-IV defines brief psychotic disorder as an illness lasting from 1 day to 1 month, with an eventual return to the premorbid level of functioning.[1]

The diagnosis has been better appreciated and more completely studied in Scandinavia and other western European countries than in the United States.

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Pathophysiology

Some data suggest increased incidence of mood disorders in families of patients with brief psychotic disorder. Psychodynamic theories suggest that the psychotic symptoms occur because of inadequate coping mechanisms, as a defense against prohibited fantasy, or as an escape from a specific psychological situation or an overwhelming stressful circumstance. It must be understood that the individual perceives the stress as totally overwhelming. Neither biological nor psychological theories have been validated by carefully controlled clinical studies.

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Epidemiology

Frequency

United States

Brief psychotic disorder is not common. According to one follow-up study of 221 first-admission patients with affective and nonaffective psychoses, only 20 (9%) of the 221 experienced brief psychoses, and only 7 (3%) experienced acute brief psychoses.

International

According to an international epidemiologic study, in contrast to schizophrenia, incidence of nonaffective acute remitting psychoses was 10-fold higher in developing countries than in industrialized countries.[2] Some clinicians believe that the disorder may most frequently occur in patients from low socioeconomic classes, patients with preexisting personality disorders, and immigrants.

In nonindustrialized countries, such terms as yak, latah, koro, amok, and whitiligo have been used to describe psychotic states precipitated by stressful events. These and several similar cultural terms are now considered to be culture-bound syndromes.

Mortality/Morbidity

As with any other psychotic episode, the risk of harm to self and/or others increases with an acute episode of brief psychotic disorder.[3]

Sex

According to an international epidemiologic study, incidence of the disorder was 2-fold higher in women than in men.[2] Study reports in the United States indicate even higher incidence in women than in men.

Age

The disorder is more common in patients late in the third to early in the fourth decade of life. Cases have also been recognized later in life.

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Contributor Information and Disclosures
Author

Mohammed A Memon, MD  Chairman and Attending Geriatric Psychiatrist, Department of Psychiatry, Spartanburg Regional Medical Center

Mohammed A Memon, MD is a member of the following medical societies: American Association for Geriatric Psychiatry, American Medical Association, and American Psychiatric Association

Disclosure: Nothing to disclose.

Coauthor(s)

Michael F Larson, DO  Clinical Instructor, Department of Child and Adolescent Psychiatry, Harvard Medical School; Psychiatrist, Harvard Vanguard Medical Associates and Private Practice

Michael F Larson, DO is a member of the following medical societies: American Academy of Addiction Psychiatry, American Academy of Child and Adolescent Psychiatry, and American Society of Addiction Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Alan D Schmetzer, MD  Professor Emeritus, Interim Chairman, Vice-Chair for Education, Associate Residency Training Director in General Psychiatry, Fellowship Training Director in Addiction Psychiatry, Department of Psychiatry, Indiana University School of Medicine; Addiction Psychiatrist, Midtown Mental Health Cener at Wishard Health Services

Alan D Schmetzer, MD is a member of the following medical societies: American Academy of Addiction Psychiatry, American Academy of Clinical Psychiatrists, American Academy of Psychiatry and the Law, American College of Physician Executives, American Medical Association, American Neuropsychiatric Association, American Psychiatric Association, and Association for Convulsive Therapy

Disclosure: Eli Lilly & Co. Grant/research funds Other

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Harold H Harsch, MD  Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin

Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: lilly Honoraria Speaking and teaching; Forest Labs None None; Pfizer Grant/research funds Speaking and teaching; Northstar None None; Novartis Grant/research funds research; Pfizer Honoraria Speaking and teaching; Sunovion Speaking and teaching; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research; Merck Honoraria Speaking and teaching

Chief Editor

David Bienenfeld, MD  Professor of Psychiatry, Vice-Chair and Director of Residency Training, Department of Psychiatry, Wright State University, Boonshoft School of Medicine

David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, and Association for Academic Psychiatry

Disclosure: Nothing to disclose.

References

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Washington DC:. American Psychiatric Press;2000.

  2. Susser E, Wanderling J. Epidemiology of nonaffective acute remitting psychosis vs schizophrenia. Sex and sociocultural setting. Arch Gen Psychiatry. Apr 1994;51(4):294-301. [Medline].

  3. Jorgensen P, Mortensen PB. Reactive psychosis and mortality. Acta Psychiatr Scand. Mar 1990;81(3):277-9. [Medline].

  4. Chaudron LH, Pies RW. The relationship between postpartum psychosis and bipolar disorder: a review. J Clin Psychiatry. Nov 2003;64(11):1284-92. [Medline].

  5. [Best Evidence] Valdimarsdottir U, Hultman CM, Harlow B, Cnattingius S, Sparen P. Psychotic illness in first-time mothers with no previous psychiatric hospitalizations: a population-based study. PLoS Med. Feb 10 2009;6(2):e13. [Medline].

  6. Jorgensen P, Bennedsen B, Christensen J, Hyllested A. Acute and transient psychotic disorder: comorbidity with personality disorder. Acta Psychiatr Scand. Dec 1996;94(6):460-4. [Medline].

  7. Karagianis JL, Dawe IC, Thakur A, et al. Rapid tranquilization with olanzapine in acute psychosis: a case series. J Clin Psychiatry. 2001;62 Suppl 2:12-6. [Medline].

  8. Brook S, Lucey JV, Gunn KP. Intramuscular ziprasidone compared with intramuscular haloperidol in the treatment of acute psychosis. Ziprasidone I.M. Study Group. J Clin Psychiatry. Dec 2000;61(12):933-41. [Medline].

  9. Correll CU, Smith CW, Auther AM, McLaughlin D, Shah M, Foley C, et al. Predictors of remission, schizophrenia, and bipolar disorder in adolescents with brief psychotic disorder or psychotic disorder not otherwise specified considered at very high risk for schizophrenia. J Child Adolesc Psychopharmacol. Oct 2008;18(5):475-90. [Medline].

  10. Beighley PS, Brown GR, Thompson JW Jr. DSM-III-R brief reactive psychosis among Air Force recruits. J Clin Psychiatry. Aug 1992;53(8):283-8. [Medline].

  11. Jablensky A, Sartorius N, Ernberg G, et al. Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study. Psychol Med Monogr Suppl. 1992;20:1-97. [Medline].

  12. Jauch DA, Carpenter WT Jr. Reactive psychosis. I. Does the pre-DSM-III concept define a third psychosis?. J Nerv Ment Dis. Feb 1988;176(2):72-81. [Medline].

  13. Jauch DA, Carpenter WT Jr. Reactive psychosis. II. Does DSM-III-R define a third psychosis?. J Nerv Ment Dis. Feb 1988;176(2):82-6. [Medline].

  14. Johnson FA. African perspective on mental disorder. In: Mezzich JE, Honda Y, Kastrup MC, eds. Psychiatric Diagnosis: A World Perspective. New York, NY: Springer Verlag; 1994.

  15. Jorge MR, Mezzich JE. Latin American contributions to psychiatric nosology and classification. In: Mezzich JE, Honda Y, Kastrup MC, eds. Psychiatric Diagnosis: A World Perspective. New York, NY: Springer Verlag; 1994.

  16. Jorgensen P, Jensen J. An attempt to operationalize reactive delusional psychosis. Acta Psychiatr Scand. Nov 1988;78(5):627-31. [Medline].

  17. Karno M, Jenkins JH. Cultural considerations in the diagnosis of schizophrenia and related disorders and psychotic disorders not otherwise classified. In: TA Widiger, ed. DSM-IV Source Book. Washington DC: American Psychiatric Press; 1994.

  18. Lin KM. Cultural influences on the diagnosis of psychotic and organic disorders. In: Mezzich JE, Kleinman A, Horacio F, Parron DL, eds. Culture and Psychiatric Diagnosis: A DSM-IV Perspective. Washington DC: American Psychiatric Press; 1996.

  19. Mezzich JE, Lin KM. Acute and transient psychotic disorders and culture-bound syndromes. In: Sadock BJ, Sadock VA, eds. Kaplan and Sadock's Comprehensive Textbook of Psychiatry. 6th ed. Baltimore, Md: Lippincott Williams & Wilkins; 1995:1049.

  20. Pull CB, Chaillet G. The nosological views of French-speaking psychiatry. In: Mezzich JE, Honda Y, Kastrup MC, eds. Psychiatric Diagnosis: A World Perspective. New York, NY: Springer Verlag; 1994.

  21. Vanderhart O, Witztum E, Friedman B. From hysterical psychosis to reactive dissociative psychosis. J Trauma Stress. 1993;6:43.

 
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