Brief Psychotic Disorder 21

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.
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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.
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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.