Brief Psychotic Disorder

Brief psychotic disorder is the presence of 1 or more psychotic symptoms lasting more than 1 day and less than 1 month. An episode is often stress-related with a sudden onset, and the patient fully returns to baseline functioning after an episode. Diagnosis is clinical and management includes a brief course of 2nd-generation antipsychotics for 1–3 months, along with education and reassurance.

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Definition and Epidemiology

Definition

A brief psychotic disorder is defined by psychotic symptoms lasting at least 1 day but no longer than 1 month. After the episode, the patient returns to a normal level of functioning.

Epidemiology

  • Brief psychotic disorder is rare and has a low incidence compared to other psychotic disorders.
  • More common in women than men
  • More common in developing countries
  • Average age of onset is mid-30s. 
  • A personality disorder is a risk factor for the development of brief psychotic disorder.

Etiology

Although the specific etiology is unknown, an association with a marked, stressful life condition has been described:

  • Trauma
  • Death of a loved one
  • Immigration 
  • Postpartum period (within 4 weeks of birth)

Brief psychotic disorder without a marked, stressful life condition may be explained by genetics, neurologic factors, or other environmental factors.

Diagnosis

Diagnostic criteria

The DSM-5 diagnostic criteria for brief psychotic disorder includes: 

  • Presence of 1 or more psychotic symptoms:
    • Hallucinations
    • Delusions
    • Disorganized speech
    • Disorganized behavior
    • Catatonia
  • Duration: > 1 day and < 1 month
  • Full return to the normal level of function before the disease

Exclusion of other causes

Rule out other potential causes for abnormal behavior by considering the following tests:

  • Basic labs: CMP
  • Pregnancy test for women
  • Urine toxicology for substance-induced psychosis
  • CT or MRI of brain

Management

  • Consider hospitalization if a patient is suicidal, homicidal, or unable to care for self.
  • Social support and socioeconomic stability may help decide disposition. 
  • Pharmacotherapy:
    • A brief course of 2nd-generation antipsychotics
    • Maintain treatment for 1–3 months after resolution of symptoms. 
  • Psychotherapy: education and reassurance for patients, family, and friends

Differential Diagnosis

  • Schizophrenia: a chronic mental health disorder characterized by positive symptoms (e.g., delusions, hallucinations, disorganized speech/behavior) and negative symptoms (e.g., flat affect, anhedonia, poor attention, and alogia). Schizophrenia is associated with a decline in function lasting > 6 months. The severity and duration of symptoms differentiate schizophrenia from a brief psychotic disorder.
  • Delusional disorder: singular or multiple delusions for 1 month or more, no additional psychotic symptoms or behavioral changes, and no decline in functioning abilities. Despite arguments to challenge the thoughts, the patient holds strong, false beliefs. Unlike in brief psychotic disorder, delusional disorder does not impair function.

References

  1. Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan and Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Chapter 7, Schizophrenia spectrum and other psychotic disorders, pages 300-346. Philadelphia, PA: Lippincott Williams and Wilkins.
  2. Mojtabai, R. (2021). Brief psychotic disorder. UpToDate. Retrieved March 18, 2021, from https://www.uptodate.com/contents/brief-psychotic-disorder
  3. Stephen A, Lui F. (2021). Brief Psychotic Disorder. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK539912/
  4. Sharma, V., & Baczynski, C. (2020). Clarifying the onset of brief psychotic disorder at childbirth. Archives of women’s mental health, 23(2), 221. https://doi.org/10.1007/s00737-019-00965-5

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