Diagnosis, prognosis, and treatment of brief psychotic episodes: a review and research agenda

Paolo Fusar-Poli; Gonzalo Salazar de Pablo; Ravi Philip Rajkumar; Álvaro López-Díaz; Savita Malhotra; Stephan Heckers; Stephen M Lawrie; Frank Pillmann

doi:10.1016/S2215-0366(21)00121-8

Diagnosis, prognosis, and treatment of brief psychotic episodes: a review and research agenda

Lancet Psychiatry. 2022 Jan;9(1):72-83. doi: 10.1016/S2215-0366(21)00121-8. Epub 2021 Nov 29.

Authors

Paolo Fusar-Poli¹, Gonzalo Salazar de Pablo², Ravi Philip Rajkumar³, Álvaro López-Díaz⁴, Savita Malhotra⁵, Stephan Heckers⁶, Stephen M Lawrie⁷, Frank Pillmann⁸

Affiliations

¹ Early Psychosis: Interventions and Clinical-detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy. Electronic address: paolo.fusar-poli@kcl.ac.uk.
² Early Psychosis: Interventions and Clinical-detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, UK; Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERSAM, Madrid, Spain.
³ Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
⁴ University Hospital Virgen Macarena, Seville, Spain; Institute of Biomedicine of Seville, Seville, Spain.
⁵ Fortis Hospital, Mohali, Panjab, India.
⁶ Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
⁷ University of Edinburgh, Edinburgh, Scotland, UK.
⁸ WO Center of Psychiatry, Halle, Germany; Martin Luther University, Halle-Wittenberg, Germany.

PMID: 34856200
DOI: 10.1016/S2215-0366(21)00121-8

Abstract

Brief psychotic episodes represent an intriguing paradox in clinical psychiatry because they elude the standard knowledge that applies to the persisting psychotic disorders such as schizophrenia. This Review describes key diagnostic considerations such as conceptual foundations, current psychiatric classification versus research-based operationalisations, epidemiology, and sociocultural variations; prognostic aspects including the risk of psychosis recurrence, types of psychotic recurrences, other clinical outcomes, prognostic factors; and therapeutic issues such as treatment guidelines and unmet need of care. The advances and challenges associated with the scientific evidence are used to set a research agenda in this area. We conclude that brief psychotic episodes can be reconceptualised within a clinical staging model to promote innovative translational research and improve our understanding and treatment of psychotic disorders.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Humans
Prognosis
Psychotic Disorders / classification
Psychotic Disorders / diagnosis*
Psychotic Disorders / therapy*
Schizophrenia / classification
Schizophrenia / diagnosis*
Schizophrenia / therapy*
Time Factors