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Antipsychotic medications are very effective in ending a brief psychotic episode. A number of different antipsychotics are used for the purpose of terminating acute psychotic episodes. Haloperidol (Haldol) is most commonly used if the psychotic symptoms are accompanied by agitation. Agitation is a state of frantic activity that is often accompanied by anger or fearfulness; when in an agitated state, the client is more likely to cause harm to self or others. In agitated psychotic states, the haloperidol is often given as an injection, accompanied by other medications that decrease anxiety (lorazepam, also known as Ativan) and slow behavior (diphenhydramine, also known as Benadryl). If the client is not agitated, usually a newer-generation antipsychotic is used, given daily as tablets, capsules or liquid, for a lengthier period of time. The novel antipsychotic that would be used is likely to be one of the following: olanzapine (Zyprexa), quetiapine (Seroquel), or risperidone (Risperdal). Hormones may also be prescribed for postpartum psychosis. Supportive therapy may also prove helpful in some situations, in decreasing the client's anxiety and educating the client about the psychiatric illness. In culture-bound syndromes, the most effective treatment is often the one that is societally expected; for example, bathing in a river viewed as sacred might be a usual method of curing the psychotic-like state, in a particular culture.

Prognosis

The prognosis is fairly positive in brief psychotic disorder because by its own definition, a return to normal functioning is expected. If there is a major life event as a stress or an unusual traumatic experience that initiated the episode, chances are very good that there will be no recurrence. If there is not a particular triggering event or if the episode occurred in an individual with a personality disorder, the likelihood of recurrence is higher. If an episode is a recurrence without a specific triggering event, then the beginnings of the development of schizophrenia or bipolar disorder may be at hand, in which case the prognosis is poor. In the individual with personality disorder, the pattern may recur in response to stress, so that there are intermittent experiences of brief psychotic disorder over the course of a lifetime.

Prevention

In women who have experienced brief postpartum psychosis, one prevention option is to forgo having additional children. If a postpartum psychosis has occurred in the past, in subsequent pregnancies the physician may be proactive in prescribing an antipsychotic medication regimen to be taken in the postpartum period in order to prevent psychotic symptoms from recurring. Severe stressors can be a trigger for brief psychotic disorder in many cases. Therefore, in response to identifiable extreme stressors, such as natural disasters or terrorist attacks, u strong social support and immediate post-crisis counsel- m ing could possibly prevent the development of brief psy- 5 •

chotic disorder in susceptible persons. g r

See also Borderline personality disorder; Delirium; ° Dementia; Postpartum depression; Post-traumatic stress a disorder; Schizotypal personality disorder; Substance abuse

Resources books

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revised. Washington, DC: American Psychiatric Association, 2000.

periodicals

Ferfel D. "Rationale and guidelines for the inpatient treatment of acute psychosis." Journal of Clinical Psychiatry 61, Suppl 14 (2000): 27-32. Johns, L. C., J. van Os. "Continuity of psychotic experiences." Clinical Psychology Review 21, no. 8 (2001): 11251141.

Kulhara, P. and S. Chakrabarti. "Culture, schizophrenia and psychotic disorder." Psychiatric Clinics of North America 24, no. 3 (2001): 449-464. Stocky A. and J. Lynch. "Acute psychiatric disturbance in pregnancy and the puerperium." Baillere's Best Practices and Research in Obstetrics and Gynaecology 14, no. 1 (2000): 73-87.

Unguari, G. and others. "Reactive psychosis." Psychiatry & Clinical Neuroscience 54, no. 6 (2000): 621-623.

Deborah Rosch Eifert, Ph.D.

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