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We present the case of a 29-year-old single Bulgarian woman, Alice, who lived and worked alone in Germany at the time she presented with signs of acute psychosis, more specifically work-related paranoid ideation. She was diagnosed with Brief Psychotic Disorder and treated successfully with Perphenazine. A return to her home town in Bulgaria with concurrent discontinuation of antipsychotic treatment brought about a change in delusional content. She was now excessively preoccupied with religious themes, ancient rituals, and local traditions, and responded well to treatment with Olanzapine. Alice reluctantly returned to Germany but every time she started a new job she experienced depressive and paranoid exacerbations in spite of strict medication adherence. In the last 3 years, she has lived in Bulgaria and has been medication and episode free. We discuss the complex interaction between the experiences of expatriation, premorbid personality, and cultural values (of the patient and her family) in the etiology, course and outcome of brief psychotic disorder. We raise the possibility that contemporary Bulgarian cultural values (as described in a recent comparative international study) were important in Alice’s recovery and, as such, may have wider significance as protective factors for those at risk of mental disorder.

Premorbid Personality and Expatriation as Possible Risk Factors for Brief Psychotic Disorder: A Case Report from Post-Soviet Bulgaria