History and exam
Key diagnostic factors
common
presence of risk factors
Risk factors include: presence of significant life stressors, family history of psychotic disorder, being pregnant or within 4 weeks postnatal, previous psychiatric symptoms in women, age late 30s to early 40s, and being a single mother.
age over 18 years
Psychotic disorders are more prevalent in people over the age of 18 years.
at least 1 positive psychotic symptom lasting >1 day but <1 month
The duration of time for which the patient experiences psychotic symptoms is important to the diagnosis. Symptoms presenting and not resolved within 1 month do not meet the criteria for brief psychotic disorder (BPD).[1] Other diagnoses, such as schizophrenia or bipolar disorder, should be considered in these cases.
symptoms not due to substance use
Use of and dependence on alcohol and many illicit drugs can lead to substance-induced psychotic symptoms. Substance use history and urine toxicology screen are helpful in ruling out.
Other diagnostic factors
common
pregnant or within 4 weeks postnatal
BPD can occur during pregnancy or the postnatal period, and women should be questioned as to timing of last delivery.
recent stress and trauma
Significant stress and trauma can precipitate BPD. The patient should be questioned about stressful and traumatic events in the recent past.
Risk factors
weak
significant life stressor
Brief psychotic disorder (BPD) with marked stressor(s) (formerly called 'brief reactive psychosis') is diagnosed when the psychotic symptoms occur in response to 1 or more events that would be considered markedly stressful to almost anyone in a similar situation in the individual’s culture.[1] It generally has an abrupt onset. Precipitants include overwhelming fear, threat of imminent destruction, social isolation (e.g., imprisonment, immigration, deafness), bereavement, and intense sexual or interpersonal conflicts.[11]
family history of psychotic disorder
Some patients may have a genetic vulnerability to BPD, and it is found to be higher in people with family members who have had BPD.[17]
pregnancy or 4 weeks postnatal
Features of pregnancy or the postnatal period (e.g., sleep deprivation, obstetric complications, puerperal hormone shifts) and an increase in environmental stress can be a contributing factor to the onset of psychotic symptoms.[18]
previous psychiatric symptoms in women
Data suggest that prior psychiatric symptoms and hospitalisations increase the risk for postnatal BPD.[16]
age 35 to 45 years
This disorder is more common in people in their late 30s and early 40s. In women it has been associated with an increased risk of hospitalisation for postnatal BPD.[19]
single mother
Being a single mother is shown to increase the risk of hospitalisation for postnatal BPD. However, it is not known whether this reflects a difference in incidence of BPD or merely a difference in the support needed.[19]
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