(How) Can You Recognize Brief Psychotic Disorder, Or A Psychotic Break, In A Loved One?

A brief psychotic episode, sometimes called a psychotic break, can happen to anyone — and it's often triggered by extreme stress that the mind isn't able to make sense of. If someone you care about, whether a relative, a friend, a partner, or a child, suddenly goes through extreme behavioral changes that suggest they have lost touch with reality through delusions, hallucinations, or both, you may go searching for information about what could be happening to them. 

What is psychosis?

The term psychosis is used to describe a mental state in which someone has lost touch with reality. It is marked by delusions and hallucinations. 

Delusions are strong beliefs that can't be shaken despite all evidence pointing to the fact that they aren't true. People may believe that they're being followed or persecuted when they're not, that random things in their environment are messages from someone directed at them (such as something on TV, or even the weather), that their famous or somehow very important, that someone is in love with them when they're not, or that they have a specific physical health problem. 

Delusions are termed "bizarre" in psychology if they are not physically feasible — and these bizarre delusions may include someone's belief that their relatives have been replaced with copies who look and act exactly the same, but are in fact different people, or that they have been abducted by aliens. Non-bizarre delusions are those false beliefs that are plausible, like believing that your neighbors are trying to get you evicted.

Hallucinations are experiences in which a person sees, hears, smells, feels, or otherwise perceives things that are not there, and that others cannot perceive. Hallucinations can be threatening and frightening, or benign. 

Diagnoses that fall in the category of psychotic disorders include schizophrenia spectrum disorder, schizoaffective disorder, and delusional disorder, but also brief psychotic disorder, which is not chronic.

What is brief psychotic disorder?

In brief psychotic disorder, someone who previously wasn't displaying psychotic symptoms quickly starts having symptoms of psychosis. After a period of one day to one month, the episode comes to an end, and the person will gradually return to their former self. 

The diagnostic criteria for brief psychotic disorder, as laid out in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), are: 

• At least one of the following symptoms, and sometimes more or all — delusions, hallucinations, disorganized speech (rambling or being incoherent and not making any sense), and very disorganized or catatonic behavior. Catatonia is a state in which a person becomes uncommunicative, has highly unusual physical movements, and may become highly irritable or agitated. 
• The episode lasts a minimum of one day, and a maximum of one month. The person eventually returns to their former level of functioning, in which psychosis isn't present. (It is, on the other hand, possible to relapse and have another psychotic episode.)
• The symptoms aren't better explained by another mental disorder, a physical disorder, or induced by medications or illicit drugs. 

Is it possible to tell if someone you care about becomes psychotic? How?

Symptoms like sudden social withdrawal, extreme suspicion or distrust, outbursts of irritability that do not make sense to you, and disorganized speech, strange physical behavior, or accusations, will immediately be apparent to the loved ones of someone displaying them. They are likely to be the first signs that something is "off". 

You may be able to recognize delusions as well, if your loved one talks about them, and the same holds true for hallucinations. 

It may be easy to tell that your loved one is a very general "not well", and you may specifically suspect psychosis as well. Beware of the urge to "armchair diagnose" your relative or friend, though, as many symptoms can be caused by a variety of mental and physical disorders, or even be induced by substances or prescription medications. Keep in mind that brief psychotic disorder is often triggered by extreme stresses, such as the loss of a loved one, a natural disaster, or stressful service in the military.

A disorder of brief psychotic disorder can only be made by a qualified professional — but while experiencing psychosis, it can be hard for someone to recognize that they need medical assistance, and they may become extremely suspicious of you if you suggest that they need to seek help.

Brief psychotic disorder can be treated. First- or second-generation antipsychotic medications and benzodiazepines can help a person emerge from their psychosis faster and talk therapy can help them mentally process and recover from the episode after it comes to an end. Because symptoms that initially point to brief psychotic disorder can indicate a more long-term mental disorder in some cases, and the psychosis can recur, ideally, long-term monitoring should form a part of the treatment plan, as well.