Brief psychotic disorder

Last reviewed: February 2019

Last updated: June 2018

Summary

Sudden onset of at least 1 positive psychotic symptom (e.g., delusions, hallucinations, disorganised speech, grossly disorganised or catatonic behaviour).

Episode lasts for a short duration (1 to 30 days), with return to full pre-morbid level of functioning; can occur in the presence or absence of a major stressor.

Diagnosis can only be made if other drug-induced, medical, neurological, or other psychiatric conditions can be excluded as causes.

Postnatal brief psychotic disorder is probable when the onset of psychotic symptoms occurs within 4 weeks after giving birth.

Treatment is with antipsychotic medicine and follow-up care with a psychiatric consultant to monitor progress and reduce risk of recurrence.

Definition

Brief psychotic disorder (BPD) is a short-term disturbance that involves the sudden onset of at least 1 positive psychotic symptom. These symptoms include delusions, hallucinations, disorganised speech (e.g., frequent derailment or incoherence), or grossly disorganised or catatonic behaviour. BPD can last between 1 and 30 days before the patient fully returns to the pre-morbid level of functioning. To be diagnosed as BPD, the disturbance must not be substance induced and not be better accounted for by schizoaffective disorder, a mood disorder with psychotic features, schizophrenia, or a general medical condition (e.g., seizure disorder, syphilis, sarcoidosis, lung cancer, thyrotoxicosis, or head trauma). [1] BPD is categorised as occurring with marked stressors, without marked stressors, or postnatal. [1]

History and exam

Key diagnostic factors

presence of risk factors
age over 18 years
at least 1 positive psychotic symptom lasting >1 day but <1 month
symptoms not due to substance use
symptoms not due to medical condition

Full details

Other diagnostic factors

recent childbirth: within last 4 weeks
recent stress and trauma

Full details

Risk factors

significant life stressor
personality disorder
FHx of psychotic disorder
4 weeks postnatal
previous psychiatric symptoms in women
age 35 to 45 years
single mother

Full details

Diagnostic investigations

1st investigations to order

serum pregnancy test (females)

Full details

Investigations to consider

electrolytes
urea
creatinine
glucose
LFTs
TFTs
syphilis serology
urinalysis
urine toxicology
ECG
CT scan brain
MRI brain

Full details

Treatment algorithm

ACUTE

able to accept or tolerate oral treatment

refusing or unable to tolerate oral treatment

Contributors

Authors VIEW ALL 

Kimberly R. Warren, PhD

Faculty Research Associate

Maryland Psychiatric Research Center

University of Maryland

School of Medicine

Department of Psychiatry

Catonsville

Disclosures

KRW declares that she has no competing interests.

William R. Keller, MD

Assistant Professor

Department of Psychiatry

University of Maryland

School of Medicine

Department of Psychiatry

Catonsville

Disclosures

WRK declares that he has no competing interests.

Deanna L. Kelly, PharmD

Associate Professor

Director

Treatment Research Program

Maryland Psychiatric Research Center

University of Maryland

School of Medicine

Department of Psychiatry

Catonsville

Disclosures

DLK has served on the advisory boards for Bristol-Myers Squibb and Solvay. She has received an honorarium from Astra Zeneca.

Peer reviewers VIEW ALL 

Joel Yager, MD

Professor

Department of Psychiatry

University of New Mexico School of Medicine

Albuquerque

Disclosures

JY is an author of a reference cited in this topic.

Craig N. Sawchuk, PhD

Affiliate Assistant Professor

Department of Psychiatry and Behavioral Sciences

University of Washington Medical Center

Seattle

Disclosures

CNS declares that he has no competing interests.

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Brief psychotic disorder

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

able to accept or tolerate oral treatment

refusing or unable to tolerate oral treatment

Contributors

Authors VIEW ALL 

Kimberly R. Warren, PhD

Disclosures

William R. Keller, MD

Disclosures

Deanna L. Kelly, PharmD

Disclosures

Peer reviewers VIEW ALL 

Joel Yager, MD

Disclosures

Craig N. Sawchuk, PhD

Disclosures

Differentials

Guidelines

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