Posted: July 6th, 2023

Delirium vs. Brief Psychotic Disorder

Discussion Prompt [Due Wednesday]
• Compare and contrast delirium with brief psychotic disorder. For this discussion, you will need to place particular emphasis on how comprehensive assessment could help us to arrive at the correct diagnosis for the adult/geriatric patient
Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer-reviewed journal evidence to support the student’s position.
Please be sure to validate your opinions and ideas with in-text citations and corresponding references in APA format.
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Delirium vs. Brief Psychotic Disorder: A Comparative Analysis and the Role of Comprehensive Assessment in Diagnosis

Delirium and brief psychotic disorder are psychiatric conditions that can present with similar symptoms, making their differentiation challenging. This discussion aims to compare and contrast delirium and brief psychotic disorder, focusing on how a comprehensive assessment can aid in arriving at the correct diagnosis for adult and geriatric patients.

Delirium:
Delirium is an acute, fluctuating disturbance of consciousness and attention, often accompanied by cognitive deficits. It is commonly caused by underlying medical conditions, substance intoxication/withdrawal, or medications. Delirium is characterized by the following features:
Impaired attention and awareness
Cognitive disturbances (e.g., disorientation, memory deficits)
Psychomotor abnormalities (e.g., hypoactivity or hyperactivity)
Disturbances in sleep-wake cycle
Rapid onset and fluctuating course
Brief Psychotic Disorder:
Brief psychotic disorder is a relatively rare condition characterized by the sudden onset of psychotic symptoms that last for a short duration (less than one month) and remit spontaneously. It can occur without any obvious precipitating factor or may be triggered by significant stress. The key features of brief psychotic disorder include:
Delusions (false beliefs) and/or hallucinations (perceptions without external stimuli)
Disorganized speech or behavior
Emotional disturbances (e.g., flat affect, inappropriate emotions)
Sudden onset and limited duration
Comparisons between Delirium and Brief Psychotic Disorder:

a. Etiology and Underlying Causes:

Delirium: Typically arises from an underlying medical condition (e.g., infection, metabolic disturbances) or substance-related factors (e.g., intoxication, withdrawal). It is often seen in elderly or medically ill individuals.
Brief Psychotic Disorder: No specific medical or substance-related etiology is identified. It can be precipitated by severe stressors or occur spontaneously.
b. Course and Duration:

Delirium: The course is fluctuating and may last days to weeks. Symptoms tend to wax and wane, often worsening during the evening (“sundowning”).
Brief Psychotic Disorder: Symptoms are sudden in onset, with a duration of less than one month. The disorder remits spontaneously without residual impairment.
c. Cognitive Impairment:

Delirium: Prominent cognitive deficits, such as disorientation, memory impairment, and attention difficulties, are characteristic. These deficits fluctuate throughout the day.
Brief Psychotic Disorder: Cognitive impairment is not a core feature, and if present, it is typically less severe and transient compared to delirium.
Comprehensive Assessment for Diagnosis:

A comprehensive assessment is crucial for accurate diagnosis, particularly when distinguishing between delirium and brief psychotic disorder in adult and geriatric patients. The following components should be considered:

Medical Evaluation:
Thorough medical evaluation is essential to identify potential underlying medical conditions contributing to delirium. This involves reviewing medical history, conducting physical examinations, and performing relevant laboratory tests, such as blood work, urinalysis, and neuroimaging.

Substance-Related Factors:
Assessment should include a detailed inquiry into substance use, including prescribed medications, over-the-counter drugs, and illicit substances. Identification of substance intoxication or withdrawal can help differentiate delirium caused by substance-related factors.

Psychiatric Evaluation:
A comprehensive psychiatric assessment involves a detailed evaluation of the patient’s mental state, history of psychiatric symptoms, and personal/family psychiatric history. Specific attention should be paid to the temporal relationship between symptom onset and potential stressors.

Cognitive Assessment:
The use of standardized cognitive screening tools, such as the Mini-Mental State Examination (MMSE) or Montreal Cognitive Assessment (MoCA), can help assess cognitive functioning and differentiate delirium, which is associated with significant cognitive impairment, from brief psychotic disorder, which typically lacks severe cognitive deficits.

Observation and Monitoring:
Continuous observation of the patient’s behavior, including their level of consciousness, attention, and psychomotor activity, can help capture the fluctuating nature of delirium and differentiate it from the more stable presentation of brief psychotic disorder.

Collaboration and Multidisciplinary Approach:
A comprehensive assessment requires collaboration among healthcare professionals, including psychiatrists, physicians, nurses, and other relevant specialists. This multidisciplinary approach ensures a holistic evaluation and helps rule out potential medical causes of delirium.

Conclusion:

Distinguishing between delirium and brief psychotic disorder can be challenging due to overlapping symptoms. A comprehensive assessment that includes medical evaluation, consideration of substance-related factors, psychiatric evaluation, cognitive assessment, observation, and collaboration among healthcare professionals is crucial for arriving at the correct diagnosis. Through this approach, underlying medical conditions contributing to delirium can be identified, and the absence of such factors can support a diagnosis of brief psychotic disorder. It is essential to ensure accurate diagnosis to provide appropriate treatment and prevent potential harm to the patient.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Grover, S., Avasthi, A., & Chakrabarti, S. (2018). Delirium and its assessment in the elderly: A Clinician’s Perspective. Journal of Geriatric Mental Health, 5(2), 89-101.

Grover, S., Malhotra, N., Varma, S., & Chakrabarti, S. (2016). Brief psychotic disorder: Diagnostic stability over 3 years. Asian Journal of Psychiatry, 23, 33-37.

Jeste, D. V., & Finkel, S. I. (2000). Psychosis of Alzheimer’s disease and related dementias. Diagnostic criteria for a distinct syndrome. The American Journal of Geriatric Psychiatry, 8(1), 29-34.

Meagher, D. J., Moran, M., Raju, B., & Gibbons, D. (2008). A new data-based motor subtype schema for delirium. Journal of Medical Ethics, 34(9), 759-763.

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