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CLINICAL CASE

STRESS AND BRIEF PSYCHOTIC DISORDER

Andreea Ciornei1, Carmen Bumbu1, Ramona Spnu1

Abstract: Rezumat:
Brief Psychotic Disorder is a short-term illness with Tulburarea psihotic scurt este o boala ce dureaz o
psychotic symptoms. The symptoms often come on perioad scurt de timp i este asociat cu simptome
suddenly, lasting from 1 day to 1 month, after which the psihotice. Simptomele au de obicei un debut brusc i pot
person can recover completely and return to the premorbid dura ntre 1 zi si 1 lun, dup care pacientul se poate
level of functioning. Most cases of Brief Psychotic recupera n totalitate i poate reveni la nivelul de
Disorder occur as a reaction to a very disturbing event. We funcionare anterior bolii. Cele mai multe cazuri de
reported a case of a 33 years old man, who presented to the tulburare psihotic scurt apar ca o reacie la un
Clinical Hospital of Psychiatry with symptoms associated eveniment inoportun. Prezentm cazul unui barbat n
with psychotic episode: hallucinations, delusions, vrst de 33 de ani, care vine la Spitalul Clinic de
disorganized behavior. After excluded other possible Psihiatrie cu simptome asociate episodului psihotic acut:
causes (organic, traumatic, drugs or other substance halucinaii, idei delirante, comportament dezorganizat.
abuse) and based on a full medical, personal, family Dupa excluderea altor cauze ( organice, traumatice, abuz
history and psychiatric evaluation, we concluded that a de droguri sau alte substante) i pe baza unei anamneze
high rate of stress may be associated with Brief Psychotic medicale, personale i heredo-colaterale, pacientul a fost
Disorder. diagnosticat cu tulburare psihotic acut datorat
Key words: psychosis, schizophrenia, legal drugs, stresului crescut.
posttraumatic Cuvinte cheie: psihoz, schizofrenie, droguri legale,
psttraumatic

Brief psychotic disorder is uncommon and is hearing hallucinations (I saw and I heard my
difficult to diagnosis it because there are no laboratory test parents in my room, I saw the cameras in my room, they
to specifically diagnose psychotic disorder except those were fallowing me), delusions - exterior influence ideas
that accompany a physical illness, such brain tumors and (they took my parents' and my friends' identities),
there are no laboratory tests for some adverse drugs effects prejudice ideas (they what to take my room because is
prescribed or illicit or legal (eg ethnobotanics). more spacious and has better conditions), bizarre
Brief psychotic disorder is a short- term disorder behavior (he stayed locked in his room and let nobody to
that lasts for a limited period of time. An individual with enter, because he was afraid they would occupy his
brief psychotic disorder must have experience at least one beautiful room), anxiety and mix insomnia.
of the major symptoms of psychosis for less than a month From family history there were no psychiatric
such as hallucinations, delusions, lack of movement, disorders in his family. From his medical history there
strange behavior or peculiar speech. Preexisting was a cranial cerebral trauma with loosing of conscience
personality disorders (eg paranoid, histrionic, narcissistic, for a short period of time (2-3 minutes) two years before
schizotypal, borderline) predispose to its development. A this episode.
major stressor may precipitate the disorder. (1) He always was an eminent student (finished the
The disorder is not diagnosed if a psychotic mood Military High School, he took his Degree on Automatic
disorder, a schizoaffective disorder, schizophrenia, a and Computers College) and had no behavior problems.
physical disorder or an adverse drug effect (prescribed or He is a single child. He lives alone in a student's hall room.
illicit) better accounts for the symptoms. Differentiating He denies alcohol or drugs or other substances abuse
between brief psychotic disorder and schizophrenia in a (family, friends, co-workers say he never took any kind of
patient without any prior psychotic symptoms is based on drugs and there were no evidence of them in his room,
duration of symptoms, if the duration of the symptoms clothes, among his stuffs).
exceeds 1 month, the patient no longer meets required According to his family members and friends
diagnosis criteria for brief psychotic disorder. Since there another episode (with hearing hallucinations -I heard my
are several similarities between brief psychotic disorder parents in my room, prejudice ideas someone from
and schizophrenia, many researchers and clinicians think one radio played an joke on me and bizarre behavior)
that the former is an antecedent for the latter. (2) happened 6 months ago, but the symptoms disappeared in
We describe the case of a 33 year old man who few days without treatment or any other psychiatric help.
came to the Clinical Hospital of Psychiatry with an acute The dates we gathered from the patient, family and friends
psychotic picture: psychomotor restlessness, visual an link these 2 episodes with very stressful events. First

1
Resident in Adult Psychiatry, Clinical Hospital of Psychiatry Prof Dr. Alex Obregia Bucharest, Romania, contact: bumbucarmen@gmail.com. tel:
+40726752399.
Received January 12, 2011, Revised April 04, 2011, Accepted May 30, 2011.

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Romanian Journal of Psychiatry, vol. XIII, No.2, 2011

episode he had lost his scholarship for a short period of short duration of symptoms, absence of
time, because he had a lot of work to do and had a schizophrenic relatives and good premorbid adjustment.
disagreement with his tutor teacher, and before he manage Although hospitalization and pharmacotherapy
to find another teacher he had no money and no place to are likely to control short-term situations, the difficult part
stay. Second episode a lot of work and many deadlines of the treatment is the psychological integration of the
(he works, he is a doctorand and he is also on his second experience into the lives of the patients and their family
master). It is important to educate the patient and the
Objective clinic examination and neurological patients family about the situation. (3)
exam were in normal limits. Laboratory test revealed few
modifications in hepatic test with no clinical value. DISCUSSION
Toxicology tests were negative. Psychological tests Our days stress and the overcame are the causes
conclusions - supplementary sensibility trends, paranoid of many medical and psychiatric problems.
trends, anxiety and depressive trends. Because he had a Brief psychotic disorder is not common,
cranial-cerebral traumatism we recommended to the generally occurs in adolescence or early adulthood, with
patient a native brain CT and there were no modifications the average age at onset being in the late 20s or early 30s. It
at this level. is more common in women than men. People who have
Psychiatric examinations revealed a conscious personality disorders such as paranoid personality
patient with proper hygiene, cooperating, disorder or antisocial personality disorder- are more prone
psychomotor restlessness, little suspicious, with mimicry to develop brief psychotic disorder.
and broad gestures easy hypo-mobility. Perception-visual The exact cause of this disorder in unknown. One
and hearing hallucinations. He was orientated in time, theory is based on genetic vulnerability (is more common
place and person, with spontaneous and voluntary hypo- in people who have family members with mood disorders
prosexia. Memory within normal limits, anxiety, such as bipolar disorder). Other theory suggests that the
suspicions. He had prejudice ideas, followings and disorder is caused by poor coping skills as a defense
exterior influence ideas. He also had sleep problems. against or escape from a particularly frightening or
He was diagnosed with Brief Psychotic Disorder. stressful situation. It must be understood that the
We had to consider other problems such as individual perceives the stress as totally overwhelming.
psychotic disorder secondary to general condition, Neither biological nor psychological theories have been
delirium and various other disorder, but history, physical validated by carefully controlled studies. In most cases
examination or laboratory tests ( which were normal) the trigger is a major or traumatic stress event (traumatic
helped us to differentiate. Our major problem was events, family conflict, employment problems, accidents,
substance induced psychotic disorder (especially legal severe illness, death of a love one, uncertain immigration
drugs), because there are no specific laboratory tests to status). Childbirth may also trigger the disorder in women
help us identify the drugs (we exclude it on toxicological (5)
tests and a history taken from the family, friends, co- A variety of general medical conditions can
workers and there were no evidence of drugs in his room, present psychotic symptoms for a short period of time.
clothes, among his stuffs and the that the onset is linked to Delirium or psychotic disorder due general medical
a obviously stressor). condition is diagnosed when there is evidence in the
Other problem to be considered occurrence of a physical examination and laboratory test ( eg Cushing
psychotic episode during a full affective episode excludes Syndrome, brain tumor). Substance induced psychotic
the diagnosis of brief psychotic disorder. If psychotic disorder should be distinguished from brief psychotic
symptoms persist longer than a month, the diagnoses of disorder ( eg a medication, exposure to a toxin, a drug
schizophreniform disorder, schizoaffective disorder, abuse). The diagnosis of brief psychotic disorder cannot
schizophrenia, delusional disorder, mood disorder with be made if the psychotic episode is better accounted by a
psychotics features. In case of malingering, there is mood disorder. The differential diagnosis between brief
usually some evidence indicating that the illness was psychotic disorder and schizophreniform disorder is
feigns for an understandable goal. In factitious disorder, difficult when the psychotic symptoms have remitted
past history may reveal that the symptoms are before 1 month in response to medication. Because
intentionally produced. Presence of a florid psychosis recurrent episodes of brief psychotic disorder are rare,
makes the diagnosis of dissociative disorder unlikely. (3) careful attention should be given to the possibility that a
Treatment for brief psychotic disorder typically recurrent disorder could be responsible for that psychotic
includes medication and psychotherapy (a type of episode (bipolar disorder, exacerbations of
counseling). Hospitalization is necessary if the symptoms schizophrenia).
are severe or if there is a risk that the person may harm An episode of factitious disorder could have the
himself or others. Antipsychotic drugs may be prescribed appearance of brief psychotic disorder, but in such cases
to decrease or eliminate the symptoms and end the brief there is evidence that the symptoms are intentionally
psychotic disorder. produced. Malingering can also look like brief psychotic
We initiated the treatment with Olanzapine 10 disorder, but usually there is evidence that the illness was
mg/day. The symptoms disappeared very quickly (in 2 feiged for an understandable goal.
days) and the patient had tolerated well the treatment. (4) In personality disorders some psychosocial
Generally brief psychotic disorder has a good stressors may precipitate brief periods of psychotic
prognosis and its run its course in less than a month. A symptoms, they are usually transient, but if they persist
good prognosis is usually associated with sudden onset of more than a day an additional diagnosis of brief psychotic
symptoms,few premorbid schizoid traits, affective disorder may be appropriate.
symptoms, confusion and perplexity during psychosis, Patients with acute psychotic attack may need a

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Andreea Ciornei, Carmen Bumbu, Ramona Spnu: Stress And Brief Psychotic Disorder

brief hospitalization for evaluation and safety concerns. psychoses. On the other hand, stress impairs
Patients may be at risk of committing suicide during clinical features in psychotic and prepsychotic patients
psychotic episodes, especially when brief psychotic (6).
disorder is associated with affective symptoms. Patients with no premorbid psychiatric history
If the symptoms are only minimally impairing have been associated with excellent prognosis. Therefore,
the patient's function and a specific stressor is identified, educating the patient and the patient's family about the
removing the stressor should be sufficient, in event that situation is essential. There is no way to prevent Brief
symptoms are disabling an antipsychotic agent should be Psychotic Disorder, however early diagnosis and
used. The goals of pharmacotherapy are to reduce treatment can help decrease the disruption of the person's
morbidity and to prevent complications. Psychotherapy is life, family and friends (7).
also need it because helps the person identify and cope
with the situation or event that triggered the disorder. REFERENCES
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