When a patient has experienced one or more delusions (false beliefs) for a period of 1 month or more, a diagnostic picture of delusional disorder can be painted (American Psychiatric
Association 2013). Delusions can present in a variety of ways and tend to be resistant to change. Sometimes this is termed as being a fixed delusion. As discussed earlier, delusions in themselves do not constitute a psychiatric emergency, but an emergency can be considered if the delusions are causing impairments in the patient’ s ability to keep themselves safe, others around them safe, or in caring for their basic needs including obtaining food, clothing, and shelter. If the delusions that the individual expresses are causing a strain on daily relationships with family, friends, and workplace colleagues, an outpatient treatment plan may be beneficial to consider.
Brief Psychotic Disorder
Jason, a 31-year-old male, presents to the emergency department with his parents who report that over the past 2 days, he has “not been himself.” Jason’s parents report that he has been paranoid, stating that he believes that the FBI is tracking him and has placed cameras in the house. They also report that Jason has not been sleeping over the past two nights and they have heard him holding complete conversations with himself when alone in his bedroom. They report that he has never behaved like this in the past and, as far as they know, he does not use any illicit substances. Jason’s parents report that his fiance of 2 years broke off their relationship 1 week ago. Jason’s diagnostic picture can be attributed to a case of brief psychotic disorder.
In brief psychotic disorder, delusions, hallucinations, and disorganized speech or behaviors can be present. Per the DSM-5, either delusions, hallucinations, or disorganized speech must have developed suddenly (within a 2-week period) in the person and last from 1 day to less than 1 month. The person must experience an eventual remission of all symptoms at some point during the course of the episode (American Psychiatric Association 2013).