Brief Psychotic Disorder Clinical Presentation

  • Author: Mohammed A Memon, MD; Chief Editor: David Bienenfeld, MD   more...
 
Updated: Jan 17, 2012
 

History

DSM-IV-TR diagnostic criteria require presence of one or more of the following: delusions, hallucinations, disorganized speech, or grossly disorganized or catatonic behavior. These criteria also require an episodic duration of the disturbance for at least 1 day but less than 1 month, with eventual return to the premorbid level of functioning. According to the DSM-IV-TR, the diagnosis of brief psychotic disorder can be specified as with or without marked stressors or with postpartum onset.[4, 5] Some clinicians believe that persons with personality disorders (eg, narcissistic, paranoid, borderline, schizotypal) are more prone to develop brief psychotic disorder in stressful situations.[6]

  • Patients with brief psychotic disorder have an abrupt onset of one 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 (for some patients)
  • Characteristic symptoms in brief psychotic disorder
    • Emotional volatility
    • Outlandish dress or behavior
    • Screaming or muteness
    • Impaired memory for recent events
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Physical

  • Routine physical examination is necessary to exclude medical causes of psychosis.
  • Mental Status Examination: Patients usually present with severe psychotic agitation that may be associated with strange or bizarre behavior, uncooperativeness, physical or verbal aggression, disorganized speech, screaming or muteness, labile or depressed mood, suicidal and/or homicidal thoughts or behaviors, restlessness, hallucinations, delusions, disorientation, impaired attention, impaired concentration, impaired memory, poor insight, and poor 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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Causes

Causes are largely unknown.

  • Patients with personality disorder may have biological or psychological vulnerability toward the development of psychotic symptoms.
  • One or more severe stress factors, such as traumatic events, family conflict, employment problems, accidents, severe illness, death of a loved one, and uncertain immigration status, can precipitate brief reactive psychosis.
  • Some studies support a genetic vulnerability to brief psychotic disorder.
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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, and American Psychiatric Association

Disclosure: Nothing to disclose.

Coauthor(s)

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.

Specialty Editor Board

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

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

Chief Editor

David Bienenfeld, MD  Professor of Psychiatry, Vice-Chair and Director of Residency Training, Department of Psychiatry, Wright State University, Boonshoft School of Medicine

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

Disclosure: Nothing to disclose.

References

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Washington DC:. American Psychiatric Press;2000.

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

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

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

  5. [Best Evidence] 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. Feb 10 2009;6(2):e13. [Medline].

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

  7. 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].

  8. 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. Dec 2000;61(12):933-41. [Medline].

  9. 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. Oct 2008;18(5):475-90. [Medline].

  10. Beighley PS, Brown GR, Thompson JW Jr. DSM-III-R brief reactive psychosis among Air Force recruits. J Clin Psychiatry. Aug 1992;53(8):283-8. [Medline].

  11. Jablensky A, Sartorius N, Ernberg G, et al. Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study. Psychol Med Monogr Suppl. 1992;20:1-97. [Medline].

  12. Jauch DA, Carpenter WT Jr. Reactive psychosis. I. Does the pre-DSM-III concept define a third psychosis?. J Nerv Ment Dis. Feb 1988;176(2):72-81. [Medline].

  13. Jauch DA, Carpenter WT Jr. Reactive psychosis. II. Does DSM-III-R define a third psychosis?. J Nerv Ment Dis. Feb 1988;176(2):82-6. [Medline].

  14. Johnson FA. African perspective on mental disorder. In: Mezzich JE, Honda Y, Kastrup MC, eds. Psychiatric Diagnosis: A World Perspective. New York, NY: Springer Verlag; 1994.

  15. Jorge MR, Mezzich JE. Latin American contributions to psychiatric nosology and classification. In: Mezzich JE, Honda Y, Kastrup MC, eds. Psychiatric Diagnosis: A World Perspective. New York, NY: Springer Verlag; 1994.

  16. Jorgensen P, Jensen J. An attempt to operationalize reactive delusional psychosis. Acta Psychiatr Scand. Nov 1988;78(5):627-31. [Medline].

  17. Karno M, Jenkins JH. Cultural considerations in the diagnosis of schizophrenia and related disorders and psychotic disorders not otherwise classified. In: TA Widiger, ed. DSM-IV Source Book. Washington DC: American Psychiatric Press; 1994.

  18. Lin KM. Cultural influences on the diagnosis of psychotic and organic disorders. In: Mezzich JE, Kleinman A, Horacio F, Parron DL, eds. Culture and Psychiatric Diagnosis: A DSM-IV Perspective. Washington DC: American Psychiatric Press; 1996.

  19. Mezzich JE, Lin KM. Acute and transient psychotic disorders and culture-bound syndromes. In: Sadock BJ, Sadock VA, eds. Kaplan and Sadock's Comprehensive Textbook of Psychiatry. 6th ed. Baltimore, Md: Lippincott Williams & Wilkins; 1995:1049.

  20. Pull CB, Chaillet G. The nosological views of French-speaking psychiatry. In: Mezzich JE, Honda Y, Kastrup MC, eds. Psychiatric Diagnosis: A World Perspective. New York, NY: Springer Verlag; 1994.

  21. Vanderhart O, Witztum E, Friedman B. From hysterical psychosis to reactive dissociative psychosis. J Trauma Stress. 1993;6:43.

 
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