Brief psychotic disorder: when should antipsychotic treatment be discontinued? A case report
DOI:
https://doi.org/10.25118/2763-9037.2026.v16.1605Keywords:
antipsychotic agents, brief psychotic disorder, first-episode psychosis, catatonia, treatment discontinuation, antipsychoticsAbstract
Introduction: The duration of antipsychotic treatment after remission from a first episode of psychosis remains debated, and direct extrapolation from schizophrenia protocols to brief psychotic disorder requires caution. Objective: To discuss early antipsychotic discontinuation in a case of brief psychotic disorder with catatonic symptoms, considering differential diagnosis, functional recovery and the literature on first-episode psychosis. Method: Case report supported by a narrative literature review on brief psychotic disorder, catatonia, early intervention in psychosis and maintenance, dose-reduction or discontinuation strategies for antipsychotics. Research Ethics Committee of Military Police Hospital, under opinion number 8.362.020, CAAE 195790526.5.0000.0283. Submitted signed Informed Consent Form. Result: A man younger than 25 years presented with an acute first episode of psychosis, including persecutory and guilt-related delusions, disorganized thought, postural rigidity, fixed gaze, reduced verbal spontaneity and psychomotor behavior compatible with catatonia. Initial clinical and neurological investigation did not identify an organic cause. He responded rapidly to lorazepam and risperidone, with remission of psychotic, catatonic and apparent negative symptoms. Antipsychotic medication was gradually discontinued early because of functionally relevant adverse effects, and approximately one year of outpatient follow-up showed no relapse. Conclusion: In brief psychotic disorder, antipsychotic discontinuation should be individualized, longitudinally reassessed and accompanied by close monitoring, particularly when catatonia, negative symptoms, diagnostic uncertainty or treatment-related functional impairment is present.
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Copyright (c) 2026 Daniel Nunes Pinto, Jussara Alvarenga Mendonça, Rodrigo Nicolato, Antonio Marcos Alvim Soares Júnior, Austen Venâncio Drummond
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