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Brief Psychotic Disorder Medication

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

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications. Both typical and atypical antipsychotic agents have been used in the treatment of brief psychotic disorder.

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Antipsychotics

Class Summary

Antipsychotics are high-potency agents that provide rapid, predictable, and effective sedation in the management of patients who are acutely psychotic. They are less sedating and more easily titrated than lower-potency agents but more likely to cause extrapyramidal syndrome (EPS). They are often combined in the same syringe with a benzodiazepine to improve sedation and anxiety and reduce dystonia or akathisia. For prophylaxis of EPS, temporary use of a serotonin-dopamine antagonist may be needed.

Antipsychotics may be administered intramuscularly (IM) or intravenously (IV). In a nonemergency setting, haloperidol may be given orally. Haloperidol also has a monthly depot form (haloperidol decanoate), but this is not useful for brief psychotic disorder, because of the short duration of the psychotic episode.

Haloperidol (Haldol)

 

Haloperidol controls psychosis and provides rapid tranquilization. It can be administered with a benzodiazepine to protect against a lowered seizure threshold. IV haloperidol can be used effectively to treat acute psychotic agitation in a low dosage of 1-2 mg every 8 hours for 2-3 days, and the drug can be continued orally for the next several days until symptoms completely subside. In cases where it is difficulty to differentiate brief psychotic disorder and delirium, it should be kept in mind that IV haloperidol is also effective for delirium.

Thiothixene

 

Thiothixene blocks postsynaptic blockade of central nervous system (CNS) dopamine receptors, inhibiting dopamine-mediated effects. It provides rapid tranquilization in both oral and IM forms.

Risperidone (Risperdal)

 

Unlike haloperidol, risperidone has serotonergic blocking effects that alleviate negative symptoms of psychosis (eg, anhedonia, avolition, amotivation, and flat affect). It is well tolerated and has fewer extrapyramidal adverse effects than typical antipsychotics do. Dosages higher than 6 mg/day increase the risk of extrapyramidal effects.

Olanzapine (Zyprexa)

 

Olanzapine may inhibit serotonin, muscarinic, and dopamine effects. Its efficacy is similar to that of risperidone; it has fewer dose-dependent adverse effects but is more likely to be associated with weight gain.

Quetiapine (Seroquel)

 

Quetiapine may act by antagonizing dopamine and serotonin effects. Its efficacy is similar to those of risperidone and olanzapine; it has fewer dose-dependent adverse effects and poses less of a concern with regard to weight gain.

Paliperidone (Invega)

 

Paliperidone is the major active metabolite of risperidone and the first oral agent that can be given once daily. It is indicated for treatment of acute schizophrenia. The mechanism of action is not completely understood but is thought to involve mediation of central receptor antagonism of dopamine type 2 (D2) and serotonin type 2 (5-HT2A). It also elicits antagonist activity at alpha1- and alpha2-adrenergic receptors and histamine-1 receptors. It has no affinity for cholinergic, muscarinic, or beta-adrenergic receptors.

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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

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