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Brief Psychotic Disorder

Brief Psychotic Disorder

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Published by: api-3712326 on Oct 14, 2008
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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 indistinguishable 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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