| Brief reactive psychosis | |
|---|---|
| Classification and external resources | |
| ICD-10 | F23.9 |
| ICD-9 | 298.8 |
| MeSH | D011618 |
Brief reactive psychosis - referred to in the DSM IV-TR as "brief psychotic disorder with marked stressor(s)" - is the psychiatric term for psychosis which can be triggered by an extremely stressful event in the life of a patient.
'BRP is characterized by delusions, hallucinations, catatonic symptoms, and strange speech, but the symptoms last for a very short period (one day to one month) after which the individual returns to full normal functioning'.[1]
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'These "brief reactive psychoses", as they are now called, were once termed "hysterical psychoses"'.[2] Otto Fenichel noted that 'in World War II there were reported many more schizophrenic or schizoid episodes of short duration that ended spontaneously than in World War I', following traumatic shocks: he considered in such cases that 'enough preconscious attention remains to re-establish the contact with reality as soon as it becomes bearable again'.[3]
'A violent form of this condition known as amok occurs in Malaysia'.[4]
BRP generally occurs 'following a stressful life event (i.e. house move, divorce, becoming homeless, etc.)'[5] - but the trigger 'may be any experience deemed catastrophic by the affected individual'.[6]
Such 'stressful life event' can thus take many forms, including (but not limited to) the death of a loved one, professional loss such as unexpectedly losing one's job or otherwise becoming unemployed, or serious adverse changes in the patient's personal life, such as the breakdown of their family through divorce, etc.
It must be emphasised that this is by no means an exhaustive list of stressful life events, because the events which trigger brief reactive psychosis tend, due to the individualistic nature of human psychology, to be extremely personalized. BRP may be the first breakdown for someone with a chronic psychiatric disorder but only time will tell whether the disorder will be brief or life-long, whether BRP or a chronic condition that is controlled well enough by medication that symptoms do not return.
The condition usually resolves spontaneously within a timespan of weeks to months: typically, 'the severity of the symptoms diminishes during this time in a continuous manner'.[7]
A primary goal of treatment is to prevent patients from harming themselves or others during the episode. Jungians also stress the importance of recognising the patient's perspective throughout, the danger being that 'if psychiatry itself considers the situation incomprehensible...many exclusion mechanisms will be set to work and [s]he will slide down the slope of a deeper and deeper regression'.[8]
R. D. Laing pointed repeatedly to 'the possibility that what we call psychosis may be sometimes a natural process of healing (a view for which I claim no priority)',[9] he sometimes added. Under the title "A Ten Day Voyage", he published an acquaintance's first-hand account of a reactive psychosis, triggered by a festering dog-bite. The protagonist reported '"living in a - in another time dimension added to the time situation in which I am now"', as well as '"an awareness of - um - of another sphere, another layer of existence lying above...the present"'.[10]
At the close of the experience, the patient '"thought, well, somewhere or other I've got to sort of join up with my present - er - self, very strongly. So I...kept on saying my own name over and over again and all of a sudden, just like that - I suddenly realized that it was all over"'.[11]
Erik H. Erikson considered that 'no matter what conditions may have caused a psychotic break, the bizarreness and withdrawal...hides an attempt to recover social mutuality by a testing of the borderlines between senses and physical reality, between words and social meanings'.[12]
John Sorensen, Relapse Prevention in Schizophrenia and Other Psychoses (2006) p. 16
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