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Diagnosis of Brief Psychotic Disorder

Brief psychotic disorders are diagnosed based on a clinical assessment performed by a mental health professional, usually a psychiatrist.  This assessment includes an interview with the individual, a review of any previous assessments in their medical records, and can also include an interview with the individual's family members or close friends. 

The goal of this assessment is to determine whether the individual meets the clinical criteria for any of the forms of brief psychosis (Brief Psychotic Disorder, Schizophreniform Disorder, ATPD, or NARD) based on the information obtained. Given that these different diagnostic terms are very similar and overlap in many ways, it is very possible that the same individual could fulfill the diagostic criteria for more than one of these conditions. Sometimes it is not possible to arrive at a definitive diagnosis of the disorder from a single clinical interview, and a period of observation either in hospital or as an out-patient may be required.

There are no laboratory tests or imaging tests (such as CT scans or MRI scans) that can help make a diagnosis of a brief psychotic disorder. However, these sorts of tests are often important in order to determine whether a general medical condition or the effects of a particular substance may be contributing to, or causing, the psychotic symptoms.

Differential Diagnosis of Brief Psychotic Disorders

There are various medical and psychiatric conditions that can cause psychotic symptoms and that should be distinguished from brief psychotic disorders:

Medical causes of psychosis

In theory any form of damage or insult to the brain could cause psychosis. Most of the time, this will occur in the context of a delirium, and there will also be many other physical signs and symptoms to suggest that there is something wrong medically. Medical problems that can affect the brain include:

  • Tumors
  • Strokes
  • Infections (eg. HIV/AIDS, Syphilis, Herpes)
  • Inflammation (eg. Systemic Lupus Erythematosus, Multiple Sclerosis)
  • Electrolyte and nutrient imbalances (eg. sodium and calcium imbalance, Wilson's Disease, liver failure, deficiencies of Folate, Niacin, Thiamine, and Vitamin B12)
  • Degenerative diseases (eg. Dementia, Parkinson's Disease, Huntington's Disease)
  • Endocrine diseases (eg. Cushing's Syndrome, thyroid imbalances)
  • Paraneoplastic syndrome

Substances that can cause psychosis

Various street drugs and substances of abuse can cause psychosis, including:

Many kinds of medications can also cause psychotic symptoms. The ones that are most likely to do this include:

Most of the time, the above substances and medications will cause psychotic symptoms only for a few hours or days - the time it takes for the substance to clear from the brain. However, corticosteroids can trigger psychotic symptoms that can last for weeks after the drug has been stopped [ref]. Long-term, heavy marijuana use has been found to increase the risk of developing Schizophrenia (see here for further information).

Psychiatric conditions that can be mistaken for Brief Psychotic Disorders

It is important to note that, over time, a large percentage of people with brief psychotic disorders will eventually be diagnosed with Schizophrenia or a Mood Disorder (see here for further information).

 

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Nonaffective Acute Remitting Psychosis (NARP)

Causes