Brief Psychotic Disorder

Brief psychotic disorder is sudden onset psychosis with delusions, hallucinations or disorganised speech or behaviour lasting at least 1 day but under 1 month, with full return to premorbid function.

• Rare (0.05 to 0.1%), most often in young adults, in women, and in people with personality disorders.
• Triggers: major stress (with marked stressor), postpartum period, culture specific syndromes.
• Recurrence risk 50% over years; some progress to schizophrenia or mood disorder.

• Abrupt delusions, hallucinations, disorganisation, emotional turmoil, confusion, catatonia.
• Resolves within days to weeks.
• Insight lacking during episode; risk of suicide and violence.

• DSM-5 duration criteria; exclude delirium, substance induced psychosis, epilepsy, encephalitis (autoimmune, infective), brain tumour, metabolic disease, mood episodes and schizophreniform disorder.
• Investigations: toxicology, electrolytes, glucose, TSH, calcium, B12, HIV, syphilis, infection screen, ECG, EEG and MRI as indicated.
• Pregnancy and postpartum status.

• Safe environment, de-escalation, admission if risk to self or others.
• Short course antipsychotic: olanzapine 5 to 15 mg, risperidone 1 to 4 mg, aripiprazole 10 to 15 mg; for agitation lorazepam 1 to 2 mg.
• Continue for 1 to 3 months after remission, then taper with monitoring.
• Psychoeducation, stress management, family support, relapse signature plan.
• Follow up for at least 1 to 2 years to detect progression.
• Postpartum cases: treat urgently with mother and baby unit.