How Does Transient Psychosis Work?

Reviewed by Whitney White, MS CMHC, NCC., LPC

Published 12/28/2020

Transient psychosis, also known as brief psychotic disorder and brief reactive psychosis, is a rare disorder in which an individual has sudden symptoms of psychosis that do not last more than a month. Other names for transient psychosis include atypical psychosis, emotional psychosis, cycloid psychosis, and schizophreniform psychosis. A transient psychosis definition is described as a break from reality when a person has trouble recognizing what is real and fake. A stressful or traumatic event typically brings on a psychotic episode.

What Is Transient Psychosis?

Acute and transient psychotic disorders have been described since the 1800s, varying from mild to severe but lasting less than 30 days. Although the episodes are short, someone experiencing acute transient psychosis has severe hallucinations and delirium symptoms. These episodes come on suddenly (within less than 14 days), have variable schizophrenic symptoms, and are usually associated with some type of stressor. The criteria for transient psychosis include:

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  • Acute onset of incoherent speech, hallucinations, and delusions within two weeks.
  • The symptoms must not be able to be described as depressive or manic.
  • The individual must not be (or have been) using any kind of drug or alcohol.
  • No proof of a metabolic or nervous system disease or other organic illness.

According to the experts, there are three categories of psychotic disorder, which include:

  • Brief psychotic disorder with a stressful or traumatic incident
  • Brief psychotic disorder without a stressful or traumatic incident
  • Brief psychotic postpartum disorder within a few months of giving birth

Warning Signs and Symptoms of Transient Psychosis

Regardless of the type, there are typically warning signs before the real symptoms present. These early signs may include:

  • Seeming out of touch or aloof
  • Ignoring responsibilities
  • Having inappropriate emotional responses such as going into a rage over something small
  • Speaking to someone who is not there
  • Coming up with conspiracy theories
  • Obsession with religion or governmental involvement
  • Forgetting things or remembering things that did not happen
  • Lacking in emotions
  • Seeming to be on edge or paranoid

The symptoms usually escalate quickly, within a few days or a week. Eventually leading to more severe symptoms, including:

  • Hallucinations, which include hearing or seeing things that are not there
  • Delusions, which include believing in things that are not real.
  • Disorganized speaking and thinking, which includes speaking different (fake) languages or about strange topics
  • Not being able to make decisions
  • Not sleeping, having a weird sleep schedule, or sleeping too much
  • Being confused or disoriented
  • Attention and memory problems
  • Wearing strange clothes or dressing unusual in general

Causes and Risk Factors of Transient Psychosis

The cause of transient psychosis is still being researched. But the experts have found that psychosis is often coordinated with other mental health illnesses such as classic schizophrenia, major depression, schizophreniform disorder, and others. Other risk factors include:

  • There is a familial history of schizophrenia, bipolar disorder, or depression
  • It occurs in females more often than men
  • Living in a rural or low-income population may be a factor
  • A traumatic brain injury may be involved
  • Some were found to have had a short fever before the onset
  • It seems to happen more often during the summer months
  • Major stress before the incident is seen in over 60% of cases
  • It often happens within three months of childbirth

Genetics

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There have been many studies conducted on the familial connection of transient psychosis. One study found that those with first-degree relatives who have transient psychosis are three times more likely to develop the problem. A similar study determined that those with a familial history of schizophrenia was 2.06 times more likely to develop transient psychosis. The same study learned that the risk of getting the disorder was 1.55 times higher for those with a family history of bipolar disorder.

Gender and Income

In addition to familial factors, transient psychotic episodes are more frequently found in women and those in lower-income areas. In a 2014 study, it was found that 51% of those patients who were diagnosed with transient psychosis were women. Although this is not a huge difference, other studies also corroborate these findings. In fact, another study found an overrepresentation of females to have the disorder, but many of them were postpartum. In addition, many of the studies found that the highest numbers of incidents were found to be in low-income families or rural areas.

Other studies learned that those who had a traumatic brain injury were almost three times as likely to have transient psychosis. Similar findings include a 60% increase in the risk of transient psychosis after a traumatic brain injury. However, the study was also concerned that the transient psychosis might have been caused by the injury’s stress rather than just a physical injury to the brain.

Treatment for Transient Psychosis

Although the most common treatment for transient psychosis is antipsychotic medication, therapy, and rehabilitation are also important to the patient’s recovery. Since it is a short-term illness, the worry of permanent problems is negligent, but it is important to note that the illness can cause enough psychoses symptoms to interrupt daily life. In addition, since those who have one episode are 70% to 80% more likely to have another within 12 months, ongoing treatment is recommended.

Cognitive Remediation

To improve cognitive functioning in those who have had transient psychosis, cognitive remediation is a necessary part of the process. The process uses repeated exercises to sharpen and strengthen important cognitive skills. This can be done by a therapist online using computerized programs or one-on-one therapy in the office. This type of therapy involves teaching executive functioning, planning, language, memory, and attention. Some of the programs include:

  • Scaffolding methods such as demonstrating how to do things before letting the patient try
  • Dyadic teaching, which is a goal-directed teaching method
  • Homework assignments such as journaling and worksheets
  • Changing the environment that you live in
  • Shaping behavior through reinforcement
  • Neuropsychological testing if needed
  • Social functioning skills through role-playing

Cognitive Behavioral Therapy

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Also known as CBT, this therapy has been around for years and has been proven to help many different mental illnesses, primarily depression. However, it has recently become a popular choice for treating psychosis. According to the experts, early treatment of CBT with medication and familial and vocational support has cut the risk of future psychotic episodes in half.

A CBT program specifically used in treating psychosis helps you see how you think about situations and how your thoughts shape your behavior. The therapy enables you to see how your thoughts and behavior affect how you feel and how you can change them. The main goal is to help reduce stress because stress is a likely cause of transient psychosis.

The treatment typically lasts about four months with one treatment a week. The therapist has a major role in this treatment as they try to understand your perspectives to see what is going on. They do not try to change how you think or tell you that things are not real. They are just there to help you understand and get rid of those troubling thoughts and behaviors. The process includes five phases, which are:

  • Building a relationship between you and the therapist
  • Assessing the experiences you are having
  • Developing a formula to help process thinking patterns
  • Applying the intervention and building skills
  • Consolidating skills for you to use on your own

Psychotherapy for Resilience Training

Resilience is the ability of a body to recover its shape and size after compressive stress or the ability to adjust to a change. Although it was once believed that we all had this resilience built into our psyche, it has been found that this is not true. Mental health experts have found that resilience may have to be built over time but can be strengthened as needed.

In resilience training, you are assessed to determine your resilience level and what needs to be worked on. Building resilience helps you develop the skills you need to overcome stressors and other adversities in your life. It is a way to take control over your life for the things you can control and understand that you cannot control things.

Building on your resilience is done by being more flexible to the things around you, adapting easier to whatever life gives you. When you are confronted with a major life crisis or trauma, you can handle it and deal with it if you have the resilience you need. No tool can give the therapist a way to assess your resilience. That is why you have to build a relationship with them. Over time, the therapist can determine what you need to work on and help you get it done.

Talk to A Mental Health Professional

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It is essential to talk to a mental health professional if you or someone you care about is experiencing transient psychosis. If you are not sure, this free psychosis screening may help you determine if what you’re experiencing is something you should follow up with your doctor or therapist about.