Brief psychotic disorder

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Somal Khan, MD Kiran Singh, M.D. [2]

Synonyms and keywords: Brief reactive psychosis; hysterical psychosis; reactive schizophrenia; transient psychosis; acute and transient psychotic disorders; stress psychosis; good prognosis schizophrenia; thought disturbances

Overview

Brief psychotic disorder is a period of psychosis whose duration is less than a month. The disorder is characterized by a sudden onset of psychotic symptoms, which may include delusions, hallucinations, disorganized speech or behavior, or catatonic behavior. The symptoms must not be caused by schizophrenia, schizoaffective disorder, delusional disorder or mania in bipolar disorder. They must also not be caused by a drug (such as amphetamines) or medical condition (such as a brain tumor).

Differential Diagnosis

• Depressive and bipolar disorders
• Medical conditions

• Cushing's syndrome
• Brain tumor

• Malingering and factitious disorders
• Other psychotic disorders

• Schizophrenia
• Schizophreniform disorder
• Delusional disorder
• Depressive disorder with psychotic features
• Bipolar disorder with psychotic features

• Personality disorders
• Substance-related disorders

Epidemiology and Demographics

The prevalence of psychosis is 9,000 per 100,000 (9%) of the overall population.

Risk Factors

• Preexisting personality disorders

• Schizotypal personality disorder

• Borderline personality disorder

• Traits in the psychoticism domain

• Perceptual dysregulation

• Suspiciousness

Diagnostic Criteria

DSM-V Diagnostic Criteria for Brief Psychotic Disorder

“

A. Presence of one (or more) of the following symptoms. At least one of these must be (1), (2), or (3): 1. Delusions. 2. Hallucinations. 3. Disorganized speech (e.g., frequent derailment or incoherence). 4. Grossly disorganized or catatonic behavior. Note: Do not include a symptom if it is a culturally sanctioned response. AND B. Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual full return to premorbid level of functioning. AND C. The disturbance is not better explained by major depressive or bipolar disorder with psychotic features or another psychotic disorder such as schizophrenia or catatonia, and is not attributable to the physiological effects of a substance (e.g., a drug of abuse,a medication) or another medical condition. Specify if: With marked stressor(s) (brief reactive psychosis): If symptoms occur in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the individual’s culture. Without marked stressor(s): If symptoms do not occur in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the individual’s culture. With postpartum onset: If onset is during pregnancy or within 4 weeks postpartum. Specify current severity: Severity is rated by a quantitative assessment of the primary symptoms of psychosis,including delusions, hallucinations, disorganized speech, abnormal psychomotor behavior, and negative symptoms. Each of these symptoms may be rated for its current severity (most severe in the last 7 days) on a 5-point scale ranging from 0 (not present) to 4 (present and severe).

”

Note: Diagnosis of brief psychotic disorder can be made without using this severity specifier.

History and Symptoms

• Delusions
• Hallucinations
• Disorganized speech
• Disorganized motor function
• Negative symptoms
  • Flat affect
  • Anhedonia
  • Monotonic speech