Brief Psychotic Disorder

Background

• Brief psychotic disorder is characterized by the rapid onset of psychotic symptoms, generally within 2 weeks, that last between 1 day and 1 month, followed by a full resolution of symptoms and a return to premorbid level of functioning.
• Brief psychotic disorder is most commonly seen in young adults and adolescents. A family history of psychosis increases the risk of developing brief psychotic disorder.
• Common presentations include paranoid, grandiose, or bizarre delusions, and/or auditory hallucinations. Symptoms often begin after a specific stressor such as the start of university, a relationship loss, or change in work status, or postpartum (see also Postpartum psychosis).
• The course of first-episode psychotic symptoms may be hard to predict. Brief psychotic disorder is characterized by a full resolution of symptoms; however, it is associated with an increased risk of developing schizophrenia within 2-6 years of follow-up.

Evaluation

• Evaluate patients with delusions, hallucinations, and disorganized behavior carefully for alternative causes, including substance use, other psychiatric disorders such as bipolar disorder, and medical and neurologic conditions including delirium, dementia, focal brain lesions, and infections.
• Consider testing as needed to rule out other causes of psychosis.
• The diagnosis of brief psychotic disorder is made clinically based on the presence of delusions, hallucinations, and/or disorganized behavior for more than 1 day, but no more than 1 month, and the exclusion of alternative causes of psychosis.
• Use formal criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) for diagnosis.

Management

• Management of brief psychotic disorder is extrapolated from treatment for first-episode schizophrenia.
• Consider a comprehensive approach to management of brief psychotic disorder with medication and counseling.
• Offer immediate referral to emergency care if the patient expresses suicidal ideation or intent. Consider postpartum psychosis a psychiatric emergency due to an increased risk of harm to the infant and mother. See also Postpartum psychosis for patients who are pregnant or within 4 weeks after pregnancy.
• For patients with acute agitation, consider oral antipsychotics or benzodiazepines. If rapid management is needed, consider intramuscular antipsychotic and/or intramuscular benzodiazepine.
• For treatment of psychotic symptoms, consider second-generation antipsychotics, such as aripiprazole, quetiapine, risperidone, or ziprasidone.
• For affective symptoms, consider the diagnosis of bipolar disorder. Consider adding an antidepressant to an antipsychotic for patients with depression, but avoid antidepressant monotherapy. For patients with mania, consider adding a mood stabilizer, such as lithium or valproate. See also Bipolar disorder.