Brief psychotic disorder
- Ramin Mojtabai, MD, PhD, MPH
Ramin Mojtabai, MD, PhD, MPH
- Professor of Mental Health
- Johns Hopkins Bloomberg School of Public Health
Brief psychotic disorder is defined in DSM-5 as the presence of one or more psychotic symptoms with a sudden onset and full remission within one month .
Brief psychotic disorder is often a provisional or retrospective diagnosis with a substantial rate of recurrence and subsequent diagnosis of another psychotic disorder or affective disorder with psychosis. Symptom duration is one factor distinguishing brief psychotic disorder from schizophreniform disorder (one to six months) and schizophrenia (at least six months). Other disorders with psychotic features in the differential diagnosis include affective disorders, substance-induced disorders, psychosis due to a general medical condition and psychotic disorder, not otherwise specified (NOS).
This topic discusses brief psychotic disorder. The epidemiology, pathogenesis, course, clinical manifestations, diagnosis, and treatment of other psychotic disorders are described separately. (See "Schizophrenia in adults: Clinical manifestations, course, assessment, and diagnosis" and "Schizophrenia in adults: Epidemiology and pathogenesis" and "Pharmacotherapy for schizophrenia: Acute and maintenance phase treatment" and "Psychosocial interventions for schizophrenia" and "Evaluation and management of treatment-resistant schizophrenia" and "Clinical manifestations, differential diagnosis, and initial management of psychosis in adults".)
Brief psychotic disorder is diagnosed based on DSM-5 diagnostic criteria, which require the disorder to last more than one day and less than one month . An ICD-10 (International Classification of Diseases, 10th edition) criterion for overlapping conditions, acute and transient psychotic disorders, applies to psychoses with an acute onset and a duration of one to three months depending on subtype . (See 'Diagnosis' below.)
Other terms have been used by European authors to describe psychotic syndromes which have an acute onset and remitting course, including bouffée delirantés (in French speaking countries) and cycloid psychosis (in German speaking countries) .
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington 2013.
- World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines, World Health Organization, Geneva 192. Vol xii, p.362.
- Castagnini A, Galeazzi GM. Acute and transient psychoses: clinical and nosological issues. BJPsych Advances 2016; 22:292.
- Schwartz JE, Fennig S, Tanenberg-Karant M, et al. Congruence of diagnoses 2 years after a first-admission diagnosis of psychosis. Arch Gen Psychiatry 2000; 57:593.
- Perälä J, Suvisaari J, Saarni SI, et al. Lifetime prevalence of psychotic and bipolar I disorders in a general population. Arch Gen Psychiatry 2007; 64:19.
- Kingston T, Scully PJ, Browne DJ, et al. Diagnostic trajectory, interplay and convergence/divergence across all 12 DSM-IV psychotic diagnoses: 6-year follow-up of the Cavan-Monaghan First Episode Psychosis Study (CAMFEPS). Psychol Med 2013; 43:2523.
- Susser E, Wanderling J. Epidemiology of nonaffective acute remitting psychosis vs schizophrenia. Sex and sociocultural setting. Arch Gen Psychiatry 1994; 51:294.
- Manton KG, Korten A, Woodbury MA, et al. Symptom profiles of psychiatric disorders based on graded disease classes: an illustration using data from the WHO International Pilot Study of Schizophrenia. Psychol Med 1994; 24:133.
- Marneros A, Pillmann F. Acute and transient psychoses, Cambridge University Press, Cambridge, UK 2004.
- Singh SP, Burns T, Amin S, et al. Acute and transient psychotic disorders: precursors, epidemiology, course and outcome. Br J Psychiatry 2004; 185:452.
- Jørgensen P, Bennedsen B, Christensen J, Hyllested A. Acute and transient psychotic disorder: comorbidity with personality disorder. Acta Psychiatr Scand 1996; 94:460.
- Jørgensen P, Bennedsen B, Christensen J, Hyllested A. Acute and transient psychotic disorder: a 1-year follow-up study. Acta Psychiatr Scand 1997; 96:150.
- Costa PT Jr, McCrae RR. Stability and change in personality assessment: the revised NEO Personality Inventory in the year 2000. J Pers Assess 1997; 68:86.
- Pillmann F, Blöink R, Balzuweit S, et al. Personality and social interactions in patients with acute brief psychoses. J Nerv Ment Dis 2003; 191:503.
- Marneros A, Pillmann F, Haring A, et al. Features of acute and transient psychotic disorders. Eur Arch Psychiatry Clin Neurosci 2003; 253:167.
- Susser E, Fennig S, Jandorf L, et al. Epidemiology, diagnosis, and course of brief psychoses. Am J Psychiatry 1995; 152:1743.
- Sajith SG, Chandrasekaran R, Sadanandan Unni KE, Sahai A. Acute polymorphic psychotic disorder: diagnostic stability over 3 years. Acta Psychiatr Scand 2002; 105:104.
- Collins PY, Wig NN, Day R, et al. Psychosocial and biological aspects of acute brief psychoses in three developing country sites. Psychiatr Q 1996; 67:177.
- Malhotra S, Varma VK, Misra AK, et al. Onset of acute psychotic states in India: a study of sociodemographic, seasonal and biological factors. Acta Psychiatr Scand 1998; 97:125.
- Alexandre J, Ribeiro R, Cardoso G. Ethnic and clinical characteristics of a Portuguese psychiatric inpatient population. Transcult Psychiatry 2010; 47:314.
- Lau PW, Cheng JG, Chow DL, et al. Acute psychiatric disorders in foreign domestic workers in Hong Kong: a pilot study. Int J Soc Psychiatry 2009; 55:569.
- Littlewood R, Lipsedge M. Acute psychotic reactions in Caribbean-born patients. Psychol Med 1981; 11:303.
- Das SK, Malhotra S, Basu D. Family study of acute and transient psychotic disorders: comparison with schizophrenia. Soc Psychiatry Psychiatr Epidemiol 1999; 34:328.
- Castagnini AC, Laursen TM, Mortensen PB, Bertelsen A. Family psychiatric morbidity of acute and transient psychotic disorders and their relationship to schizophrenia and bipolar disorder. Psychol Med 2013; 43:2369.
- Pfuhlmann B, Stöber G, Franzek E, Beckmann H. Cycloid psychoses predominate in severe postpartum psychiatric disorders. J Affect Disord 1998; 50:125.
- Mojtabai R, Susser ES, Bromet EJ. Clinical characteristics, 4-year course, and DSM-IV classification of patients with nonaffective acute remitting psychosis. Am J Psychiatry 2003; 160:2108.
- Castagnini A, Bertelsen A, Berrios GE. Incidence and diagnostic stability of ICD-10 acute and transient psychotic disorders. Compr Psychiatry 2008; 49:255.
- Fusar-Poli P, Cappucciati M, Bonoldi I, et al. Prognosis of Brief Psychotic Episodes: A Meta-analysis. JAMA Psychiatry 2016; 73:211.
- Castagnini A, Foldager L, Bertelsen A. Excess mortality of acute and transient psychotic disorders: comparison with bipolar affective disorder and schizophrenia. Acta Psychiatr Scand 2013; 128:370.
- Thomas P, Alptekin K, Gheorghe M, et al. Management of patients presenting with acute psychotic episodes of schizophrenia. CNS Drugs 2009; 23:193.
- Risk factors
- Stressful life events
- Postpartum period
- CLINICAL MANIFESTATIONS
- Differential diagnosis
- - Affective disorders
- - Non-affective psychotic disorders
- Schizophreniform disorder
- - Substance-induced psychoses
- - Psychosis due to general medical conditions
- Level of care
- Supportive psychotherapeutic techniques
- SUMMARY AND RECOMMENDATIONS