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Brief Psychotic Disorder Clinical Presentation

  • Author: Mohammed A Memon, MD; Chief Editor: David Bienenfeld, MD  more...
 
Updated: Nov 17, 2015
 

History

Brief psychotic disorder is characterized by the abrupt onset of 1 or more of the following symptoms:

  • Delusions - Rapidly changing delusional topics
  • Hallucinations
  • Bizarre behavior and posture
  • Disorganized speech

Patients may present with a variety of associated symptoms, including the following:

  • Affective symptoms - Rapidly changing mood
  • Disorientation - A careful Mental Status Examination can distinguish this from delirium, dementia, or other organic brain syndromes
  • Impaired attention
  • Catatonic behavior (in some cases)

The following are also commonly observed in brief psychotic disorder:

  • Emotional volatility
  • Outlandish dress or behavior
  • Screaming or muteness
  • Impaired memory for recent events

A psychiatric history may be helpful. Some clinicians believe that persons with personality disorders (eg, narcissistic, paranoid, borderline, schizotypal) are more prone to develop brief psychotic disorder in stressful situations.[8]

DSM-5 stresses that symptoms of brief psychotic disorder must be distinguished from culturally sanctioned response patterns that may resemble such symptoms.[1] For instance, hearing voices may be a component of some religious ceremonies; this generally would not be considered abnormal by most members of the religious community, and the voices typically would not persist into daily life. Cultural and religious background must always be taken into account when a judgment is to be made about whether a given patient’s beliefs are delusional.

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Physical Examination

Routine physical examination is necessary to exclude medical causes of psychosis. A careful Mental Status Examination is vital. Patients usually present with severe psychotic agitation that may be associated with the following:

  • Strange or bizarre behavior
  • Uncooperativeness
  • Physical or verbal aggression
  • Disorganized speech
  • Screaming or muteness
  • Labile or depressed mood
  • Suicidal or homicidal thoughts or behaviors
  • Restlessness
  • Hallucinations
  • Delusions
  • Disorientation
  • Impaired attention, concentration, or memory
  • Poor insight or judgment

Psychological stressors in individuals with personality disorders may precipitate brief periods of psychotic symptoms. In such cases, if symptoms persist longer than 1 day, an additional diagnosis of brief psychotic disorder may be considered.

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Contributor Information and Disclosures
Author

Mohammed A Memon, MD Chairman and Attending Geriatric Psychiatrist, Department of Psychiatry, Spartanburg Regional Medical Center

Mohammed A Memon, MD is a member of the following medical societies: American Association for Geriatric Psychiatry, American Medical Association, American Psychiatric Association

Disclosure: Nothing to disclose.

Chief Editor

David Bienenfeld, MD Professor, Departments of Psychiatry and Geriatric Medicine, Wright State University, Boonshoft School of Medicine

David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, Association for Academic Psychiatry

Disclosure: Nothing to disclose.

Acknowledgements

Harold H Harsch, MD Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin

Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: lilly Honoraria Speaking and teaching; Forest Labs None None; Pfizer Grant/research funds Speaking and teaching; Northstar None None; Novartis Grant/research funds research; Pfizer Honoraria Speaking and teaching; Sunovion Speaking and teaching; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research; Merck Honoraria Speaking and teaching

Michael F Larson, DO Clinical Instructor, Department of Child and Adolescent Psychiatry, Harvard Medical School; Psychiatrist, Harvard Vanguard Medical Associates and Private Practice

Michael F Larson, DO is a member of the following medical societies: American Academy of Addiction Psychiatry, American Academy of Child and Adolescent Psychiatry, and American Society of Addiction Medicine

Disclosure: Nothing to disclose.

Alan D Schmetzer, MD Professor Emeritus, Interim Chairman, Vice-Chair for Education, Associate Residency Training Director in General Psychiatry, Fellowship Training Director in Addiction Psychiatry, Department of Psychiatry, Indiana University School of Medicine; Addiction Psychiatrist, Midtown Mental Health Cener at Wishard Health Services

Alan D Schmetzer, MD is a member of the following medical societies: American Academy of Addiction Psychiatry, American Academy of Clinical Psychiatrists, American Academy of Psychiatry and the Law, American College of Physician Executives, American Medical Association, American Neuropsychiatric Association, American Psychiatric Association, and Association for Convulsive Therapy

Disclosure: Eli Lilly & Co. Grant/research funds Other

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References
  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC: American Psychiatric Association; 2013.

  2. Chaudron LH, Pies RW. The relationship between postpartum psychosis and bipolar disorder: a review. J Clin Psychiatry. 2003 Nov. 64(11):1284-92. [Medline].

  3. Valdimarsdottir U, Hultman CM, Harlow B, Cnattingius S, Sparen P. Psychotic illness in first-time mothers with no previous psychiatric hospitalizations: a population-based study. PLoS Med. 2009 Feb 10. 6(2):e13. [Medline].

  4. Susser E, Fennig S, Jandorf L, Amador X, Bromet E. Epidemiology, diagnosis, and course of brief psychoses. Am J Psychiatry. 1995 Dec. 152(12):1743-8. [Medline].

  5. Susser E, Wanderling J. Epidemiology of nonaffective acute remitting psychosis vs schizophrenia. Sex and sociocultural setting. Arch Gen Psychiatry. 1994 Apr. 51(4):294-301. [Medline].

  6. Jorgensen P, Mortensen PB. Reactive psychosis and mortality. Acta Psychiatr Scand. 1990 Mar. 81(3):277-9. [Medline].

  7. Correll CU, Smith CW, Auther AM, McLaughlin D, Shah M, Foley C, et al. Predictors of remission, schizophrenia, and bipolar disorder in adolescents with brief psychotic disorder or psychotic disorder not otherwise specified considered at very high risk for schizophrenia. J Child Adolesc Psychopharmacol. 2008 Oct. 18(5):475-90. [Medline].

  8. Jorgensen P, Bennedsen B, Christensen J, Hyllested A. Acute and transient psychotic disorder: comorbidity with personality disorder. Acta Psychiatr Scand. 1996 Dec. 94(6):460-4. [Medline].

  9. Karagianis JL, Dawe IC, Thakur A, et al. Rapid tranquilization with olanzapine in acute psychosis: a case series. J Clin Psychiatry. 2001. 62 Suppl 2:12-6. [Medline].

  10. Brook S, Lucey JV, Gunn KP. Intramuscular ziprasidone compared with intramuscular haloperidol in the treatment of acute psychosis. Ziprasidone I.M. Study Group. J Clin Psychiatry. 2000 Dec. 61(12):933-41. [Medline].

 
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