"Psychotic break" is the term that is usually used to refer to acute psychotic episodes, especially when this is the first time it happens to someone. It is defined as a mental state that implies in some degree a loss of contact with reality, that is, a confusion between what is real and what is not.
In this article, we are going to explain what a psychotic break is and what are the symptoms and causes of it. As we are going to see in the text, cannabis, traumatic events or intense stress are some of the most common causes, but not the only ones.
The concept "psychotic break" refers to an acute episode of psychosis, this is, states of loss of contact with reality that are characterized, among other symptoms and signs, by hallucinations (generally auditory type), delusions (ideas in which it is believed with great conviction despite its incoherence) or alterations in language.
So, in these cases, the people affected are not able to distinguish appropriately which of the stimulus they sense are real and which are not. For example, in the case of auditory hallucinations, which are quite usual, people fail to attribute the sounds or voices they hear to an external source rather than their mind.
Although on many occasions this disorder happens in the context of mental disorders such as schizophrenia or dementia, most of this kind of episodes happen as a consequence of the consumption of cannabis or other psychoactive substances. We will talk in detail about the causes of these episodes further on.
To sum up, a psychotic break is a loss of contact with reality that can intensify and cause increasing problems if this is not prevented in time. Although they may be abrupt, it is more common for signs to develop throughout weeks or even months.
If we base ourselves on the criteria collected by the DSM and ICD diagnostic manuals, what we know as a psychotic break would be included in the entity "Brief psychotic disorder." A person is considered to be suffering from this problem if they present delusions, hallucinations, incoherent language or disorganized behavior.
Compared to other psychological alterations of the psychosis spectrum, brief psychotic disorders are characterized by a very limited duration in time; a psychotic episode is generally considered to be short when it lasts less than one month. In contrast, the diagnosis of schizophrenia requires relevant symptoms for at least one month.
According to the DSM-IV, there are two types of brief psychotic disorder: Psychotic breaks that are caused as a reaction of intense stress (called "brief reactive psychosis") and those that appear without such evident risk factors. On the other hand, the manual highlights that it is relatively common for this type of episode to occur in the postpartum period.
In the initial phases, a psychotic break is characterized by the presence of some signs and symptoms that are different depending on the case and that, if it is not treated correctly, it can get worse and cause severe problems for the affected person and the people that belong to their social surroundings.
One of the most typical symptoms of psychotic breaks is social isolation, which in many cases means the first sign of the development of a psychotic episode. So, in the previous weeks of the detection of the break, the person can avoid interaction with friends, miss work, opt for seclusion and even avoid close family members.
Sleeping difficulties are also very common prodromes (something that also happens in manic episodes of bipolar disorder), and the same can be said of problems understanding written texts or oral messages.
On the other hand, hallucinatory and delirious experiences are also symptoms of psychotic breaks: many people that have suffered this type of episode said to have experienced light flashes, shades, buzzing, voices, melodies, smells or tastes without a real basis.
Other very frequent signs are the neglect of appearance, hygiene, and general self-care, strange facial expressions and the emission of meaningless sounds. In addition, it is possible that these people get self-injured or harm others; this may depend on the content of delusions and hallucinations.
The possible causes of psychotic breaks are multiple; for this reason, it is essential to bear in mind that the mechanisms by which they occur can vary greatly, as the prognosis or specific symptoms and signs.
As mentioned above, probably the most common precipitating factor for brief psychotic episodes is prolonged consumption of substances with psychoactive effects. These breaks are quite frequent in people addicted to cannabis, alcohol, cocaine or hallucinogens, among other drugs, but they can also occur in occasional users.
Drug intoxication (or medication), traumatic events and multiple diseases can also facilitate the appearance of psychotic breaks. The most common ones are the neurodegenerative disorders that disturb the functioning of the brain and therefore of thought.
However, it is believed that a more or less intense biological predisposition is necessary for a psychotic break to develop; this hereditary factor also explains why psychosis is more likely in people with affected relatives.
In this sense, it is hypothesized that precipitating factors, such as the consumption of large quantities of drugs or the experience of intense stress, would trigger the episodes when acting on a biological basis (specific alterations in the structure of the brain or the release of neurotransmitters, for example) and/or the personality that favors them.
Psychotic episodes seem to be more common in people who show certain personality patterns. In particular, they are more likely in those with schizoid traits (tendency to social isolation, low emotionality), schizotypical (social anxiety, thought disorganization, eccentricism) and paranoid (characterized by suspicion and distrust of others).
Stress is a common cause of this type of disorder. When the reason of a psychotic break is clearly a situation (punctual or prolonged) of intense stress, from the point of view of clinical diagnosis we refer to it as "brief reactive psychosis."
Among the types of events that are frequently associated with the appearance of this disorder because of stress, are the death of loved ones, life-threatening situations (for example, a natural catastrophe or rape) or traumatic events that are prolonged.
Postpartum psychotic breaks are also quite frequent. Generally, this diagnosis is distinguished from the brief reactive psychosis.
In any case, the person who suffers a psychotic break will usually have a genetic predisposition for it. More than a cause itself, stress is a precipitating or aggravating factor of these episodes in most cases.