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Patients who experience an acute psychotic episode lasting longer
than one day but less than one month and that may or may not immediately
follow an important life stress or a pregnancy (with postpartum
onset). This illness usually comes as a surprise as there
is no forewarning that the person is likely to "break down,"
although this disorder is more common in people with a pre-existing
personality disorder (particularly histrionic
and borderline
types). The main diagnostic criteria is as follows:
The patient has at least one of the following that is not a culturally
sanctioned response:
Delusions
Hallucinations
Speech that is markedly disorganized
Behavior that is markedly disorganized
or catatonic.
The patient has symptoms from 1 to 30 days and eventually recovers
completely.
The disturbance is not better accounted for by a
Mood Disorder With Psychotic Features, Schizoaffective
Disorder, or Schizophrenia
and is not due to the direct physiological effects of a substance
(e.g., a
drug of abuse, a medication) or a general medical condition.
Specify
if:
With Marked Stressor(s) (brief
reactive psychosis): if symptoms occur shortly after and apparently
in response to events that, singly or together, would be markedly
stressful to almost anyone in similar circumstances in the person's
culture.
Without Marked Stressor(s): if psychotic symptoms do not occur
shortly after, or are not apparently in response to events that,
singly or together, would be markedly stressful to almost anyone
in similar circumstances in the person's culture.
With
Postpartum Onset: if onset within 4 weeks postpartum.
Associated Features:
Learning
Problem.
Hypoactivity.
Psychotic.
Euphoric
Mood.
Depressed
Mood.
Somatic
or Sexual Dysfunction.
Hyperactivity.
Differential Diagnosis:
Some disorders have similar or even the same symptom. The clinician,
therefore, in his diagnostic attempt has to differentiate against
the following disorders which he needs to rule out to establish
a precise diagnosis.
Psychotic Disorder Due to a General Medical Condition or a Delirium.
Substance-Induced
Psychotic Disorder.
Substance-Induced
Delirium and Substance Intoxication.
Mood Episode.
Schizophreniform Disorder.
Delusional Disorder.
Mood Disorder With
Psychotic Features.
Factitious Disorder, With
Predominantly Psychological Signs and Symptoms.
Malingering.
A
Personality Disorder.
Psychotic Disorder Not Otherwise Specified.
Cause:
Brief psychotic
disorder (also known as brief reactive psychosis) is a short-term
break from reality. The disorder usually strikes people between
20 and 30 years of age. With treatment, symptoms usually disappear
within a month. However, a short hospitalization may be necessary.
A brief psychotic episode is usually triggered by a traumatic
event such as a death, assault, or rape. Previous emotional problems
increase the possibility of an episode. Some women develop the
problem after giving birth. The disorder is NOT brought on by
physical illness, and is not a reaction to drugs.
Treatment:
Treatment
for an acute attack can require full-time hospitalization in a
locked inpatient unit.
Counseling
and Psychotherapy [ See
Therapy Section ]:
Group Therapy:
These meetings are somewhat like a support group session, allowing
patients to share coping strategies. The meetings are run by medical
staff.
Individual
Therapy: This is a time for you to meet alone with your
therapist to discuss ways of dealing with the illness.
Medical
Treatments:
Electroconvulsive
Therapy: For patients who become severely withdrawn or depressed,
this form of treatment can help speed recovery. Also known as
ECT or shock therapy, it applies a mild electric current to the
brain. Although the treatment temporarily disrupts the memory,
full recall typically returns within 2 weeks.
Pharmacotherapy
[ See
Psychopharmacology Section ] :
Antipsychotic
medications will usually bring an end to the episode. However,
a short hospital stay may be necessary.
Antipsychotics (typical)
Chlorpromazine
(Thorazine).
Thioridazine (Mellaril).
Trifluoperazine (Stelazine).
Thiothixene (Navane).
Fluphenazine (Prolixin).
Haloperidol (Haldol).
Antipsychotics (atypical)
Risperidone
(Risperdal).
Olanzapine (Zyprexa).
Clozapineł (Clozaril).
Special Antipsychotic Adverse Reactions
Neuroleptic
Malignant Syndrome. May occur at any point during the course of
treatment. Includes symptoms of autonomic instability, altered
mental status, which may progress to hyperthermia, stupor, and
muscle hypertonicity. Death may occur.
Tardive Dyskinesia.
Involuntary movements of the tongue, face, mouth, or jaw associated
with long-term administration of antipsychotics. Elderly females
at highest risk. May be irreversible.
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