Brief Psychotic Disorder

What Causes Brief Psychotic Disorder?

Scientists don’t know precisely why some people experience psychotic symptoms in reaction to trauma. Psychotic episodes likely arise as part of a complex brain chemical reaction to the event, and the precise mechanism of the chemical process probably varies from person to person.

Is Brief Psychotic Disorder Hereditary?

There is no clear evidence that susceptibility to DIP is inherited. However, there is a complex association between brief psychotic disorder and other psychotic disorders, which may have an inherited component. Brief psychotic disorder is also more common in people with a family history of mood disorders such as depression or bipolar disorder, suggesting a possible genetic link between these disorders.

How Is Brief Psychotic Disorder Detected?

Brief psychotic disorder can be challenging to identify because its symptoms are similar to other mental health-related issues. Some drugs may also have effects, such as causing hallucinations, that are not in themselves evidence of psychosis. The only definite differentiating factors between BPD and other psychotic disorders are the duration of symptoms and their triggers.

Because BPD symptoms are often intense, have a rapid onset, and can have life-threatening consequences, it is crucial to seek medical attention immediately when someone experiences psychotic symptoms.

How Is Brief Psychotic Disorder Diagnosed?

A doctor with experience in diagnosing mental illnesses may diagnose brief psychotic disorder. The Diagnostic and Statistical Manual of Mental Disorders (DSM) includes diagnostic criteria providers can use to diagnose brief psychotic disorder. The criteria include:

• The person has experienced hallucinations or delusions. Other psychotic symptoms may be present as well.
• The symptoms persist for at least a day but resolve on their own in less than a month.
• The symptoms aren’t better explained by a mental disorder or substance use.
• The symptoms cause significant distress or impairment.

PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.

How Is Brief Psychotic Disorder Treated?

BPD symptoms resolve completely within a month, even without treatment. However, because the potential consequences of psychotic symptoms are severe, treatment may be required during the course of the disorder.

In some cases, anti-anxiety or antipsychotic drugs may be administered to control the psychotic symptoms during episodes. These medications are usually the same used to treat schizophrenia and may include:

• First-generation antipsychotics. These drugs include chlorpromazine, fluphenazine, haloperidol, and perphenazine. These drugs are often available at a lower cost than newer medications, but they also come with the risk of potentially serious side effects.
• Second-generation antipsychotics. These newer drugs include aripiprazole, asenapine, brexpiprazole, cariprazine, clozapine, iloperidone, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, and ziprasidone. These medications tend to have fewer side effects than older antipsychotics.

In some cases, symptoms may recur after the initial episode, and many people with BPD also suffer from other underlying mental health-related issues. In these cases, ongoing treatment may be recommended, including:

• Psychotherapy such as cognitive-behavioral therapy
• Counseling or rehabilitation for underlying addiction or substance use disorders
• Treatment for underlying mental health-related issues

How Does Brief Psychotic Disorder Progress?

By definition, brief psychotic disorder is a temporary condition. In most cases, its symptoms resolve within weeks and do not recur. However, if symptoms last longer than a month, schizophreniform is a possible diagnosis, and if symptoms last at least six months, doctors may consider a diagnosis of schizophrenia.

Although BPD symptoms are temporary, they can produce potentially serious consequences. Therefore, people experiencing BPD symptoms may be a danger to themselves or others, and prompt medical attention is vital to avoid potentially harmful situations.

How Is Brief Psychotic Disorder Prevented?

There is no known way to prevent brief psychotic disorder.

Brief Psychotic Disorder Caregiver Tips

Some people with brief psychotic disorder also suffer from other brain and mental health-related issues, a condition called co-morbidity. Here are a few of the disorders commonly associated with BPD:

• Alcoholism and other substance use disorders may be more common in people who have experienced BPD.
• Many people with BPD also experience symptoms of anxiety or depression.
• People with BPD are more likely to have a personality disorder such as borderline personality disorder or paranoid personality disorder.

Brief Psychotic Disorder Brain Science

Scientists don’t know exactly what’s going on in the brains of people who experience psychotic symptoms. Research has provided some clues, though, and several different theories of possible sources of the symptoms have been developed.

Dopamine is a brain chemical that acts as a neurotransmitter, a substance that allows the brain’s nerve cells to communicate. Among other functions, dopamine helps us think and plan for the consequences of our actions. Scientists believe that dopamine plays a role in the symptoms of psychosis because drugs that block dopamine are often effective at treating schizophrenia. This suggests that excessive or abnormal dopamine processing in the brain could be a cause.

NMDA receptors are areas of brain cells that respond to the neurotransmitter glutamate. Some drugs, such as ketamine, affect these receptors and produce effects (hallucinations, etc.) similar to psychosis. This has led some researchers to believe a problem with NMDA receptors could underlie psychosis.

Some researchers believe that underdevelopment in the brain’s frontal cortex might play a role in psychosis. This part of the brain controls rational thought, planning, decision-making, memory, and many other conscious functions. People with psychotic symptoms sometimes exhibit thinning of the frontal cortex, leading some scientists to believe that this region plays a critical role in psychosis.

Brief Psychotic Disorder Research

Title: An Integrated Program for the Treatment of First Episode of Psychosis (RAISE ETP)

Stage: Completed

Principal investigator: John Kane, MD

Feinstein Institute for Medical Research

Manhasset, NY

Schizophrenia is a major mental illness characterized by psychosis, negative symptoms (e.g., apathy, social withdrawal, anhedonia), and cognitive impairment. Depression and substance abuse commonly co-occur. These individuals have impaired functioning in the areas of work, school, parenting, self-care, independent living, interpersonal relationships, and leisure time. Schizophrenia is the most disabling among adult psychiatric disorders, and its treatment accounts for a disproportionate share of mental health services.

This study is part of the National Institute of Mental Health’s Recovery After an Initial Schizophrenia Episode (RAISE) Project. The RAISE Project seeks to fundamentally change the trajectory and prognosis of schizophrenia through coordinated and aggressive treatment in the earliest stages of illness. This study, the RAISE Early Treatment Program (ETP), is one of the two independent research studies that NIMH has funded to conduct the NIMH RAISE Project. ETP is being supported in whole or in part with Federal funds from the American Recovery and Reinvestment Act of 2009 and the NIMH, National Institutes of Health, Department of Health and Human Services.

The ETP study aims to compare two early treatment interventions for adolescents and adults experiencing a first episode of psychosis. The clinical centers have been randomly allocated to offer one of the two treatment programs. Both treatment interventions are designed to provide a person with treatment soon after they experience the early signs of schizophrenia. Participants will be offered mental health services such as medication and psychosocial therapy. These strategies are all aimed at promoting symptom reduction and improving life functioning. Participation in this study will last between 2 and 3 years. All participants will first undergo an initial videoconference interview to confirm a diagnosis of schizophrenia, schizoaffective disorder, psychosis NOS, brief psychotic disorder, or schizophreniform disorder. Eligible participants will then be offered mental health services.

In addition to the mental health services, participants will participate in a series of research interviews. Participants will be interviewed every three months for the first six months and then every six months for up to 3 years. At the research visit, participants will complete an interview about their symptoms and general quality of life, complete questions about experiences with their illness, their vital signs will be measured, and a blood draw will be collected. During the initial, 12- and 24-month visits, participants will also complete a brief test that assesses skills such as memory, attention, and problem-solving. Participants will also have monthly telephone interviews about their illness and the services they have received.

Title: Targeting Physical Health in Schizophrenia: Physical Activity Can Enhance Life (PACE-life)

Stage: Completed

Principal investigator: David Penn, PhD

University of North Carolina

Chapel Hill, NC

Purpose: To develop and test the feasibility of an exercise intervention that combines group walking, activity tracking, and heart rate monitoring and determine its effectiveness on the physical and mental health of individuals with schizophrenia spectrum disorders.

Participants: 14 individuals with schizophrenia spectrum disorders.

Procedures (methods): During the baseline assessment, subjects will be provided with a Fitbit wristband and instructed on how to use it. During the first group session, subjects will be taught how to use their heart rate (on the Fitbit) to determine how fast subjects should walk (to achieve the appropriate exercise dosage). Information on proper care, usage, and how to determine the appropriate heart from the watch, which will be used to guide the intensity of the walk, will be provided to subjects and reviewed at each group session. For all clinic-based group sessions, subjects will arrive at the STEP clinic to meet the entire group and leaders and be reminded of the heart rate (HR) that corresponds with the intensity of that group session. Next, the group will go outside and walk for 30 minutes. At the completion of 30 minutes, everyone will go back into the clinic for water and a review of the walk. After the second group session of each week, subjects will receive weekly progress reports of their steps and minutes spent walking the prior week (obtained from Fitbit devices). During this session, subjects will also set individual goals for the upcoming week for both their “intensity walks” and total steps per day.

Title: Clinical Trial of Integrated Treatment Versus Standard Treatment in First Episode Psychosis

Stage: Recruiting

Principal investigator: Merete Nordentoft, PhD

Bispebjerg Hospital

Copenhagen, Denmark

The purpose of the study was to evaluate the effects of integrated treatment for patients with the first episode of psychotic illness. We conducted a randomized clinical trial in Copenhagen Hospital Corporation and Psychiatric Hospital Aarhus, Denmark. We included 547 patients with the first episode of schizophrenia spectrum disorder who had not received antipsychotic medication for more than 12 weeks.

Patients were randomized to integrated treatment or standard treatment. The integrated treatment lasted for two years and consisted of assertive community treatment with programs for family involvement and social skills training. Standard treatment offered contact with a community mental health center.

We wanted to study the effect on psychotic (hallucinations and delusions) and negative (lack of initiative, apathy, blunted affect) symptoms (each scored from 0 to a maximum of 5) at one and two years’ follow-up.

We found that integrated treatment improved clinical outcomes and adherence to treatment. The improvement in clinical outcome was consistent at one-year and two-year follow-ups. We will study further outcome measures such as social network, quality of life, depression, and suicidal behavior.