Do Those with a Brief Psychotic Disorder Often Turn to Drugs or Alcohol?
By definition, brief psychotic disorder involves a sudden onset of psychotic behavior and lasts less than one month with the person returning to their full functioning. The disorder can last from less than a day to less than one month, but its duration cannot extend beyond 30 days.
The American Psychiatric Association (APA) does report that in undeveloped countries, it is more common for the transient symptoms of psychosis to remain active for 1–6 months. This would garner a different diagnosis of schizophreniform disorder, according to DSM–5 diagnostic criteria.
Symptoms of Brief Psychotic Disorder
There may be high rates of relapse of psychotic disorders in individuals who are diagnosed with brief psychotic disorder, but typically, these relapses are triggered by some event and resolved within 30 days. The notion of a sudden onset means that the person develops psychotic symptoms within two weeks of expressing psychotic-like behaviors and does not demonstrate any particular warning signs that they are about to have a psychotic break.
According to APA, there is set diagnostic criteria associated with brief psychotic disorder.
- Exhibiting one or more of the listed psychotic-type symptoms:
- Delusions, which are fixed beliefs that are often bizarre and false despite significant evidence that they are not true
- Hallucinations, which are sensory experiences that do not really exist, such as seeing things that are not there or hearing things that are not there
- Disorganized speech, which includes psychotic speech or speech that is totally incoherent, continually going off on tangents, and other specific diagnosable issues with speech patterns
- Disorganized behavior or catatonic behavior, which includes unproductive and seemingly useless behaviors or being frozen in fixed postures
- Duration of psychosis that is at least 24 hours but less than one month and returning to previous level of functioning within this period of time
- A psychosis that cannot be better explained by some other psychological condition, medical condition, or the effects of substance use
At least one of the symptoms must be delusions, hallucinations, or disorganized speech for a formal diagnosis of brief psychotic disorder to be made. The disorder can occur as a result of a significant stressor, without any significant stressor, or within four weeks of giving birth to a child (postpartum onset). Depending on the severity of the person’s issues, a clinician can also specify how severe the disturbance is.
It is important to understand that brief psychotic disorder cannot be the result of the effects of drugs or alcohol as this would be a different diagnosis (substance/medication-induced psychotic disorder) or as a result of a medical condition like a head injury, stroke, or some other condition (psychotic disorder due to another medical condition).
Other Features of the Disorder
According to APA, brief psychotic disorder is relatively rare and accounts for less than 10 percent of all cases of first-time onset of psychotic behaviors. It is two times more common in females than it is males, and it can appear at any time across one’s lifespan, but the average age of individuals who have the disorder is around 30.
By definition, the disorder must be fully remitted within 30 days of its onset, thus it is a temporary condition can resolve without treatment, even though the psychotic symptoms may be treated by physicians (psychiatrists) with medications. The overall outcome of individuals that develop brief psychotic disorder is considered to be good, thus there are typically no long-term issues with the person’s functioning as a result of their brief psychosis.
There are numerous ways for clinicians to distinguish between brief psychotic disorders and other related types of disorders. For instance, laboratory tests could rule out psychosis due to the use of drugs, a physical examination could rule out medical causes of the psychosis, and a significant clinical examination and observation of the person could help to rule out other types of psychotic disorders. In some instances, making a differentiation between brief psychotic disorder and other forms of psychosis can be difficult, but the disorder always dissipates within one month of onset whether or not the person gets treatment.
Brief Psychotic Disorder and Substance Abuse
Because brief psychotic disorder is a time-limited disorder that fully remits within 30 days, APA does not list different comorbidities for this disorder (other mental health disorders that can co-occur with brief psychotic disorder). There is a large body of evidence indicating that individuals who have first-time psychotic disorders are often at a greater risk to have some type of lifetime substance use disorder, such as a tobacco use disorder, alcohol use disorder, or stimulant use disorder. However, the research is often cluttered by a significant number of individuals who have substance abuse issues prior to their first experience of psychotic breaks, and often, there is little differentiation between chronic issues with psychosis and brief psychotic disorder.
The research on the experience of perceived trauma and substance abuse indicates that there is an increased risk for individuals who experience trauma to have higher rates of substance abuse issues than individuals who do not have these experiences. In these cases, individuals who initially expressed psychotic symptoms that resolved within 30 days, but later met the diagnostic criteria for a trauma- or stressor-related disorder would have a higher risk of developing substance abuse issues. Such a subset of individuals would represent a small percentage. The information provided by APA suggests that the majority of individuals diagnosed with brief psychotic disorder return to full functioning and their prognosis is good.
Research supports the claims by APA. A meta-analytic study reported in the Journal of the American Medical Association (JAMA) indicated that the prognosis for brief psychotic disorder is better than for other first episode psychosis-related issues. There were no significant findings of later substance abuse issues in this group.
Meta-analysis is a research technique that is able to combine the effects of similar studies and determine the overall picture of an issue based on numerous studies. Meta-analytic studies are considered to have better quality conclusions than single studies alone.
One of the issues that disqualifies an individual from being diagnosed with brief psychotic disorder is that the effects of drugs and alcohol cannot account for the psychotic episode. Thus, in this meta-analysis, there was no relationship between brief psychotic disorder and substance abuse.
Moreover, the National Drug and Alcohol Research Centre (NDARC), an organization that researches issues associated with substance abuse and other mental health issues, reports that individuals who develop psychotic symptoms will often resort to the use of drugs or alcohol in an effort to “self-medicate” their issues. However, they offer no prevalence figures for substance abuse associated with individuals who are diagnosed with brief psychotic disorder.
While it is possible that an individual who develops brief psychotic disorder may attempt to address their initial symptoms with the use of alcohol or drugs, there are no reliable prevalence rates to determine how often this may actually occur in this subset of individuals. Moreover, because by definition the disorder must resolve within 30 days and the person must return to their previous level of functioning, only individuals with substance abuse issues prior to the onset of brief psychotic disorder would continue to have substance abuse issues after the disorder resolves.
In individuals who develop brief psychotic disorder as an initial reaction to severe trauma, there could be an increased risk for the development of substance abuse later, after the person has returned to their normal level of functioning and developed a different mental health disorder. However, if the individual is presenting with psychotic symptoms as a result of experiencing perceived stress and is initially diagnosed with a trauma- or stressor-related disorder, then by definition they would not be diagnosed with brief psychotic disorder. This is because the psychosis associated with brief psychotic disorder cannot be better explained by the presence of some other mental health disorder. Therefore, someone that is expressing psychotic symptoms as well as the symptoms of a trauma- and stressor-related disorder would most likely not be given a diagnosis of brief psychotic disorder.
It should be noted that in a subset of individuals who experience post-traumatic stress disorder (PTSD), the onset of the symptoms can occur much later and long after the person’s experience of the traumatic event. If the PTSD symptoms do not occur until at least six months after the experience of the event, then the individual would be diagnosed with PTSD with delayed expression).
One can imagine a situation where a person experiences a very stressful event, develops brief psychotic disorder, the psychosis resolves within 30 days, and then much later, the person begins to display the symptoms of PTSD. It is quite possible that these individuals, however rare the situation may be, would be at an increased risk for the development of substance abuse issues because of the strong relationship between substance abuse and trauma- and stressor-related disorders like PTSD.