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Briefpsychoticdisorder
Author: RaminMojtabai,MD,PhD,MPH
SectionEditor: StephenMarder,MD
DeputyEditor: RichardHermann,MD

Alltopicsareupdatedasnewevidencebecomesavailableandourpeerreviewprocessiscomplete.
Literaturereviewcurrentthrough:Sep2016.|Thistopiclastupdated:Nov11,2015.
INTRODUCTIONBriefpsychoticdisorderisdefinedinDSM5asthepresenceofoneormorepsychoticsymptomswitha
suddenonsetandfullremissionwithinonemonth[1].
Briefpsychoticdisorderisoftenaprovisionalorretrospectivediagnosiswithasubstantialrateofrecurrenceandsubsequent
diagnosisofanotherpsychoticdisorderoraffectivedisorderwithpsychosis.Symptomdurationisonefactordistinguishing
briefpsychoticdisorderfromschizophreniformdisorder(onetosixmonths)andschizophrenia(atleastsixmonths).Other
disorderswithpsychoticfeaturesinthedifferentialdiagnosisincludeaffectivedisorders,substanceinduceddisorders,
psychosisduetoageneralmedicalconditionandpsychoticdisorder,nototherwisespecified(NOS).
Thistopicdiscussesbriefpsychoticdisorder.Theepidemiology,pathogenesis,course,clinicalmanifestations,diagnosis,
andtreatmentofotherpsychoticdisordersaredescribedseparately.(See"Schizophrenia:Clinicalmanifestations,course,
assessment,anddiagnosis"and"Schizophrenia:Epidemiologyandpathogenesis"and"Pharmacotherapyfor
schizophrenia:Acuteandmaintenancephasetreatment"and"Psychosocialinterventionsforschizophrenia"and"Evaluation
andmanagementoftreatmentresistantschizophrenia"and"Clinicalmanifestations,differentialdiagnosis,andinitial
managementofpsychosisinadults".)
CLASSIFICATIONBriefpsychoticdisorderisdiagnosedbasedonDSM5diagnosticcriteria,whichrequirethedisorder
tolastmorethanonedayandlessthanonemonth[1].AnICD10(InternationalClassificationofDiseases,10thedition)
criterionforoverlappingconditions,acuteandtransientpsychoticdisorders,appliestopsychoseswithanacuteonsetanda
durationofonetothreemonthsdependingonsubtype[2].(See'Diagnosis'below.)
OthertermshavebeenusedbyEuropeanauthorstodescribepsychoticsyndromeswhichhaveanacuteonsetand
remittingcourse,includingbouffedelirants(inFrenchspeakingcountries)andcycloidpsychosis(inGermanspeaking
countries).
EPIDEMIOLOGYBriefpsychoticdisorderisrare.Littleisknownaboutthedisordersepidemiologyduetoaverylow
incidenceandduetovariationsinthedisordersclassificationacrosscountries.Availableepidemiologicdataaredescribed
below.(See'Classification'above.)
IntheSuffolkCountyStudy(US),only11outof547(2.0percent)ofpatientswithfirstadmissionpsychosismetthe
DSMIVdiagnosticcriteriabriefpsychoticdisorderatsixmonths[3].
ApopulationbasedstudyinFinlandreportedlifetimeprevalenceestimatesof0.05percentforbriefpsychoticdisorder
[4].
AstudyintworuralcommunitiesinIrelandidentified10casesofbriefpsychoticdisorderamong196casesoffirst
episodepsychosis[5].
RiskfactorsThereislittlesystematicdataonriskfactorsforbriefpsychoticdisorder.Thereismoreinformation
regardingriskfactorsforotherpsychoticconditionswithremittingcourseandacuteonset:
Ahigherincidenceofacuteandtransientpsychoticdisordershasbeenreportedindevelopingcountriescomparedto
developedcountries[6,7].IntheWorldHealthOrganizationDeterminantsofOutcomeStudybasedon444firstonset
nonaffectivepsychosiscasesdrawnfromsitesineightcountries,theincidenceofnonaffectiveacuteremitting

psychoseswereapproximately10timeshigherinthetwodevelopingcountrysitesthatthesixindustrializedsites.The
nonaffectiveacuteremittingpsychosesinthatstudywerediagnosedbasedonthecriteriaintroducedbytheauthors
thatrequiredanacuteonset(withinoneweek)andcompleteremissionofpsychoticepisode[6].
Briefpsychoticdisorderismorecommoninwomencomparedwithmen[5].Transientpsychoticdisorders,someof
whichwouldmeetthecriteriaforDSM5briefpsychoticdisorder,havealsobeenfoundtobemorecommoninwomen
thaninmen[6,8,9].
ComorbidityAnecdotalevidenceanddiagnostictaxonomyhavelinkedpsychoticdisorderswithremittingcourseand
acuteonsetwithpremorbidpersonalitydisorders.DSM5describedminipsychoticepisodesasapotentialfeatureof
borderlinepersonalitydisorder[1].Researchstudiesoftheassociationbetweenpersonalityandremittingpsychoseswith
acuteonsethaveproducedmixedfindings:
Inasampleof51patientswithanacute,transientpsychoticdisorderinDenmark,63percentwerediagnosedwithaco
occurringpersonalitydisorderbasedonICD10orDSMIVcriteriashortlyafterremissionofpsychoticsymptoms[10].
Theproportionofthesamplediagnosedwithapersonalitydisorderdecreasedatoneyearreassessmentto46percent
usingICD10criteriaand29percentusingDSMIVcriteria[11].
Asampleof42inpatientsdiagnosedwithICD10acuteandtransientpsychoticdisorderswascomparedtomatched
controlgroupof42surgicalinpatientswithacuteillnesseswhowerefreefrommentalhealthproblemsontheNEOfive
factorpersonalityinventory[12].Nodifferencebetweenthegroupswasseenonanyofthefivepersonalitysubscales
[13].
Acomparisonof42inpatientswithacuteandtransientpsychoticdisorderswithamatchedcontrolgroupof42surgical
inpatientswhowerefreefrommentalhealthproblemsfoundnodifferencesineducationlevelorinahistoryofmarriage
orstablerelationships[14].
PATHOGENESISThecausesofbriefpsychoticdisorderarenotknown.Limitedresearchdataandmoreextensive
researchonotherpsychoticdisorderswithremittingcourseandacuteonsetimplicate:
StressfullifeeventsStressfullifeeventsintheperiodimmediatelyprecedingonsethavebeenimplicatedincasesof
briefpsychoticdisorderandinotherdescriptionsofbriefpsychosis[10,1518].Theactualprevalenceofsucheventsinthe
lifehistoriesofpatientswithDSMIVbriefpsychoticdisordershasnotbeensystematicallyinvestigated.Itissometimes
unclearinindividualpatientswhetherastressorwasaprecipitantorconsequenceoftheillness.
ImmigrationHigherincidencesofpsychoticdisorderswithremittingcourseandacuteonsethavebeenfoundamong
immigrantstoseveraldevelopedcountries[1921].Thisfindingmayberelatedtohigherprevalenceratesofthedisorder
observedinundevelopedcountries(describedabove).Anotherhypothesizedcontributingfactorisheightenedstress
associatedwithdiscriminationandsocialadversitythatmanyimmigrantsexperience.(See'Epidemiology'above.)
GeneticsThereislittlesystematicdataonpossiblecontributionofgeneticfactorstotheetiologyofbriefpsychotic
disorder.Mostoftheavailabledataonthegeneticriskfactorsarefromstudiesofotherpsychoticdisorderswithremitting
courseandacuteonset[14,22,23].Implicationsofthesefindingsforbriefpsychoticdisorderremainunclear.
PostpartumperiodManycasesofpsychosisinthepostpartumperiodmeetdiagnosticcriteriaforbriefpsychotic
disorder[24].DSM5criteriaallowforspecificationofasubtypewithpostpartumonset[1].(See"Postpartumpsychosis:
Epidemiology,clinicalmanifestations,assessment,anddiagnosis",sectionon'Pathogenesis'and"Treatmentofpostpartum
psychosis".)
CLINICALMANIFESTATIONSBriefpsychoticdisorderischaracterizedbysymptomsofpsychosislasting,bydefinition,
betweenonedayandonemonth.
Symptomsofpsychosisseeninthedisorderincludeoneormoreofthefollowing:
HallucinationsTheperceptionofasensoryprocessintheabsenceofanexternalsource.Hallucinationscanbe
auditory,visual,somatic,olfactory,orgustatory.
DelusionsAfixed,falsebelief.Delusionscanbebizarreornonbizarre.

 DisorganizedspeechDisorganizedspeechpatternsreflectdisruptionintheorganizationofpersonsthoughts.
Commonlyobservedformsincludetangentialityandcircumstantiality
DisorganizedbehaviorApatientwithgrosslydisorganizedbehaviorisoftenrecognizedbytheirinabilitytocomplete
daily,normativetasks(eg,clothed,clean,belongingsinorder).
COURSEThereislittlesystematicdataontheageofonsetofbriefpsychoticdisorder.Theaverageageatonsethas
beenfoundtovarywidelyinotherpsychoticconditionswitharemittingcourseandacuteonset,thoughmaybesomewhat
higherthantheageatonsetofschizophrenia(lateteensandearly20s)[6,14,25,26].
Assessmentofdurationofthenaturalhistoryofbriefpsychoticdisorderisoftencomplicatedbyearlytreatmentwhichcan
leadtoremissionofpsychoticsymptoms.Therehasbeenlittlestudyofuntreatedindividualswiththedisorder.Symptomsof
briefpsychoticdisorder,bydefinition,remitwithinamonthbasedonDSM5criteria.
Manyindividualswhoinitiallymetcriteriaforabriefpsychoticdisorderhavegoneontomeetcriteriaforotherpsychotic
disordersoraffectivedisorderswithpsychosis.IntheSuffolkCountyStudyoffirstadmissionpsychosis,onlythreeofthe11
patientswhomettheDSM5diagnosticcriteriaforbriefpsychoticdisorderatsixmonthsmaintainedthediagnosisattwo
yearfollowup[3].Threeotherpatientsreceiveddiagnosesofamooddisorder,twowithschizophreniaorschizophreniform
disorder,andthreeotherswithotherdisordersincludingpsychoticdisorder,NOS.Inastudyoffirstepisodepsychosisin
Ireland,only2of10patientsinitiallydiagnosedwithbriefpsychoticdisordermaintainedthisdiagnosissixyearslater[5].
AstudybasedonregistrydatafromDenmarkidentifiedevidenceofexcessmortalitybothfromnaturalcausesandsuicidein
patientsinitiallyrecordedashavingacuteandtransientpsychoticdisorder[27].
ASSESSMENTAcomprehensiveclinicalassessmentofapatientpresentingwithnewonsetofpsychosisincludesa
carefulhistoryandphysicalexamination,exclusionofgeneralmedicalandsubstancerelatedcausesofpsychosis,and
assessmentforcooccurringconditions[28].
Informationfromthepatientsfamilyandfriendscanbehelpfulinassessingthepatientsfunctioningpriortheonsetofillness
andtodeterminewhetherthepatientssymptomsoccurredpriortoorfollowinganassociatedstressor.
Inadditiontothesymptomscomprisingdiagnosticcriteriaforbriefpsychoticdisorderassessment,thepatientshouldbe
evaluatedforotherfeaturessuggestiveofbriefpsychoticdisorder:
Presenceofmarkedstressorsprecedingsymptomonset
Lackofnegativesymptoms
Confusionduringtheearlycourseofillness
Diagnosisofbriefpsychoticdisorderrequiresongoing,longitudinalassessmentofthepatientsclinicalstatus.Becausethe
DSM5diagnosticcriteriarequireremissionwithinonemonth,thediagnosisisinitiallyprovisionalormaderetrospectively.
Psychoticsymptomsoftenrecursubsequenttoremission,insomecasesleadingtoafinaldiagnosisofschizophreniaor
otherpsychoticdisorders.
DIAGNOSISDSM5diagnosticcriteriaforbriefpsychoticdisorderareasfollows[1]:
Presenceofoneormoreofthefollowingsymptoms:
Delusions
Hallucinations
Disorganizedspeech
Grosslydisorganizedorcatatonicbehavior
Durationofanepisodeofthedisturbanceisatleastadaybutlessthanamonth,witheventualfullreturntopremorbid
leveloffunctioning

 Absenceofsymptomscomprisingamooddisorder,orpsychosisresultingfromsubstanceuse/withdrawalorageneral
medicalcondition
Subtypesofthedisorderinclude:
WithmarkedstressorSymptomsareprecededbyandapparentlyinresponsetoamarkedlystressfulexperience.
ThissubtypewasdescribedasbriefreactivepsychosisinanearliereditionoftheDSM.
Withoutmarkedstressor
WithpostpartumonsetWithinfourweeksofdelivery
DifferentialdiagnosisDistinguishingbriefpsychoticdisorderfromotheraffectiveandnonaffectivepsychoticconditions
isoftendifficult.Analgorithm(algorithm1)andtheparagraphsthatfollowdescribetheprinciplefeaturesdistinguishing
thesedisorders.
AffectivedisordersThemaindiagnosticchallengeistodistinguishbriefpsychoticdisorderfromaffectivedisorders,
especiallybipolardisorderwithpsychoticfeatures.Patientswithbothaffectivedisordersandbriefpsychoticdisordermay
presentwithpsychosis,irritabilityanddisorganizedbehavior.Insomecasesonlycontinuedobservationofthepatients
responsetotreatmentandlongtermcoursewillclarifythediagnosis.
NonaffectivepsychoticdisordersLongitudinalfollowupcanbenecessarytodifferentiatebriefpsychoticdisorder
fromothernonaffectivepsychoticdisorders,whichtypicallylastlongerandareassociatedwithgreaterlongtermdeficitsin
functioning.
SchizophreniformdisorderSchizophreniformdisorderisdistinguishedfrombriefpsychoticdisorderinDSM5by
thefollowingdifferencesindiagnosticcriteria:
Psychoticsymptomsarepresentformorethanonemonthbutlessthansixmonths
Twoormoretypesofpsychoticsymptomsarepresentforasignificantproportionofaonemonthperiodifthepatientis
untreated
Negativesymptomsmayconstituteoneofthecharacteristictypesofsymptomsthatarepresent
SchizophreniaSchizophreniaisdistinguishedfrombriefpsychoticdisorderbythefollowingdifferencesin
diagnosticcriteria:(See"Schizophrenia:Clinicalmanifestations,course,assessment,anddiagnosis",sectionon'Clinical
manifestations'.)
Psychoticsymptomsarepresentforatleastsixmonths
Twoormoretypesofpsychoticsymptomsmustbepresentforasignificantproportionofaonemonthperiodifthe
patientisuntreated
Negativesymptomsmayconstituteoneofthecharacteristictypesofsymptomsthatarepresent
Functioninginoneormoremajorareas(eg,interpersonalrelationships,work,selfcare)ismarkedlybelowthelevel
achievedpriortoonset
SubstanceinducedpsychosesIntoxicationwithorwithdrawalfromanumberofsubstances(including
hallucinogens,cocaine,andamphetamines)areassociatedwithacuteonsetofpsychoticsymptoms.Toxicological
examinationofpatientspresentingwithpsychoticsymptomsofacuteonsetisnecessary,especiallyinyoungerpatients.
PsychosisduetogeneralmedicalconditionsAnumberofneurological(eg,seizuredisorders),endocrine(eg,
thyroiddisease)andinfectiousdiseases(eg,viralencephalitis)areassociatedwithpsychoticsymptoms.Athorough
physicalexaminationisnecessary,withlaboratorytestingorneuroimagingbasedonthefindings.
TREATMENT

LevelofcareThedecisionwhethertohospitalizeapatientwithbriefpsychoticdisorderisbasedonthesafetyofthe
patientandothers.Considerationsincludethepresenceofsuicidalorhomicidalideation,thepatientsabilitytocarefor
him/herself,andthepresenceofothersathomewhocanprovidesupportoralertemergencyservicesincaseofneed.
Whenthepatientistreatedonanoutpatientbasis,coordinationofcarewiththepatientsfamily(orothersupporting
individuals)isrecommendedtohelpensuretreatmentadherence.Familymembersshouldbeeducatedaboutthedisorder
andtreatment.
PharmacotherapyNoclinicaltrialsorcaseserieshaveexaminedtheefficacyoftreatmentsforbriefpsychoticdisorders.
Intheirabsence,ourrecommendationsarebasedonourclinicalexperienceandevidenceoneffectivetreatmentforother
psychoticdisorders[28].
Wesuggesttreatmentofbriefpsychoticdisorderwithantipsychoticmedication.Asanexample,risperidonecanbestarted
at1to2mgperdayandincreasedto2to3mgperdayoveraweek.Thedosecanbeincreasedoverthenextonetotwo
weeksbasedonclinicalresponseandsideeffectstoamaximum8mgperday.Therearenoknowndifferencesinthe
effectivenessofantipsychoticmedications(otherthanclozapine,describedseparately).Medicationselectionistypically
basedonthedrugssideeffectprofiles.(See"Firstgenerationantipsychoticmedications:Pharmacology,administration,and
comparativesideeffects"and"Secondgenerationantipsychoticmedications:Pharmacology,administration,andside
effects"and"Guidelinesforprescribingclozapineinschizophrenia".)
Anticholinergicmedicationsmaybeneededformanagementofextrapyramidalsideeffectsofantipsychoticmedications.
Benzodiazepinescanbeusefulfortreatingagitationseeninsomecasesofbriefpsychoticdisorderforexample,
clonazepamcanbestartedat0.25mgtwicedaily,andincreasedasneededbasedonclinicalresponseandtheemergence
ofsedationandothersideeffects,uptoamaximumof2mgtwicedaily.(See"Pharmacotherapyforschizophrenia:Side
effectmanagement".)
Therearenowidelyacceptedguidelinesonthedurationoftreatmentforbriefpsychoticdisorder.Basedonourclinical
experience,forapatientwithbriefpsychoticdisorderandnopriorhistoryofpsychosisoranaffectivedisorder,wesuggest
continuingantipsychotictreatmentforonetothreemonthsfollowingremissionofsymptoms.Indiscontinuingthemedication,
taperthedoseoveronetotwoweeks.Duringthistimeandovertheweeksthatfollow,monitorthepatientcloselyforsigns
ofrelapse.Longertreatmentmaybeneededifmildorresidualpsychoticsymptomspersist.
Switchingtoanotherantipsychoticmedicationshouldbeconsideredifthepsychoticsymptomsdonotrespondtothefirst
antipsychotic.(See"Firstgenerationantipsychoticmedications:Pharmacology,administration,andcomparativeside
effects"and"Secondgeneration(atypical)antipsychoticmedicationpoisoning".)
Closemonitoringofsymptomsandfunctioningduringandintheearlymonthsafterstoppingtreatmentisrecommended.
Thepatientwhoexperiencesresidualpsychoticsymptomsformorethanonemonthorexperiencesarelapseoffullblown
symptomssoonafterstoppingmedicationwillrequirefurtherevaluationandreconsiderationofthediagnosisofbrief
psychoticdisorder.(See"Clinicalmanifestations,differentialdiagnosis,andinitialmanagementofpsychosisinadults".)
Overthecourseoftreatment,furtherinformationregardingthepatientspastpsychiatrichistoryshouldbepursuedwith
familymembersandothersources.Furtherinformationmayhelptoidentifyearlierepisodesofpsychosisoranaffective
disorder,allowingforrefinementofthediagnosisand,possibly,theneedforadditionaltreatment(eg,continuationof
antipsychoticmedication,ortreatmentwithanantidepressantormoodstabilizer).(See"Bipolardisorderinadults:
Pharmacotherapyforacutemaniaandhypomania"and"Unipolarmajordepressionwithpsychoticfeatures:Acute
treatment"and"Clinicalmanifestations,differentialdiagnosis,andinitialmanagementofpsychosisinadults".)
SupportivepsychotherapeutictechniquesNopsychosocialinterventionshavebeentestedinbriefpsychoticdisorder.
Basedonclinicalexperience,wesuggesttheuseofsupportivepsychotherapytechniquesforpatientswhofindtheacute
onsetofpsychoticsymptomstobefrightening.Thesetechniquesinclude:
Explainingtheexperienceinmedicalterms
Describingtreatment
Providingreassurancetothepatientandhis/herrelativesandfriends

SUMMARYANDRECOMMENDATIONS
BriefpsychoticdisorderisdefinedinDSM5asthepresenceofoneormorepsychoticsymptomswithasuddenonset,
absenceofamoodorsubstanceinduceddisorder,andremissionwithinonemonth.Anoverlappingcategoryof
syndromesintheICD10(InternationalClassificationofDiseases,10thedition),acuteandtransientpsychoticdisorders,
appliestopsychoseswithanacuteonsetandadurationofonetothreemonthsdependingonsubtype.(See
'Classification'above.)
Briefpsychoticdisorderisrare.Limitedepidemiologicdataincludeanestimatedprevalenceof0.05percentina
populationbasedstudyinFinland.AthreeyearfollowupassessmentoffirstepisodepsychosisintheUnitedKingdom
foundanincidencerateforacutetransientpsychoticdisorderof1.4per100,000.(See'Epidemiology'above.)
Symptomsseeninbriefpsychoticdisorderincludeoneormoreofthefollowing:hallucinations,delusions,disorganized
speech,orgrosslydisorganizedbehavior.Symptomsmayappearfollowingastressfullifeevent.Negativesymptoms
maybelesslikelytobepresentthaninotherpsychoticdisorders.(See'Clinicalmanifestations'above.)
Acomprehensiveclinicalassessmentofapatientpresentingwithnewonsetofpsychosisincludesacarefulhistoryand
physicalexamination,andassessmentforcooccurringconditions.Diagnosisofbriefpsychoticdisorderrequiresthe
presenceofoneormorepsychoticsymptomslastingmorethanadayandlessthanonemonth,andexclusionofan
affectivedisorderorageneralmedicalorsubstancerelatedcauseofpsychosis.(See'Assessment'aboveand
'Diagnosis'above.)
Wesuggesttreatmentofpsychosisinpatientswithbriefpsychoticdisorderwithanantipsychoticmedication(Grade
2C)forexample,risperidoneatadailydoseof1to3mg.Educationandreassurancemaybeahelpfuladjunctto
medication,particularlyinpatientswhoareconfusedorfrightenedbytheonsetofpsychoticsymptoms.(See
'Treatment'above.)
Forapatientwithbriefpsychoticdisorderandnopriorhistoryofpsychosisoranaffectivedisorder,wesuggest
continuingantipsychotictreatmentforonetothreemonthsfollowingremissionofsymptoms(Grade2C).Close
monitoringofsymptomsandfunctioningduringandintheearlymonthsafterstoppingtreatmentisrecommended.(See
'Treatment'above.)
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Topic14778Version6.0

GRAPHICS
Dierential diagnosis of delusions
Image

Adapted from: American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th Ed: DSM-5.
Washington, D.C.: American Psychiatric Association, 2013.
Graphic 100456 Version 2.0

Contributor Disclosures
Ramin Mojtabai, MD, PhD, MPH Nothing to disclose Stephen Marder, MD Grant/Research/Clinical Trial Support:
Forum; Neurocrine [schizophrenia and tardive dyskinesia]. Consultant/Advisory Boards: Takeda, Gideon Richter, BoeringerIngleheim, Otsuka; Allergan; Teva [schizophrenia (brexpiprazole, cariprazine)]. Richard Hermann, MD Nothing to disclose
Contributor disclosures are reviewed for conicts of interest by the editorial group. When found, these are addressed by
vetting through a multi-level review process, and through requirements for references to be provided to support the
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