DSM-III-R brief reactive psychosis among Air Force recruits

Clinical characteristics of patients diagnosed with brief reactive psychosis based on DSM-III-R criteria and the incidence of this disorder in a defined population have not been sufficiently studied. Some military recruits who are subjected to relatively uniform levels of stress in a monitored environment over a specified time period develop transient, severe psychotic symptoms consistent with a diagnosis of brief reactive psychosis.

We retrospectively reviewed all cases of brief reactive psychosis that occurred among 139,360 Air Force recruits during 6-week basic training experiences over a 3-year period. Brief case descriptions, including clinical courses, are provided.

Six cases were found among 557 consecutive psychiatric admissions between January 1, 1988, and January 1, 1991 (annual incidence = 1.43 cases per 100,000 recruits). An apparent temporal relationship was found between the onset of the stressor (basic military training) and the development of psychosis. Paranoid symptomatology, including persecutory delusions, was present in all cases. Adjustment disorders were the most common diagnoses in patients admitted from the training environment (N = 464).

Brief reactive psychosis is a rare discharge diagnosis in this large population of young Air Force recruits. Prospective studies are warranted to evaluate the usefulness of DSM-III-R criteria for this disorder and to determine the longitudinal course of patients who have received this diagnosis.