Brief Psychotic Disorder

1. Presence of one (or more) of the following symptoms:
   
   1. delusions
   2. hallucinations
   3. disorganized speech (e.g., frequent derailment or incoherence)
   4. grossly disorganized or catatonic behavior
2. Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual full return to premorbid level of functioning.
3. The disturbance is not better accounted for by a Mood Disorder With Psychotic Features, Schizoaffective Disorder, or Schizophrenia and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Specify if:

• With Marked Stressor(s) (brief reactive psychosis): if symptoms occur shortly after and apparently in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the person's culture
• Without Marked Stressor(s): if psychotic symptoms do not occur shortly after, or are not apparently in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the person's culture
• With Postpartum Onset: if onset within 4 weeks postpartum

Antipsychotics: Doses and Side Effects for Chronic Use

Antipsychotics (typical)	Dose mg/day	Anti- cholineric¹	EPS²	Sedation	Hypotension (orthostatic)
Chlorpromazine (Thorazine)	100-2000	++++	++	+++++	+++++
Thioridazine (Mellaril)	100-600	+++++	+	++++	+++++
Trifluoperazine (Stelazine)	5-60	++	++++	+	++
Thiothixene (Navane)	5-60	++	++++	++	++
Fluphenazine (Prolixin)	5-30	++	+++++	++	++
Haloperidol (Haldol)	2-200	+	+++++	++	+

Antipsychotics (atypical)	Dose mg/day	Anti- cholineric¹	EPS²	Sedation	Hypotension (orthostatic)
Risperidone (Risperdal)	1-6	+	+	+	++
Olanzapine (Zyprexa)	5-20	+	+	++	+
Clozapine³ (Clozaril)	5-60	+++++	+	+++++	+++++

¹ Dry mouth, constipation, blurred vision, urinary retention.
² Extrapyramidal side effects (dystonia, parkinsonism, akathisia, tardive dyskinesia).
³ Requires weekly White Blood Cell (WBC) count because of risk of agranulocytosis.
Adapted from Bernstein JG: Handbook of drug therapy in psychiatry, ed 3, St. Louis, 1995, Mosby.

Special Antipsychotic Adverse Reactions

1. Neuroleptic Malignant Syndrome. May occur at any point during the course of treatment. Includes symptoms of autonomic instability, altered mental status, which may progress to hyperthermia, stupor, and muscle hypertonicity. Death may occur. Cause: Neuroleptics (phenothiazines, etc.)
   Characteristics. Same symptoms as malignant hyperthermia (see below) but generally develops over days instead of minutes. Treatment: As per malignant hyperthermia.
   • Malignant Hyperthermia.
     Cause. 1:20,000 in response to a muscle-relaxing agent (such as succinylcholine) or an inhaled anesthetic (such as halothane). Is hereditary. May also be secondary to physical or emotional stress.
     Characteristics. Hyperthermia, muscle rigidity, tachycardia, acidosis, shock, coma, rhabdomyolysis.
     Treatment includes IV dantrolene 1 to 10 mg/kg IV titrated to effect, management of acidosis and shock, peripheral cooling (see management of heat stroke below).
2. Tardive Dyskinesia. Involuntary movements of the tongue, face, mouth, or jaw associated with long-term administration of antipsychotics. Elderly females at highest risk. May be irreversible.

• Learning Problem
• Hypoactivity
• Psychotic
• Euphoric Mood
• Depressed Mood
• Somatic or Sexual Dysfunction
• Hyperactivity

Some disorders have similar or even the same symptom. The clinician, therefore, in his diagnostic attempt has to differentiate against the following disorders which he needs to rule out to establish a precise diagnosis.

• Psychotic Disorder Due to a General Medical Condition or a Delirium;
• Substance-Induced Psychotic Disorder;
• Substance-Induced Delirium and Substance Intoxication;
• Mood Episode;
• Schizophreniform Disorder;
• Delusional Disorder;
• Mood Disorder With Psychotic Features;
• Psychotic Disorder Not Otherwise Specified;
• Factitious Disorder, With Predominantly Psychological Signs and Symptoms;
• Malingering;
• Personality Disorders.