![]() Given the nature of this condition, the prognosis is considerably well with complete remission of symptoms within a month per definition based on DSM-5 criteria. Substance intoxication, substance withdrawal, or medical conditions such as syphilis, neurosarcoidosis, metastasis likely secondary to lung cancer, thyrotoxicosis, and head trauma may occasionally present with symptoms that mimic that of BPD, however, a comprehensive history and physical examination in addition to necessary laboratory testing and imaging will help elucidate the underlying condition. Patients with personality disorder, especially borderline personality disorder, may also have transient episodes of psychosis mostly induced by stress that may only last for 1 day or less. Schizoaffective disorder is diagnosed in a patient who meets the criteria for major depressive disorder or manic disorder who also has psychotic symptoms consistent with schizophrenia concurrently with the mood symptoms and for at least 2 weeks in the absence of mood symptoms. Schizophrenia-spectrum disorders such as schizophreniform disorder and schizophrenia are distinguished from BPD based mainly on the presence of symptoms for longer than 30 days. Even with treatment, a patient with affective disorder with psychosis is not expected to return to baseline in 30 days, unlike patients with BPD. Psychotic affective disorder is diagnosed in the presence of a major mood component with symptoms of depression or mania. Primary differential diagnoses to consider are psychotic affective disorder, schizophrenia-spectrum disorders, personality disorders, delusional disorder, substance use disorder (including withdrawal), substance-induced psychosis, and psychosis secondary to medical conditions. Prior to symptomatic remission, a diagnosis of "psychotic disorder, not otherwise specified" may be given. A diagnosis of brief psychotic disorder can only be made retrospectively after the symptoms have remitted within one month of presentation, as the symptoms of psychosis may otherwise be an early manifestation of another disorder with a psychotic component. It is essential to consider other possible etiologies before determining a final diagnosis of the brief psychotic disorder. The biological, psychological, and social dimensions of the patient's life should in unison dictate the eventual treatment decisions made. The overall treatment plan for BPD should ideally include both pharmacological and psychosocial interventions. It is essential to support the patient to maintain medication adherence as a lack of adherence may facilitate symptom relapse. ![]() Along with emphasizing reintegration into the societal milieu, it is essential to focus on managing comorbid disorders or stressors and improving overall coping skills.ĭuring the treatment process, the patient should be monitored on a long-term basis to assess for relapse or the presence of residual symptoms that may necessitate referral to a specialist. Psychotherapeutic management of BPD would involve medically informing the patient and his/her family about the condition and treatment modalities employed for the particular patient. Īs expected, a brief yet major psychotic episode can be highly disruptive to the livelihood and functioning of an individual and his/her family and friends. Although oral formulations are preferable as first-line treatment for BPD, intramuscular formulations may have to be used in patients during immediate assessments and treatment, especially in emergency settings.īenzodiazepines: Medications within the benzodiazepine class may prove helpful to ameliorate symptom manifestation in acutely combative or agitated individuals. Although BPD characteristically shows complete resolution of symptoms within one month of symptom onset, it is suggested to continue treatment with antipsychotics for one to three months after symptom remission. Īntipsychotics, especially second-generation, are the first-line treatment for brief psychotic disorder. Because of the limited number of clinical trials evaluating the efficacy of specific treatment modalities in patients with brief psychotic disorder, current recommendations for treatment of BPD rely on pharmacological and psychotherapeutic interventions known to be effective in patients with other psychotic disorders. The basis for decisions regarding treatment should be on multiple factors such as the patient's presenting symptoms, socioeconomic stability, the presence of supporting individuals or family, and the presence of homicidal or suicidal ideation. ![]() It is important to first and foremost decide the appropriate level of care and whether the patient should be hospitalized or treated on an outpatient basis.
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