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DSM-III

In DSM-III, this disorder is called Brief Reactive Psychosis

Diagnostic Criteria

A. Psychotic symptoms appear immediately following a recognizable psychosocial stressor that would evoke significant symptoms of distress in almost anyone.

B. The clinical picture involves emotional turmoil and at least one of the following psychotic symptoms:

  1. incoherence or loosening of associations
  2. delusions
  3. hallucinations
  4. behavior that is grossly disorganized or catatonic

C. The psychotic symptoms last more than a few hours but less than two weeks, and there is an eventual return to the premorbid level of functioning. (Note: The diagnosis can be made soon after the onset of the psychotic symptoms without waiting for the expected recovery. If the psychotic symptoms last more than two weeks, the diagnosis should be changed.

D. No period of increasing psychopathology immediately preceded the psychosocial stressor.

E. The disturbance is not due to any other mental disorder, such as an Organic Mental Disorder, manic episode, or Factitious Disorder with Psychological Symptoms.

Differential Diagnosis

Schizophreniform Disorder, Paranoid Disorder, Affective Disorder, and Atypical Psychosis

Although by definition this diagnosis is not made if the psychotic symptoms persist for more than two weeks, the diagnosis can be made soon after the onset of the disturbance without waiting for the expected recovery. If the psychotic symptoms last more than two weeks, the diagnosis should be changed to either Schizophreniform Disorder, Paranoid Disorder, Affective Disorder, or Atypical Psychosis.

Organic Mental Disorders

Organic Mental Disorders, particularly those involving Delirium, Organic Delusional Syndrome, or Intoxication, can be distinguished from this disorder only on the basis of historical or laboratory information that indicates a known organic factor.

Schizophreniform Disorder

Schizophreniform Disorder by definition requires a duration of more than two weeks, and frequently there is no precipitating psychosocial stressor.

Manic and major depressive episodes

Manic and major depressive episodes may follow a major psychosocial stressor. The diagnosis of a manic or major depressive episode preempts the diagnosis of Brief Reactive Psychosis, and should be made when the criteria for it are met whether or not it is associated with a psychosocial stressor.

Personality Disorders

Individuals with a Personality Disorder may, under stress, develop Brief Reactive Psychosis, in which case both diagnoses should be made.

Factitious Disorder

An episode of Factitious Disorder with Psychological Symptoms may have apparently psychotic symptoms and may also be precipitated by a psychosocial stressor, but in such cases there is evidence that the symptoms are under voluntary control.

Malingering

When Malingering present with apparently psychotic symptoms, there is usually evidence that the illness was feigned for an understandable goal.

DSM-IV

Diagnostic Criteria

A. Presence of one (or more) of the following symptoms:

  1. delusions
  2. hallucinations
  3. disorganized speech (e.g., frequent derailment or incoherence)
  4. grossly disorganized or catatonic behavior

Note: Do not include a symptom if it is a culturally sanctioned response pattern.

B. Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual full return to premorbid level of functioning.

C. The disturbance is not better accounted for by a Mood Disorder With Psychotic Features, Schizoaffective Disorder, or Schizophrenia and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Specify if:

  • With Marked Stressor(s) (brief reactive psychosis): if symptoms occur shortly after and apparently in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the person's culture
  • Without Marked Stressor(s): if psychotic symptoms do not occur shortly after, or are not apparently in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the person's culture
  • With Postpartum Onset: if onset within 4 weeks postpartum

Specifiers

The following specifiers for Brief Psychotic Disorder may be noted based on the presence of absence of precipitating stressors:

With Marked Stressor(s)

This specifier may be noted if the psychotic symptoms develop shortly after and apparently in response to one or more events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in that person's culture. This type of Brief Psychotic Disorder was called "brief reactive psychosis" in DSM-III-R. The precipitating event(s) may be any major stress, such as the loss of a loved one or the psychological trauma of combat. Determining whether a specific stressor was a precipitant or a consequence of the illness may sometimes be clinically difficult. In such instances, the decision will depend on related factors such as the temporal relationship between the stressor and the onset of the symptoms, ancillary information from a spouse or friend about level of functioning prior to the stressor, and history of similar responses to stressful events in the past.

Without Marked Stressor(s)

This specifier may be noted if the psychotic symptoms are not apparently in response to events that would be markedly stressful to almost anyone in similar circumstances in the person's culture.

With Postpartum Onset

This specifier may be noted if the onset of the psychotic symptoms is within 4 week postpartum.

Differential Diagnosis

Psychotic Disorder Due to a General Medical Condition or Substance-Related Disorders

A wide variety of general medical conditions can present with psychotic symptoms of short duration. Psychotic Disorder Due to a General Medical Condition or a delirium is diagnosed when there is evidence from the history, physical examination or laboratory tests that indicates that the delusions or hallucinations are the direct physiological consequence of a specific general medical condition (e.g., Cushing's syndrome, brain tumor). Substance-Induced Psychotic Disorder, Substance-Induced Delirium, and Substance Intoxication are distinguished from Brief Psychotic Disorder by the fact that a substance (e.g., a drug of abuse, a medication, or exposure to a toxin) is judged to be etiologically related to the psychotic symptoms. Laboratory tests, such as a urine drug screen or a blood alcohol level, may be helpful in making this determination, as may a careful history of substance use with attention to temporal relationships between substance intake and onset of the symptoms and the nature of the substance being used.

Other Psychotic Disorders and Mood Disorder With Psychotic Features

The diagnosis of Brief Psychotic Disorder cannot be made if the psychotic symptoms are better accounted for by a mood episode (i.e., the psychotic symptoms occur exclusively during a full Major Depressive, Manic, or Mixed Episode). If the psychotic symptoms persist for 1 month or longer, the diagnosis is either Schizophreniform Disorder, Delusional Disorder, Mood Disorder With Psychotic Features, or Psychotic Disorder Not Otherwise Specified, depending on the other symptoms in the presentation. The differential diagnosis between Brief Psychotic Disorder and Schizophreniform Disorder is difficult when the psychotic symptoms have remitted before 1 month in response to successful treatment with medication. Because recurrent episode of Brief Psychotic Disorder are rare, careful attention should be given to the possibility that a recurrent disorder (e.g., Bipolar Disorder, recurrent acute exacerbations of Schizophrenia) may be responsible for any recurring psychotic episodes.

Factitious Disorder and Malingering

An episode of Factitious Disorder, With Predominantly Psychological Signs and Symptoms, may have the appearance of Brief Psychotic Disorder, but in such cases there is evidence that the symptoms are intentionally produced. Malingering involves apparently psychotic symptoms, there is usually evidence that the illness was feigned for an understandable goal.

Personality Disorders

In certain individuals with Personality Disorders, psychological stressors may precipitate brief periods of psychotic symptoms. These are usually transient and do not warrant a separate diagnosis. If psychotic symptoms persist for at least 1 day, an additional diagnosis of Brief Psychotic Disorder may be appropriate.

DSM-5

Diagnostic Criteria

A. Presence of one (or more) of the following symptoms. At least one of these must be (1), (2), or (3): (Note: Do not include a symptom if it is a culturally sanctioned response.)

  1. Delusions.
  2. Hallucinations.
  3. Disorganized speech (e.g., frequent derailment or incoherence).
  4. Grossly disorganized or catatonic behavior.

B. Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual full return to premorbid level of functioning.

C. The disturbance is not better explained by major depressive or bipolar disorder with psychotic features or another psychotic disorder such as schizophrenia or catatonia, and is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

Specify if:

  • With marked stressor(s) (brief reactive psychosis): If symptoms occur in response events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the individual's culture.
  • Without marked stressor(s): If symptoms do not occur in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the individual's culture.
  • With postpartum onset: If onset is during pregnancy or within 4 weeks postpartum.

Specify if:

  • With catatonia (Note: Record catatonia associated with brief psychotic disorder to indicate the presence of the comorbid catatonia.)

Specify current severity:

Severity is rated by a quantitative assessment of the primary symptoms of psychosis, including delusions, hallucinations, disorganized speech, abnormal psychomotor behavior, and negative symptoms. Each of these symptoms may be rated for its current severity (most severe in the last 7 days) on a 5-point scale ranging from 0 (not present) to 4 (present and severe).

Note: Diagnosis of brief psychotic disorder can be made without using this severity specifier.

Specifiers

Catatonia Specifier

A. The clinical picture is dominated by three (or more) of the following symptoms:

  1. Stupor (i.e., no psychomotor activity; not actively relating to environment).
  2. Catalepsy (i.e., passive induction of a posture held against gravity).
  3. Waxy flexibility (i.e., slight, even resistance to positioning by examiner).
  4. Mutism (i.e., no, or very little, verbal response [exclude if known aphasia]).
  5. Negativism (i.e., opposition or no response to instructions or external stimuli).
  6. Posturing (i.e., spontaneous and active maintenance of a posture against gravity).
  7. Mannerism (i.e., odd, circumstantial caricature of normal actions).
  8. Stereotypy (i.e., repetitive, abnormally frequent, non-goal-directed movements).
  9. Agitation, not influenced by external stimuli.
  10. Grimacing.
  11. Echolalia (i.e., mimicking another's speech).
  12. Echopraxia (i.e., mimicking another's movements).

Differential Diagnosis

Other medical conditions

A variety of medical disorders can manifest with psychotic symptoms of short duration. Psychotic disorder due to another medical condition or a delirium is diagnosed when there is evidence from the history, physical examination, or laboratory tests that the delusions or hallucinations are the direct physiological consequence of a specific medical condition (e.g., Cushing's syndrome, brain tumor).

Substance-related disorders

Substance/medication-induced psychotic disorder, substance-induced delirium, and substance intoxication are distinguished from brief psychotic disorder by the fact that a substance (e.g., a drug of abuse, a medication, exposure to a toxin) is judged to be etiologically related to the psychotic symptoms. Laboratory tests, such as a urine drug screen or a blood alcohol level, may be helpful in making this determination, as may a careful history of substance use with attention to temporal relationships between substance intake and onset of the symptoms and to the nature of the substance being used.

Depressive and bipolar disorders

The diagnosis of brief psychotic disorder cannot be made if the psychotic symptoms are better explained by a mood episode (i.e., the psychotic symptoms occur exclusively during a full major depressive, manic, or mixed episode).

Other psychotic disorders

If the psychotic symptoms persist for 1 month or longer, the diagnosis is either schizophreniform disorder, delusional disorder, depressive disorder with psychotic features, bipolar disorder with psychotic features, or other specified or unspecified schizophrenia spectrum and other psychotic disorder, depending on the other symptoms in the presentation. The differential diagnosis between brief psychotic disorder and schizophreniform disorder is difficult when the psychotic symptoms have remitted before 1 month in response to successful treatment with medication. Careful attention should be given to the possibility that a recurrent disorder (e.g., bipolar disorder, recurrent acute exacerbations of schizophrenia) may be responsible for any recurring psychotic episodes.

Malingering and factitious disorders

An episode of factitious disorder, with predominantly psychological signs and symptoms, may have the appearance of brief psychotic disorder, but in such cases there is evidence that the symptoms are intentionally produced. When malingering involved apparently psychotic symptoms, there is usually evidence that the illness is being feigned for an understandable goal.

Personality disorders

In certain individuals with personality disorders, psychosocial stressors may precipitate brief periods of psychotic symptoms. These symptoms are usually transient and do not warrant a separate diagnosis. If psychotic symptoms persist for at least 1 day, an additional diagnosis of brief psychotic disorder may be appropriate.