Brief Psychotic Disorder

 

Patients who experience an acute psychotic episode lasting longer than one day but less than one month and that may or may not immediately follow an important life stress or a pregnancy (with postpartum onset). This illness usually comes as a surprise as there is no forewarning that the person is likely to "break down," although this disorder is more common in people with a pre-existing personality disorder (particularly histrionic and borderline types). The main diagnostic criteria is as follows:

 

- The patient has at least one of the following that is not a culturally sanctioned response:

1.Delusions
2.Hallucinations
3.Speech that is markedly disorganized
4.Behavior that is markedly disorganized or catatonic.

 

- The patient has symptoms from 1 to 30 days and eventually recovers completely.

 

- The disturbance is not better accounted for by a Mood Disorder With Psychotic Features, Schizoaffective Disorder, or Schizophrenia and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

 

Specify if:

 

- With Marked Stressor(s) (brief reactive psychosis): if symptoms occur shortly after and apparently in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the person's culture.

- Without Marked Stressor(s): if psychotic symptoms do not occur shortly after, or are not apparently in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the person's culture.

- With Postpartum Onset: if onset within 4 weeks postpartum.

 

Associated Features:

 

-Learning Problem.
-Hypoactivity.
-Psychotic.
-Euphoric Mood.
-Depressed Mood.
-Somatic or Sexual Dysfunction.
-Hyperactivity.

 

Differential Diagnosis:
 

Some disorders have similar or even the same symptom. The clinician, therefore, in his diagnostic attempt has to differentiate against the following disorders which he needs to rule out to establish a precise diagnosis.

Psychotic Disorder due to a general medical condition or a delirium.
Substance-Induced Psychotic Disorder.
Substance-Induced Delirium and Substance Intoxication.
Mood Episode.
Schizophreniform Disorder.
Delusional Disorder.
Mood Disorder with psychotic features.
Factitious Disorder, with predominantly psychological signs and symptoms malingering personality disorder.

Psychotic Disorder Not Otherwise Specified.

 

Cause:

 

Brief psychotic disorder (also known as brief reactive psychosis) is a short-term break from reality. The disorder usually strikes people between 20 and 30 years of age. With treatment, symptoms usually disappear within a month. However, a short hospitalization may be necessary.  A brief psychotic episode is usually triggered by a traumatic event such as a death, assault, or rape. Previous emotional problems increase the possibility of an episode. Some women develop the problem after giving birth. The disorder is NOT brought on by physical illness, and is not a reaction to drugs.

 

Treatment:

 

Treatment for an acute attack can require full-time hospitalization in a locked inpatient unit.

 

Counseling and Psychotherapy:

Group Therapy:

These meetings are somewhat like a support group session, allowing patients to share coping strategies. The meetings are run by medical staff.

Individual Therapy: This is a time for you to meet alone with your therapist to discuss ways of dealing with the illness.

 

Medical Treatments:

Electroconvulsive Therapy: For patients who become severely withdrawn or depressed, this form of treatment can help speed recovery. Also known as ECT or shock therapy, it applies a mild electric current to the brain. Although the treatment temporarily disrupts the memory, full recall typically returns within 2 weeks.

Pharmacotherapy

Antipsychotic medications will usually bring an end to the episode. However, a short hospital stay may be necessary.

 

Antipsychotics (typical):

Chlorpromazine (Thorazine).
Thioridazine (Mellaril).
Trifluoperazine (Stelazine).
Thiothixene (Navane).
Fluphenazine (Prolixin).
Haloperidol (Haldol).

 

Antipsychotics (atypical):

Risperidone (Risperdal).
Olanzapine (Zyprexa).
Clozapine³ (Clozaril).

 

Special Antipsychotic Adverse Reactions:  

Neuroleptic Malignant Syndrome. May occur at any point during the course of treatment. Includes symptoms of autonomic instability, altered mental status, which may progress to hyperthermia, stupor, and muscle hypertonicity. Death may occur.

Tardive Dyskinesia. Involuntary movements of the tongue, face, mouth, or jaw associated with long-term administration of antipsychotics. Elderly females at highest risk. May be irreversible.