Brief
Psychotic Disorder
Brief psychotic disorder is a
disorder characterized by hallucinations, delusions, disorganized speech or
behavior. The duration of symptoms is between one day and one month, whereas the
diagnosis of schizophrenia requires a six month duration of symptoms
I. DSM-IV Diagnostic Criteria for Brief Psychotic
Disorder
A. At least one of the following:
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or
catatonic behavior
B. Duration of symptoms is between
one day and one month, after which the patient returns to the previous level of
functioning.
C. The disturbance is not caused
by a mood disorder with psychotic features, substance abuse, schizoaffective
disorder, schizophrenia, or other medical condition.
II. Clinical
Features of Brief Psychotic Disorder
A. Emotional turmoil and confusion
are often present.
B. Mood and affect may be labile.
C. Onset is usually sudden.
D. Attentional deficits are
common.
E. Psychotic symptoms are usually
of brief duration (several days)
III. Epidemiology of Brief Psychotic Disorder
A. The disorder is rare, and
younger individuals have a higher rate of illness, with the average age of onset
in the late twenties to early thirties.
B. The risk of suicide is
increased in patients with this disorder, especially in young patients.
C. Patients with personality
disorders have a higher risk for brief psychotic disorder.
IV.
Classification of Brief Psychotic Disorder
A. Brief
Psychotic Disorder with Marked Stressors is present if symptoms occur in
relation to severe stressors (ie, death of a loved one).
B. Brief
Psychotic Disorder without Marked Stressors is present if symptoms occur
without identifiable stressors.
C. Brief
Psychotic Disorder with Postpartum Onset: Occurs within four weeks of
giving birth.
V. Differential
Diagnosis of Brief Psychotic Disorder
A. Substance induced psychotic
disorder
1. Amphetamine, cocaine and PCP
may produce symptoms lindistinguishable from brief psychotic disorder. Alcohol
or sedative hypnotic withdrawal may also mimic these symptoms.
2. Substance abuse should be
excluded by history and with a urine toxicology screen.
B. Psychotic Disorder Caused a
General Medical Condition
1. Rule out with history, physical
exam and labs. CBC to rule out an infection leading to delirium and psychosis.
2. Routine chemistry labs to rule
out electrolyte imbalances or hepatic encephalopathy; RPR to rule out
neurosyphilis; HIV to rule out psychosis due to encephalitis in at risk
patients.
3. Consider a MRI or head CT scan
to rule out a mass or neoplasm.
4. An EEG should be considered to
rule out seizure disorders (such as temporal lobe epilepsy) especially when
there is a history of amnestic periods or impaired consciousness.
C.
Schizophreniform Disorder or Schizophrenia. Schizophreniform disorder must
last for over a month and schizophrenia must have a six month duration.
D. Mood Disorder with Psychotic
Features. Brief psychotic disorder can not be diagnosed if the full criteria for major
depressive, manic or mixed episode is present
VI. Treatment of
Brief Psychotic Disorder
A. Brief hospitalization may be
necessary, especially if suicidal or homicidal ideation is present. B. A brief course of
a neuroleptic such as haloperidol (Haldol) 5-10 mg per day is often indicated,
and adjunctive benzodiazepines may be useful. Short acting benzodiazepines such
as lorazepam 1-2 mg every 4 to 6 hours can be used as needed for associated
agitation and anxiety.
C. Supportive psychotherapy is
indicated if precipitating stressors are present.
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