Brief Psychotic Disorder Treatment & Management
Because of the short duration of brief psychotic disorder, treatment is brief and focused on being as nonrestrictive as possible. However, it remains clinically imperative to prevent patients from harming themselves or others. Accordingly, patients experiencing an acute psychotic attack may have to be hospitalized briefly so that they can be evaluated and their safety ensured. If a patient becomes aggressive and combative, brief seclusion or restraint may be necessary.
If symptoms are only minimally impairing the patient’s function and a specific stressor is identified, removing the stressor should suffice for treatment of the brief psychotic episode.
If, however, symptoms are disabling, an antipsychotic agent should be given, but for no longer than 1 month.
Oral second-generation antipsychotic drugs, including lanzapine, risperidone, quetiapine, ziprasidone, aripiprazole, or paliperidoneare, are first-line treatment for brief psychotic disorder because they are less likely to cause extrapyramidal symptoms.
Oral first-generation antipsychotic drugs are second-line treatment. Options include haloperidol, chlorpromazine, perphenazine, fluphenazine, trifluoperazine, and loxapine. If extrapyramidal adverse effects occur, prophylactic treatment with benztropine can be adminstered.
Lorazepam can be given for its anxiolytic effect when there is the need for rapid sedation of violent or agitated individuals
At present, the available evidence is not sufficient to support the use of atypical antipsychotics to treat brief psychotic disorder. A case series suggests that rapid tranquilization with olanzapine can achieve symptom relief in acute psychosis. [10] A study involving intramuscular (IM) ziprasidone showed this agent to be more effective and better tolerated than IM haloperidol for treating acute psychosis. [11] In the authors’ experience, IM ziprasidone is the most effective treatment for acute severe psychotic agitation.
For pregnant women, first-line treatment includes administering an antipsychotic medication, like olanzapine or haloperidol, alongside short-term use of benzodiazepines, such as lorazepam. When administering more than 5 mg of IM haloperidol, it is advisable to use benztropine or diphenhydramine to prevent extrapyramidal symptoms and dystonia. [12]
Once the acute attack has ended, further inpatient care is unnecessary. Individual, family, and group psychotherapy may be considered to help cope with stressors, resolve conflict, and improve self-esteem and self-confidence.
