Brief Psychotic Disorder

Brief Psychotic Disorder is characterized by psychotic behavior such as delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior. The symptoms must be present for at least 1 day but less than 1 month and there is a return to full premorbid functioning. Puzzlement and emotional disorder are characteristic associated features. Stress may trigger or exacerbate the symptoms. Specifiers include: With Marked Stressor, Without Marked Stressor, and Postpartum onset. If the psychosis continues past 1 month the diagnosis would then be upgraded to one of the other psychotic disorders. These include, Delusional Disorder, Schizophreniform Disorder, Schizophrenia, Major Depression with Psychotic Features, Bipolar Disorder, or Psychotic Disorder NOS.

One of the disadvantages of a symptom based categorization (as shown in the DSM-IV) can be seen with the lumping together of postpartum psychosis with the brief psychotic disorder. It is much more likely that postpartum psychosis (which occurs in .01 to.02% of new mothers) is related to a mood disorder. However, postpartum disturbances may actually be discrete from other disorders.

Theoretical approaches most often applied to this disorder are psychoeducation, and cognitive-behavioral. Supportive psychotherapy is probably the most effective form of treatment. Support and empathy as well as a safe environment will often assist a person in returning to normal functioning. You should emphasize ways in which the patient can make lifestyle changes that will be helpful in impeding a recurrence. Treatment of postpartum onset of Brief Psychotic Disorder should include the baby and mother together. This of course must take into account the severity of the psychosis and the level of dangerousness in the situation. Some theorists believe that postpartum illnesses are related to relational disturbances between mother and baby and attachment issues from the mother’s history.

You will need to conduct an assessment, address any safety issues, stabilize the symptoms and institute a working rapport with the patient and his/her family. The next step will be to verify the diagnosis through the MSE and a short assessment. A referral to a psychiatrist will be needed to rule out medical and substance-related causes of the symptoms (get a release). If the patient presents as a danger to him/herself arrange for involuntary hospitalization.

If the patient does not need to be hospitalized then refer them out for a medication evaluation (obtain a release). Before you decide on the outpatient treatment, you should discuss the treatment goals and strategies with the patient and their family.

Intitially it may be useful to see the patient several times a week, especially if treatment takes place in an outpatient setting. In a hospital setting, there should be consistent support and structure. This is often enough to help the individual return to premorbid levels of functioning. In the acute stages of psychosis, it is best not to challenge psychotic beliefs but to explore them for meaning. While psychotic symptoms appear to be nonsensical and meaningless, they undoubtedly have meaning for the patient. Empathic attunement and understanding of the patients suffering will often cause significant and rapid remission of symptoms. Then a clinician may choose to address issues related to tolerating and coping with stress and distress.