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Brief Psychotic Disorder Treatment & Management

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

Approach Considerations

Because of the short duration of brief psychotic disorder, treatment is brief and focused on being as nonrestrictive as possible. However, it remains clinically imperative to prevent patients from harming themselves or others. Accordingly, patients experiencing an acute psychotic attack may have to be hospitalized briefly so that they can be evaluated and their safety ensured. If a patient becomes aggressive and combative, brief seclusion or restraint may be necessary.

If symptoms are only minimally impairing the patient’s function and a specific stressor is identified, removing the stressor should suffice for treatment of the brief psychotic episode.

If, however, symptoms are disabling, an antipsychotic agent should be given, but for no longer than 1 month. Commonly used typical (first-generation) antipsychotics include the following:

  • Haloperidol
  • Thiothixene
  • Thioridazine
  • Fluphenazine
  • Chlorpromazine

If adverse effects are intolerable, it may be helpful to use one of the following atypical (second-generation) antipsychotics:

  • Olanzapine
  • Quetiapine
  • Ziprasidone
  • Risperidone
  • Paliperidone

At present, the available evidence is not sufficient to support the use of atypical antipsychotics to treat brief psychotic disorder. A case series suggests that rapid tranquilization with olanzapine can achieve symptom relief in acute psychosis.[9] A study involving intramuscular (IM) ziprasidone showed this agent to be more effective and better tolerated than IM haloperidol for treating acute psychosis.[10] In the authors’ experience, IM ziprasidone is the most effective treatment for acute severe psychotic agitation.

Once the acute attack has ended, further inpatient care is unnecessary. Individual, family, and group psychotherapy may be considered to help cope with stressors, resolve conflict, and improve self-esteem and self-confidence.

 
 
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
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  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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