Brief psychotic disorder

Question 1

Brief psychotic disorder - dx

Answer 1

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. Disorganised speech (e.g. frequent derailment or incoherence)
4. Grossly disorganised or catatonic behaviour
B. Duration of episode >1d but

Question 2

Brief psychotic disorder - epi (3)

Answer 2

1. Associated with certain personality types (e.g. paranoid, borderline, histrionic)
2. More prevalent in developing nations where there is a strong emphasis on traditional values (?)
3. Age of onset later in industrialised nations; more common in women

Question 3

Brief psychotic disorder - ddx

Answer 3

1. Organic disorders - dementia, delirium
2. Bipolar affective disorder/depression - delusions of guilt and persecution
3. Drug and alcohol disorders
4. Personality disorder - paranoid, borderline, histrionic
5. Schizophrenia (if >1mo)

Question 4

Brief psychotic disorder - mx (same as for first psychotic episode)

Answer 4

1. Psychiatric hx, MSE, physical ex (with neurological focus), ix (FBE, UEC + ca, LFTs, FBG, serum lipids, TFTs, prolactin, urine toxicology, CT/MRI brain, immunological screen/EEG if indicated). Conduct blood tests before commencing antipsychotics, if possible
2. Risk assessment - to themselves, risk of violence, insight + ability to accept treatment. Assess need for hospital admission and suitability of the ward environment (clinical condition of pt + availability of both community mental health resources and family or other social supports; be aware of drug-induced/drug-withdrawal state). Regular review in first 72 hours
3. Emergency tx of behavioural disturbance (3):
   a. Oral lorazepam 1-2mg + oral antipsychotic (e.g. haloperidol 10-20mg, chlorpromazine 50-100mg)
   b. IM lorazepam + haloperidol if oral medication refused/failed
   c. If immediate tranquilisation necessary (exceptional circumstances) = IV benzodiazepines (e.g. diazepam 10mg slow IV bolus