Brief reactive psychosis

Brief reactive psychosis
Classification and external resources
Specialty	psychiatry
ICD-10	F23.9
ICD-9-CM	298.8
MedlinePlus	001529
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 an individual.

Typically such brief psychoses last from a day to a month only, with the delusions, speech disorders and hallucinations eventually yielding to a return to normal functioning.^[1]

History

Once known as hysterical psychosis, BRP takes the violent form of running amok in Malaysia.^[2]

Otto Fenichel noted how such short psychotic breaks were more common in World War II than in World War I, in the wake of 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]

Stressors

Brief reactive psychosis generally follows a recognisably traumatic life event like divorce or homelessness,^[4] but may be triggered by any subjective experience which appears catastrophic to the person affected.^[5]

Among such stressors are 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 lifelong, whether BRP or a chronic condition that is controlled well enough by medication that symptoms do not return.

Timespan

The condition usually resolves spontaneously within a timespan of weeks to months, with the severity of the symptoms reducing continuously over the period in question.^[6] A primary goal of treatment is to prevent patients from harming themselves or others during the episode.

Jungians emphasise the importance of recognising the patient's perspective throughout the episode, 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'.^[7]

Recovery

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)".^[8] 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...another sphere, another layer of existence lying above...the present"'.^[9]

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"'.^[10]

Psychologist Erik H. Erikson considered that whatever the causes, the psychotic break involved a primitive re-testing of the boundaries of self and other, words and meanings, in an effort to re-establish a new social mutuality.^[11]

See also

• Brief psychotic disorder
• Mental breakdown

References

1. Edelstein, Linda (2006). Writers Guide to Character Traits. F & W Media, Inc. p. 117. ISBN 9781582973906.
2. Ingham, John M. (1996). Psychological Anthropology Reconsidered. Cambridge University Press. p. 130. ISBN 9780521559188.
3. Fenichel, Otto (1946). The Psychoanalytical Theory of Neuroses. Norton & Co. ISBN 9780393010190.
4. John Sorenson, Relapse Prevention in Schizophrenia and Other Psychoses (2006) p. 16
5. J. G. Csernansky, Schizophrenia (2002) p. 60
6. Csernansky, p. 60
7. G. Maffei, in K. Papadopoulos/G. S. Saayman eds., Jung in Modewrn Perspective (1991) p. 130
8. R. D. Laing, Self and Others (Penguin 1969) p. 74
9. R. D. Laing, The Politics of Experience (1984) p. 128
10. Laing, Politics p. 131
11. Erik H. Erikson, Childhood and Society (Penguin 1973) p. 240

External links

• Brief reactive psychosis