Category: Psychotic disorders

Brief Psychotic Disorder

Brief psychotic disorder (BPD) according to DSM-5 is the sudden onset of psychotic behavior that lasts less than 1 month followed by complete remission with possible future relapses. It is differentiated from schizophreniform disorder and schizophrenia by the duration of the psychosis. The diagnosis is often anticipatory or retrospective due to the diagnostic requirement of complete remission within 1 month.

Brief psychotic disorder is an acute but transient disorder with the onset of one or more of the following psychotic symptoms:

  • Delusions
  • Hallucinations
  • Disorganized speech
  • Grossly disorganized or catatonic behavior

At least one of these symptoms must be delusions, hallucinations, or disorganized speech. The symptoms in BPD last between one day to one month, with a complete return to premorbid level of functioning after the disease course in response to antipsychotic medications. The disturbance in behavior cannot be better accounted for by schizophrenia, schizoaffective disorder, mood disorder with psychotic features, or be a direct result of a drug, medication, or medical condition like thyrotoxicosis, sarcoidosis, or syphilis.

Etiology

Although unclear, the underlying etiology of brief psychotic disorder can be a stressful event or trauma. There may be a genetic, neurological, or environmental component to BPD as well. The specific trigger of BPD, if present, must be specified as follows:

  • Brief psychotic disorder with marked stressor(s) is also referred to as brief reactive psychosis. It is the onset of psychotic symptoms that occur in response to a traumatic event that would be stressful for anyone in similar circumstances in the same culture
  • Brief psychotic disorder without marked stressor(s) is the onset of psychotic symptoms that occur in the absence of a traumatic event that would be stressful for anyone in similar circumstances in the same culture
  • Brief psychotic disorder with postpartum onset is defined as the onset of psychotic symptoms that occur within four weeks postpartum   more

Catatonic Schizophrenia

Catatonic schizophrenia is a subtype of schizophrenia that experts now consider obsolete. Experts no longer recognize it as a specific condition, and instead, attach catatonia as an additional feature when diagnosing schizophrenia. Catatonia is sometimes dangerous, but is usually very treatable with medication or other methods.

What is catatonic schizophrenia?

“Catatonic schizophrenia” is a subtype of schizophrenia that includes catatonia as a key feature. Experts no longer recognize it as a diagnosis, making this name obsolete. Today, experts recognize schizophrenia as a specific disease and a spectrum of disorders. Healthcare providers regard catatonia as an important syndrome to consider and treat, especially when it happens with schizophrenia.

The American Psychiatric Association removed catatonic schizophrenia from its list of official diagnoses when updating to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in 2013. The World Health Organization (WHO) removed “catatonic schizophrenia” from the International Classification of Diseases when updating to the 11th edition (ICD-11) in 2019.

What is catatonia?

Catatonia is a syndrome — a collection of signs and symptoms — where your brain doesn’t manage muscle movement signals as it should and you behave abnormally. It happens with many other conditions, but schizophrenia is frequently associated with catatonia. Once thought to be the only condition associated with catatonia, it’s now known that bipolar disorder is more commonly associated with catatonia and that catatonia occurs alongside a number of medical and mental health conditions.

There are three main forms of catatonia: excited, withdrawn and mixed.

  • Excited/hyperkinetic: This form involves increased movement (such as in the form of pacing), agitated behavior, unusual or exaggerated movements, repetitive movements or speaking, or mimicking someone speaking or moving near them.
  • Withdrawn/hypokinetic: This form of catatonia is often easier to spot because people with this form of catatonia have very limited responses — or no response at all — to what’s happening around them. They may be mute, show no emotions or facial expressions, hold completely still or stare or stay in an unusual position for an extended period.
  • Mixed: This form combines features of hyperkinetic and hypokinetic catatonia.

What is the difference between catatonic schizophrenia and paranoid schizophrenia?

Like “catatonic schizophrenia,” “paranoid schizophrenia” is an obsolete term for a diagnosis that no longer exists. Paranoid schizophrenia was the name for schizophrenia where experts regarded paranoia, delusions and hallucinations as key symptoms. Catatonic schizophrenia is the term for schizophrenia where catatonia is the most dominant feature.   more

Intermittent explosive disorder (IED)

Overview

Intermittent explosive disorder involves repeated, sudden episodes of impulsive, aggressive, violent behavior or angry verbal outbursts in which you react grossly out of proportion to the situation. Road rage, domestic abuse, throwing or breaking objects, or other temper tantrums may be signs of intermittent explosive disorder.

These intermittent, explosive outbursts cause you significant distress, negatively impact your relationships, work and school, and they can have legal and financial consequences.

Intermittent explosive disorder is a chronic disorder that can continue for years, although the severity of outbursts may decrease with age. Treatment involves medications and psychotherapy to help you control your aggressive impulses.

 

Symptoms

Explosive eruptions occur suddenly, with little or no warning, and usually last less than 30 minutes. These episodes may occur frequently or be separated by weeks or months of nonaggression. Less severe verbal outbursts may occur in between episodes of physical aggression. You may be irritable, impulsive, aggressive or chronically angry most of the time.

Aggressive episodes may be preceded or accompanied by:

  • Rage
  • Irritability
  • Increased energy
  • Racing thoughts
  • Tingling
  • Tremors
  • Palpitations
  • Chest tightness

The explosive verbal and behavioral outbursts are out of proportion to the situation, with no thought to consequences, and can include:

  • Temper tantrums
  • Tirades
  • Heated arguments
  • Shouting
  • Slapping, shoving or pushing
  • Physical fights
  • Property damage
  • Threatening or assaulting people or animals

You may feel a sense of relief and tiredness after the episode. Later, you may feel remorse, regret or embarrassment.   more

The Personality Disorder We Don’t Hear Enough About

The sadistic personality may be mistaken for antisocial personality disorder.

KEY POINTS

  • Sadistic personality disorder is no longer in the DSM, but it’s still recognized by personality aficionados.
  • The chief component of sadistic personality is taking pleasure in cruel, demeaning, and aggressive behaviors as a means of control.
  • It is differentiated from antisocial personality disorder in that, for the sadistic personality, cruelty and aggression is an end unto itself.
It’s no news that somepathological personalities have a sadistic quality about them. Narcissists will torture with put-downs to keep their ego afloat; antisocial personalities may make people suffer into submission to get a need met, enjoying the sense of power it provides them. However, the aforementioned are not usually openly hostile and destructive as a general way of relating to others. In these circumstances, such acts of cruelty are really means to an end; a part of the disorder. Is there a personality style where hellish cruelty is a central component?

The Sadistic Personality

While no longer addressed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), sadistic personality disorder (SPD), similar to the passive-agressive and masochistic personality, has continued to be recognized as a legitimate condition by many (e.g., Millon, 2011; Plouffe, Sakloske &Smith, 2017; Coolidge et al., 2018; Kowalski et al., 2019). Sadistic personality qualities have also been resurfacing as a hot topic in the realm of the dark triad/tetrad.

First written about as a psychological construct by Krafft-Ebbing in the mid-1800s (Millon, 2011), the sadistic character was then recognized as someone who enjoys instigation of pain, cruelty, and humiliation as sexual dominance. This was expounded upon by Freud, who discussed sadism and masochism as “bipolar dimensions of the aggressive component of the sexual instinct” (Millon, 2011).

Looking beyond this sexual basis, however, Eric Fromm later posited that sexual sadism was only one expression of some people’s need to humiliate. Millon (2011) quoted Fromm:

“Mental cruelty, the wish to humilate and to hurt another person’s feelings, is probably even more widespread than physical sadism. This type of sadistic attack is much safer to the sadist… the psychological pain can be as intense or even more so than the physical… the core of sadism…is the passion to have absolute and unrestricted control over a living being. To force someone to endure pain or humiliation without being able to defend oneself is one of the manifestations of absolute control…”

In other words, it seemed that some people’s interpersonal style is entirely constructed around sadistic behavior. It was just this line of thinking that led to SPD being included in the DSM-3 Revised edition (DSM 3-R [1987]). However, this was limited to the “Proposed Diagnostic Categories Needing Further Study” appendix, and never made it further, despite over 50% of forensic psychiatrists surveyed at that time reporting having interviewed cases that would meet criteria (Levesque, 2014). According to Millon (2011), disregarding it in future editions was a political decision, but a foolish one, given it is clear there exists an aggression-loving population in society that markedly contributes to the decline of civility.   more

Bipolar Disorder with Psychotic Features

Some people who have been diagnosed with bipolar disorder will experience episodes of psychosis during mania or depression. These episodes cause hallucinations, delusions, disordered thinking, and a lack of awareness of reality. While in extreme situations hospitalization may be necessary, most bipolar patients with psychotic features can manage these episodes with ongoing, professional treatment.

Bipolar disorder can trigger psychotic symptoms, which may include hallucinations or delusions during mania, depression, or both.

Psychosis can be distressing, but it can also be managed, treated, and even prevented with the right medications and therapy with experienced mental health professionals.

What Is Bipolar Disorder?

Bipolar and related disorders are mood disorders characterized by episodes of mania and depression. Manic episodes cause a feeling of euphoria, unusually high energy and activity levels, and irritability. Depressive episodes cause sadness, hopelessness, fatigue, loss of interest in activities, and other symptoms of depression.

Depending on the type of the condition, a person with bipolar disorder may cycle through both of these moods or may experience depression with a less extreme type of mania called hypomania. A low-grade but long-term type of bipolar disorder is called cyclothymia. Bipolar I, the disorder that triggers both depression and mania, may also cause symptoms of psychosis.

Psychosis Is a Specifier for Bipolar Disorder

When a medical or mental health professional is diagnosing bipolar disorder they may use specifiers. These are added details that describe an individual’s experience and symptoms. Specifiers include atypical features, like significant weight gain or sleeping too much, and psychotic features. If someone is diagnosed with bipolar disorder with psychotic features it means he or she meets the diagnostic criteria for bipolar but also has symptoms of psychosis.

What Is Psychosis?

Psychosis is a state of mind and a set of symptoms characterized by losing contact with reality. It is not a condition in and of itself but rather a group of symptoms that can be triggered by certain mental illnesses, like bipolar disorder, and by medical conditions, brain injuries, substance misuse, and some medications. Someone with bipolar disorder may experience psychotic symptoms during a manic or a depressive episode. The specific symptoms and their character or content vary by individual.

Symptoms of Bipolar Psychosis

Exactly what one person will experience when having psychotic symptoms during an episode of mania or depression varies. However, in general psychotic symptoms can be grouped into a few categories:

  • Hallucinations. A hallucination is something that is sensed—heard, seen, felt, tasted, or smelled—that seems real but that is not real. Hallucinations may include seeing things that aren’t there or hearing non-existent voices.
  • Delusions. A delusion is a false belief that persists in spite of evidence. Delusions can be paranoid, grandiose, persecutory, jealous, or a mixture of types.
  • Confused thinking. Psychosis can cause disordered, racing, and irrational thoughts. To an observer this person may talk very fast, jump from one topic to another, and not make a lot of sense.
  • Poor self-awareness. In the middle of a psychotic episode a person will not be aware that his or her beliefs or hallucinations are false. This can trigger fear and significant distress.

Psychosis in bipolar disorder tends to match a person’s current mood. So, for instance, during mania a person may have grandiose delusions, believing he or she is more talented and capable of doing something, or even famous and rich. During a depressive mood those delusions will take a downturn, and may include things like the paranoid belief that someone is out to get them.   more

Split (2017) – Hedwig’s Dance Scene

FILM DESCRIPTION:
Though Kevin (James McAvoy) has evidenced 23 personalities to his trusted psychiatrist, Dr. Fletcher (Betty Buckley), there remains one still submerged who is set to materialize and dominate all of the others. Compelled to abduct three teenage girls led by the willful, observant Casey, Kevin reaches a war for survival among all of those contained within him — as well as everyone around him — as the walls between his compartments shatter.

 

Pornscars – “Good Old Ed Gein” Official Music Video

Song Lyrics: “Good Old Ed Gein”

He used to babysit my kids sometimes
and don’t you know they all turned out fine
OLD ED GEIN WAS A FRIEND OF MINE
and I never spoke bad about his mother
because we all know what happened to his brother
OLD ED GEIN WAS A FRIEND OF MINE

He decided to decorate his home
all he needed was fresh skin and some bones
OLD ED GEIN WAS A FRIEND OF MINE
he stumbled in a trance stumbled in a daze
what do you know, he robbed a couple of graves
OLD ED GEIN WAS A FRIEND OF MINE

He pulled me to the side and he said maybe
I think I want to be a lady
OLD ED GEIN WAS A FRIEND OF MINE
he loved to dress up, loved to pretend
he made costumes from human flesh
OLD ED GEIN WAS A FRIEND OF MINE