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:
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Haloperidol
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Thiothixene
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Thioridazine
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Fluphenazine
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Chlorpromazine
If adverse effects are intolerable, it may be helpful to use one of the atypical (second-generation) antipsychotics, for example:
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Olanzapine
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Quetiapine
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Ziprasidone
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Risperidone
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Paliperidone
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Lurasidone
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Aripiprazole
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. [10] A study involving intramuscular (IM) ziprasidone showed this agent to be more effective and better tolerated than IM haloperidol for treating acute psychosis. [11] 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.
