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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 Reassurance Clinician–Patient Relationship.

Last updated: Nov 14, 2022

Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

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 Incidence The number of new cases of a given disease during a given period in a specified population. It also is used for the rate at which new events occur in a defined population. It is differentiated from prevalence, which refers to all cases in the population at a given time. Measures of Disease Frequency 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:

Brief psychotic disorder without a marked, stressful life condition may be explained by genetics Genetics Genetics is the study of genes and their functions and behaviors. Basic Terms of Genetics, neurologic factors, or other environmental factors.

Diagnosis

Diagnostic criteria

The clinical diagnostic criteria for brief psychotic disorder include: 

  • Presence of 1 or more psychotic symptoms:
    • Hallucinations Hallucinations Subjectively experienced sensations in the absence of an appropriate stimulus, but which are regarded by the individual as real. They may be of organic origin or associated with mental disorders. Schizophrenia
    • Delusions
    • Disorganized speech
    • Disorganized behavior
    • Catatonia Catatonia A neuropsychiatric disorder characterized by one or more of the following essential features: immobility, mutism, negativism (active or passive refusal to follow commands), mannerisms, stereotypies, posturing, grimacing, excitement, echolalia, echopraxia, muscular rigidity, and stupor; sometimes punctuated by sudden violent outbursts, panic, or hallucinations. This condition may be associated with psychiatric illnesses (e.g., schizophrenia; mood disorders) or organic disorders (neuroleptic malignant syndrome; encephalitis, etc.). Major Depressive Disorder
  • 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 Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care test for women
  • Urine toxicology for substance-induced psychosis
  • CT or MRI of brain Brain The part of central nervous system that is contained within the skull (cranium). Arising from the neural tube, the embryonic brain is comprised of three major parts including prosencephalon (the forebrain); mesencephalon (the midbrain); and rhombencephalon (the hindbrain). The developed brain consists of cerebrum; cerebellum; and other structures in the brain stem. Nervous System: Anatomy, Structure, and Classification

Management

  • Consider hospitalization Hospitalization The confinement of a patient in a hospital. Delirium 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 Psychotherapy Psychotherapy is interpersonal treatment based on the understanding of psychological principles and mechanisms of mental disease. The treatment approach is often individualized, depending on the psychiatric condition(s) or circumstance. Psychotherapy: education and reassurance Reassurance Clinician–Patient Relationship for patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship, family, and friends

Differential Diagnosis

  • Schizophrenia Schizophrenia Schizophrenia is a chronic mental health disorder characterized by the presence of psychotic symptoms such as delusions or hallucinations. The signs and symptoms of schizophrenia are traditionally separated into 2 groups: positive (delusions, hallucinations, and disorganized speech or behavior) and negative (flat affect, avolition, anhedonia, poor attention, and alogia). Schizophrenia: a chronic mental health disorder characterized by positive symptoms (e.g., delusions, hallucinations Hallucinations Subjectively experienced sensations in the absence of an appropriate stimulus, but which are regarded by the individual as real. They may be of organic origin or associated with mental disorders. Schizophrenia, disorganized speech/behavior) and negative symptoms (e.g., flat affect, anhedonia Anhedonia Inability to experience pleasure due to impairment or dysfunction of normal psychological and neurobiological mechanisms. It is a symptom of many psychotic disorders (e.g., depressive disorder, major; and schizophrenia). Schizophrenia, poor attention Attention Focusing on certain aspects of current experience to the exclusion of others. It is the act of heeding or taking notice or concentrating. Psychiatric Assessment, and alogia Alogia Poverty of speech. Schizophrenia). Schizophrenia Schizophrenia Schizophrenia is a chronic mental health disorder characterized by the presence of psychotic symptoms such as delusions or hallucinations. The signs and symptoms of schizophrenia are traditionally separated into 2 groups: positive (delusions, hallucinations, and disorganized speech or behavior) and negative (flat affect, avolition, anhedonia, poor attention, and alogia). Schizophrenia is associated with a decline in function lasting > 6 months. The severity and duration of symptoms differentiate schizophrenia Schizophrenia Schizophrenia is a chronic mental health disorder characterized by the presence of psychotic symptoms such as delusions or hallucinations. The signs and symptoms of schizophrenia are traditionally separated into 2 groups: positive (delusions, hallucinations, and disorganized speech or behavior) and negative (flat affect, avolition, anhedonia, poor attention, and alogia). Schizophrenia from a brief psychotic disorder.
  • Delusional disorder Delusional disorder In delusional disorder, the patient suffers from 1 or more delusions for a duration of 1 month or more, without any other psychotic symptoms or behavioral changes and no decline in functioning abilities. 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 Delusional disorder In delusional disorder, the patient suffers from 1 or more delusions for a duration of 1 month or more, without any other psychotic symptoms or behavioral changes and no decline in functioning abilities. 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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