The Brief Psychotic Disorder, as will be seen throughout the article, is short-lived and can present delusions and hallucinations. The team of José Carlos Minguote (2007), says that these types of disorders usually affect people with personality disorders. Above all, to patients with borderline personality disorder, histrionic, schizotypal, schizoid disorder or patients with greater biological and / or psychological fragility.
Throughout the article, we will address the brief psychotic disorder and will crumble into its main elements. It will also be investigated in both pharmacological and psychological treatment. Despite not being a disabling disorder like other similar ones, it certainly deserves to be investigated to try to minimize its impact and understand it in greater depth.
- 1 Brief Psychotic Disorder
- 2 Components of the Brief Psychotic Disorder
- 3 Treatment of Brief Psychotic Disorder
Brief Psychotic Disorder
According to the DSM-V, in order to diagnose the Brief Psychotic Disorder as such, several criteria must be met. The first of these is the presence of one or more of the symptoms detailed below. At least one of them must be 1, 2 or 3:
- Disorganized speech.
- Very disorganized or catatonic behavior.
It should not be included if a symptom is a culturally approved response. On the other hand, The duration of an episode of the disorder should be at least one day, but less than one month. Once the episode has occurred, it returns to the degree of functioning prior to the disease.
The disorder is not best explained by a major or bipolar depressive disorder with psychotic characteristics, or other psychotic disorders such as schizophrenia or catatonia. Nor is it due to the physiological effects of some substances or a medical condition.
You must specify:
- Yes presence of notable stressors (brief reactive psychosis): if symptoms occur in response to events, separately or together, they would cause a lot of stress to virtually everyone in similar circumstances in the individual's cultural environment.
- If there are no notable stressors: if the above does not occur.
- With postpartum onset: if it begins during pregnancy or in the first four weeks after delivery.
- If there is a presence of catatonia.
- The current severity must also be detailed.
Components of the Brief Psychotic Disorder
As the specialized literature includes, this type of disorder can present: delusions, hallucinations, disorganized discourse and disorganized or catatonic behavior. However, what does each aspect consist of? Let's dig into it!
As stated by the team of José Carlos Mingote (2007), in his article "The patient suffering from a psychotic disorder at work: diagnosis and treatment", a delirium is "an alteration of the content of the thought that supposes the appearance of a false idea and lived with total subjective certainty, which is not modified with the logical argument".
That is, the person takes as true a false thought and is unable to change it even though he is shown that it is not true. For example, someone believes for a long period of time that they persecute you to steal all the money. However, it is false. Its environment is seen but the subject continues with his conviction that someone wants to steal.
"The patients who showed delirium were almost always in medical or surgical halls, not in neurological or psychiatric wards, since delirium usually indicates a medical problem, a consequence of something that affects the whole body, the brain included, and that disappears in how much the medical problem is solved. "
The authors continue: "Sometimes this idea or belief has a practically impossible theme (influence of extraterrestrial beings in my body) but we can also see delusions with everyday issues (jealousy, guilt, persecution); in any case the patient lives his delirium with the same certainty of reality as normal ideas ". In the case of the example it would be persecution, but the delirium could also be perfectly based on someone's belief that the gnomes watch over their house at night.
The team of Paniagua Calzón (2007), in its article "Diagnostic protocol of the patient with hallucinations", defines hallucination as "a false perception, which is not a sensory distortion, which occurs in the absence of an appropriate stimulus, which has the full impact force of a real perception and is not susceptible to being voluntarily controlled by the subject who is experiencing it".
As Emilio Gómez, a professor at the University of Granada, stands out, we can find hallucinations: visual, auditory, olfactory, tactile, gustatory and somatic. An example of auditory hallucination could be that suffered by some patients with schizophrenia and who claim to hear voices in their heads.
Disorganized speech is also known as disorganized speech or formal thought disorders. Some of these most common alterations are usually:
- Brain drain. It consists in the constant change from one thought to another without any apparent logic or without a significant connection between them. The associative capacity of thoughts has been lost. One way of observing it is through incoherent speech and strange responses, as well as pressure on speech, that is, abundant, irrefutable and rapid verbal expression.
- Derailment. It is similar to the flight of ideas. In this case, the individual loses the central idea of his speech so that he is not able to continue linking some ideas with others in an orderly and understandable way.
- Perseveration It is about returning again and again to the same idea.
- Prolixity. Offer an excessive number of details.
- Tangentiality The individual does not answer the questions and "walks through the branches."
- Neologisms The patient invents new words that only he understands.
- Inconsistencies The phrases are meaningless at the content level and / or at the syntactic level.
- Locks Once the speech has begun, the patient crashes and does not know how to continue.
- Antagonistic language. It consists of using concepts contrary to the correct ones at the moment. For example, say "yes" when you want to say "no".
Very disorganized or catatonic behavior
The clinical picture is dominated by at least two of the following symptoms:
- Motor immobility as it appears in the cataleptic tables or in the states of stupor.
- Excessive motor activity which has no purpose or is determined by external stimuli.
- External Negativism or Mutism.
- Peculiar voluntary movements which are manifested through inappropriate or strange postures, stereotyped movements, manienrisms or grimaces.
- Ecolalia or ecopraxia.
Brief Psychotic Disorder Treatment
Because the brief psychotic disorder or episode may be triggered by external situations and a lack of individual resources, treatment can be approached from two different routes. On the one hand, the pharmacological and on the other the psychological.
Pérez, A., Gil, S., Pina, L. and García-Cabez, I. (2010), in their article "Psychopharmacology of Psychosis: Drug Choice, Treatment Adherence and New Horizons", they emphasize that before administering an antipsychotic medication, a series of personal characteristics of the patient must be taken into account:
- Current clinical status: psychopathological and somatic level.
- Patient preferences for a drug.
- Clinical course: frequency, severity and consequence of the episodes (and of the previous episodes, if any).
- Efficacy of medication on positive and negative symptoms.
- Adverse effects of previous treatments.
On the other hand, and in reference to acute or brief episodes as is the case at hand, the authors emphasize that classical antipsychotics such as haloperidol may be more helpful than atypical ones. Affirm that "in some cases the classic antipsychotics offer advantages, for example in those cases where the priority is a quick start of action (very acute episodes, treatment of psychotic agitation, etc.) ".
Psychological treatment is also of great importance since the brief psychotic outbreak may be triggered by external factors. Thus, between these stimuli and the poor control over themselves that this type of patients may have, emotional control becomes fundamental. Thus, through cognitive behavioral therapy supported with mindfulness, it could be a good choice to learn to tolerate adverse situations and prevent this type of outbreak from arising.
Cognitive behavioral therapy is based on the fact that any experience and / or event is experienced and lived differently depending on how each person interprets it. In the face of a specific situation, certain thoughts and beliefs are set in motion that will condition our feelings and emotions that will guide us towards a type of behavior. In this way, by restructuring the way of interpreting what happens to us, we can have a more adaptive behavior.
"Feelings come and go like clouds in a windy sky. Conscious breathing is my anchor."
-Thich Nhat Hanh-
For Jon-Kabat Zinn, doctor and world leader in this discipline, those who practice mindfulness "They are 'learning to be'. On the one hand, they deliberately interrupt all activity and relax in the present, without trying to fill it. They let their body and mind, regardless of its content and what it feels, rest in the present.. They connect with the basic experience of living. They give themselves permission to be in the moment with things as they are without trying to modify anything at all. " The person learns to connect with himself, to know his thoughts, reactions, emotions, in this way, to manage stressful situations much better.
- American Psychiatric Association (2013).DSM-V Diagnostic and statistical manual of mental disorders. Pan American Medical Editorial.
- Caballo, V., Salazar, I. and Carrobles, J. (2014). Manual of psychopathology and psychological disorders. Madrid: Pyramid Editions.
- Jon Kabat-Zin. (2016).Live fully the crises. How to use the wisdom of the body and mind to cope with stress, pain and disease. Barcelona: Kairos.
- Mingote, J., Del Pino, P., Huidobro, A., Gutiérrez, D., De Miguel, I. and Gálvez, M. (2007). The patient suffering from a psychotic disorder at work: diagnosis and treatment.Occupational Medicine and Safety, 53 (208), 1-23.
- Paniagua, G., Villa, R., García, L. and Sánchez, S. (2007). Diagnostic protocol of the patient with hallucinations.Medicine, 9 (85), 5510-5512.
- Pérez, A., Gil, S., Pina, L. and García-Cabez, I. (2010). Psychopharmacology of Psychosis: Drug Choice, Treatment Adherence and New Horizons. Clinic and Health, 21, (3), 271-283.
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