History
Brief psychotic disorder is characterized by the abrupt onset of 1 or more of the following symptoms:
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Delusions - Rapidly changing delusional topics
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Hallucinations
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Bizarre behavior and posture
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Disorganized speech
Patients may present with a variety of associated symptoms, including the following:
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Affective symptoms - Rapidly changing mood
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Disorientation - A careful Mental Status Examination can distinguish this from delirium, dementia, or other organic brain syndromes
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Impaired attention
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Catatonic behavior (in some cases)
The following are also commonly observed in brief psychotic disorder:
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Emotional volatility
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Outlandish dress or behavior
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Screaming or muteness
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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.
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:
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Strange or bizarre behavior
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Uncooperativeness
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Physical or verbal aggression
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Disorganized speech
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Screaming or muteness
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Labile or depressed mood
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Suicidal or homicidal thoughts or behaviors
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Restlessness
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Hallucinations
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Delusions
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Disorientation
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Impaired attention, concentration, or memory
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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.
