31 Other Psychotic Disorders
Brief psychotic disorder — according to the DSM-5 — is a psychotic condition involving the sudden onset of at least one psychotic symptom (such as incoherence, delusions, hallucinations, or grossly disorganized or catatonic behavior) lasting 1 day to 1 month, often accompanied by emotional turmoil. Remission of all symptoms is complete with patients returning to the previous level of functioning. It may follow a period of extreme stress including the loss of a loved one. The symptoms must not be caused by schizophrenia, schizoaffective disorder, delusional disorder or mania in bipolar disorder. They must also not be caused by a drug (such as amphetamines) or medical condition (such as a brain tumor).
Doctors describe three types of brief psychotic disorder. The first type is caused by some kind of traumatic stress. The second type has no known cause. Some psychologists believe it could be from stimulants such as caffeine, morphine or any type of drug. There is no known cure but staying away from caffeinated drinking may lower the risk of brief psychotic disorder. The third type is caused by childbirth and usually affects mothers about four weeks after having a baby.
In diagnosis, a careful distinction is considered for culturally appropriate behaviors, such as religious beliefs and activities. It is believed to be connected to or synonymous with a variety of culture-specific phenomena such as latah ( from Southeast Asia, is a condition in which abnormal behaviors result from a person experiencing a sudden shock), koro ( known as shrinking penis), and amok (he act of behaving disruptively or uncontrollably). The term bouffée délirante describes an acute non-affective and non-schizophrenic psychotic disorder, which is largely similar to DSM-III-R and DSM-IV brief psychotic and schizophreniform disorders.
The prevalence of psychosis is 9,000 per 100,000 (9%) of the overall population. Internationally, it occurs twice as often in women than men, and even more often in women in the United States. It typically occurs in the late 30s and early 40s.
Schizophreniform Disorder is similar to schizophrenia with the exception of the length of presentation of symptoms. Schizophreniform disorder is considered an “intermediate” disorder between schizophrenia and brief psychotic disorder as the symptoms are present for at least one month but not longer than 6 months. As you may recall, schizophrenia symptoms must be present for at least 6 months; A brief psychotic disorder is diagnosed when symptoms are present for less than 1 month. Approximately two-thirds of individuals who are initially diagnosed with schizophreniform disorder will have symptoms that last longer than 6 months, at which time their diagnosis is changed to schizophrenia (APA, 2013). The most common ages of onset are 18–24 for men and 18–35 for women.
Another key distinguishing feature of schizophreniform disorder is the lack of criteria related to impaired functioning. While many individuals with schizophreniform disorder do display impaired functioning, it is not essential for diagnosis. Finally, any major mood episodes—either depressive or manic— that are present concurrently with the psychotic features must only be present for a small period of time, otherwise a diagnosis of schizoaffective disorder may be more appropriate.
Like schizophrenia, schizophreniform disorder is often treated with antipsychotic medications, especially the atypicals, along with a variety of social supports (such as individual psychotherapy, family therapy, occupational therapy, etc.) designed to reduce the social and emotional impact of the illness. The prognosis varies depending upon the nature, severity, and duration of the symptoms, but about two-thirds of individuals diagnosed with schizophreniform disorder go on to develop schizophrenia.
Schizoaffective disorder (SZA, SZD or SAD) is characterized by abnormal thought processes and an unstable mood. The diagnosis is made when the person has symptoms of both schizophrenia (usually psychosis) and a mood disorder—either bipolar disorder or depression—but does not meet the diagnostic criteria for schizophrenia or a mood disorder individually. The main criterion for the schizoaffective disorder diagnosis is the presence of psychotic symptoms for at least two weeks without any mood symptoms present. Schizoaffective disorder can often be misdiagnosed when the correct diagnosis may be psychotic depression, psychotic bipolar disorder, schizophreniform disorder, or schizophrenia. It is imperative for providers to accurately diagnose patients, as treatment and prognosis differs greatly for each of these diagnoses. There are two types of schizoaffective disorder: the bipolar type, which is distinguished by symptoms of mania, hypomania, or mixed episode; and the depressive type, which is distinguished by symptoms of depression only. Common symptoms of the disorder include hallucinations, delusions, and disorganized speech and thinking. Auditory hallucinations, or “hearing voices,” are most common. The onset of symptoms usually begins in young adulthood.
Genetics (researched in the field of genomics); problems with neural circuits; chronic early, and chronic or short-term current environmental stress appear to be important causal factors. No single isolated organic cause has been found, but extensive evidence exists for abnormalities in the metabolism of tetrahydrobiopterin (BH4), dopamine, and glutamic acid in people with schizophrenia, psychotic mood disorders, and schizoaffective disorder. People with schizoaffective disorder are likely to have co-occurring conditions, including anxiety disorders and substance use disorders.
The prevalence of schizoaffective disorder is 300 per 100,000 (0.3%) of the overall population.
Delusional disorder requires the presence of at least one delusion that lasts for at least one month in duration. It is important to note that any other symptom of schizophrenia (i.e., hallucinations, disorganized behavior, disorganized speech, negative symptoms) rules out a diagnosis of delusional disorder. Therefore the only symptom that can be present is delusions. Unlike most other schizophrenia-related disorders, daily functioning is not overtly impacted in individuals with delusional disorder. Additionally, if symptoms of depressive or manic episodes present during delusions, they are typically brief in duration compared to the duration of the delusions.
The DSM 5 (APA, 2013) has identified several subtypes of delusional disorder in efforts to better categorize the symptoms of the individual’s disorder. When making a diagnosis of delusional disorder, one of the following specifiers is included.
- Erotomanic delusion – the individual reports a delusion of another person being in love with them. Generally speaking, the individual whom the convictions are about are of higher status such as a celebrity.
- Grandiose delusion – involves the conviction of having a great talent or insight. Occasionally, individuals will report they have made an important discovery that benefits the general public. Grandiose delusions may also take on a religious affiliation, as some people believe they are prophets or even God, himself.
- Jealous delusion – revolves around the conviction that one’s spouse or partner is/has been unfaithful. While many individuals may have this suspicion at some point in their relationship, a jealous delusion is much more extensive and generally based on incorrect inferences that lack evidence.
- Persecutory delusion – involves beliefs that they are being conspired against, spied on, followed, poisoned or drugged, maliciously maligned, harassed, or obstructed in pursuit of their long-term goals (APA, 2013). Of all subtypes of delusional disorder, those experiencing persecutory delusions are the most at risk of becoming aggressive or hostile, likely due to the persecutory nature of their distorted beliefs.
- Somatic delusion – involves delusions regarding bodily functions or sensations. While these delusions can vary significantly, the most common beliefs are that the individual emits a foul odor despite attempts to rectify their smell; there is an infestation of insects on the skin; or that they have an internal parasite (APA, 2013).
- Mixed delusions – there are several themes of delusions (e.g., jealous and persecutory)
- Unspecified delusion– these are delusions that don’t fit into one of the categories above (e.g., referential delusions without a persecutory or grandiose nature to them).
- Bizarre delusion – delusions that are clearly not plausible and do not stem from ordinary experience (e.g., the delusion that one is an alien/vampire hybrid).
Apart from their delusions, people with delusional disorder may continue to socialize and function normally; their behavior does not stand out as odd or bizarre. However, their preoccupation with delusional ideas can disrupt their lives.
“Other Psychotic Disorders” is adapted from Abnormal Psychology by Coursehero, used under CC BY-SA: Attribution-ShareAlike.
