When a client suddenly experiences psychotic symptoms, it can confuse and distress both the individual and their support system. As mental health professionals, we are relied upon to respond with clarity, compassion, and clinical skill—to assess risk, provide stabilization, and guide the client and their family through what can be a disorienting and frightening experience.  We need a solid grasp of the diagnostic criteria and implications of brief psychotic disorder, also known as ICD-10 code F23.

Understanding the unique features of acute psychosis and its subtypes helps guide effective crisis management, short-term stabilization, and long-term treatment planning. Familiarizing ourselves with the nuances of F23 allows us to provide more targeted support to clients during these challenging episodes.

In this article, we'll examine the diagnostic criteria for brief psychotic disorder, explore its various subtypes, and discuss the clinical implications for assessment, treatment, and documentation. Let's start by taking a closer look at what defines F23 and its core features.

Understanding F23: Brief Psychotic Disorder vs. Acute and Transient Psychotic Disorders

You may notice that both Brief Psychotic Disorder and Acute and Transient Psychotic Disorders are associated with the ICD-10 code F23, which can lead to confusion—especially when navigating between diagnostic systems. This overlap occurs because F23 is used differently depending on the classification framework.

In the ICD-10 (World Health Organization) system, F23 refers broadly to Acute and Transient Psychotic Disorders, a category that includes several subtypes of sudden-onset psychosis lasting less than one month. These include presentations with or without schizophrenic symptoms, as well as acute delusional or polymorphic forms. The focus is on the sudden onset, brief duration, and full remission of symptoms.

In contrast, the DSM-5 (used widely in the United States) uses the diagnostic label Brief Psychotic Disorder, which aligns closely in symptom presentation and duration. For insurance and billing purposes, the DSM-5 diagnosis of Brief Psychotic Disorder is crosswalked to the same ICD-10-CM code: F23.

So while the terminology differs slightly—“Brief Psychotic Disorder” in DSM-5 versus “Acute and Transient Psychotic Disorders” in ICD-10—they both refer to short-term psychotic episodes that typically resolve within a month and are often stress-related. Understanding this alignment is essential for accurate documentation, communication with other providers, and navigating reimbursement systems.

Defining F23: Diagnostic Criteria and Subtypes

F23 involves the sudden onset of psychotic symptoms, such as delusions, hallucinations, and disorganized speech or behavior, lasting less than one month. This diagnosis emphasizes a full return to baseline functioning after the episode resolves.

Several subtypes fall under the F23 category when using the ICD-10:

• F23.0 – Acute polymorphic psychotic disorder without schizophrenia symptoms
• F23.1 – Acute polymorphic psychotic disorder with schizophrenia symptoms
• F23.2 – Acute schizophrenia-like psychotic disorder
• F23.3 – Other acute predominantly delusional psychotic disorders
• F23.8 – Other acute and transient psychotic disorders
• F23.9 – Acute and transient psychotic disorder, unspecified

Recognizing these subtypes allows clinicians to better tailor their assessment and treatment approaches to the specific presentation of each client's acute psychotic episode.

Common Clinical Presentations and Triggers

Acute psychotic episodes under the F23 category often come on quickly, with symptoms appearing within hours or days. The sudden appearance of these symptoms can be distressing for both the individual and their loved ones, making it important for clinicians to identify potential triggers.

Some common triggers for brief psychotic disorder include:

• Extreme stress: Intense life events, such as losing a loved one, job loss, or severe relationship conflicts, can lead to an acute psychotic episode in those who are vulnerable.
• Trauma: Experiencing traumatic events, like physical or sexual assault, natural disasters, or witnessing violence, may initiate psychotic symptoms.
• Sleep deprivation: Extended lack of sleep or severe sleep issues can disrupt brain function and contribute to brief psychotic disorder.
• Postpartum changes: Although it is rare, women in the postpartum period may experience acute psychosis. If a woman experiences postpartum psychosis, it is imperative that she receive psychiatric support immediately. 

When evaluating clients with suspected F23, it's important to consider other possible diagnoses and rule out conditions that might present similar symptoms. First-episode schizophrenia, bipolar disorder with psychotic features, and substance-induced psychotic states can all resemble brief psychotic disorder. A thorough examination of symptom duration, functional impact, and potential substance use is needed to provide an accurate diagnosis and guide appropriate treatment. 

Assessment Strategies for Acute Psychotic States

When a client shows acute psychotic symptoms, the top clinical priority is to ensure the safety of both the individual and those around them. This means evaluating the risk of harm to oneself or others and deciding if hospitalization is necessary. If the client poses an immediate threat, quick intervention and referral to a higher level of care may be needed.

The mental status examination (MSE) serves as an important tool for assessing a client's current mental state during an acute psychotic episode. Key areas to focus on include:

• Thought content: Look for delusions, paranoid ideas, or other unusual beliefs that might be influencing the client's behavior.
• Perception: Check for hallucinations, illusions, or other perceptual issues, paying close attention to the client's sensory experiences.
• Orientation: Assess the client's awareness of time, place, and person to determine their level of disorientation or confusion.
• Affect: Observe the client's emotional expression to see if it matches their reported mood and the context of the situation.

Getting additional information from family members, friends, or other healthcare providers can offer valuable insights into the client's usual functioning, recent behavioral changes, and possible triggers for the acute psychotic episode. It's also important to rule out any underlying medical conditions or substance use that might contribute to the client's symptoms.

Structured assessment tools like the Positive and Negative Syndrome Scale (PANSS) or the Brief Psychiatric Rating Scale (BPRS) can help measure the severity of psychotic symptoms and monitor changes over time. However, in an acute setting, brief clinical interviews might be more practical and suitable for gathering the necessary information to make immediate treatment decisions.

Treatment and Crisis Stabilization

When a client goes through an acute psychotic episode, the immediate focus is on containment, safety, and reducing symptoms. This treatment regimen may involve a combination of medication and therapeutic interventions to help the individual regain stability and prevent self-harm or harm to others.

The specific medication and dosage will depend on the client's condition, medical history, and potential side effects. Therapists should always refer to appropriate prescribing providers—such as psychiatrists or psychiatric nurse practitioners, and collaborate as needed to support coordinated, informed care. 

Once the psychotic episode has stabilized, psychotherapy plays a key role in helping the client process their feelings about the psychotic episode and prevent future episodes. Important therapeutic strategies include:

• Validation: Acknowledging the client's distress and experiences without reinforcing delusional beliefs or hallucinations.
• Psychoeducation: Providing clear, concise information about the nature of psychosis, treatment options, and coping strategies to both the client and their support system.
• Illness acceptance and meaning-making: Support the client in making sense of what happened and gradually accepting the experience as part of their mental health journey—without reducing their identity to the diagnosis. This can include exploring feelings of fear, shame, or confusion, and helping the client integrate the experience in a way that fosters resilience and agency.

As the acute crisis starts to resolve, the focus moves to discharge planning and follow-up care. This involves assessing the client's readiness for discharge, arranging appropriate aftercare services, and educating the client and their family about signs of potential relapse. Regular follow-up appointments are essential to monitor for symptom recurrence, adjust treatment as needed, and refine the diagnostic picture over time.

Throughout the crisis stabilization process, maintaining a calm, non-threatening demeanor and using active listening skills can help build trust and rapport with the client. By focusing on safety, tailoring interventions to the individual's needs, and involving the client's support system, clinicians can effectively guide clients through the challenges of an acute psychotic episode and prepare them for ongoing recovery.

Long-Term Monitoring and Diagnostic Evolution

While brief psychotic disorder (F23) has a limited duration, it's important to recognize that this diagnosis often marks a significant psychological event and may signal future, similar episodes. Over time, some individuals initially diagnosed with F23 may develop symptoms that align with other psychotic disorders, such as schizophrenia (F20), schizoaffective disorder (F25), or bipolar I disorder with psychotic features (F31.2). 

To ensure accurate diagnosis and appropriate treatment, clinicians should set up guidelines for ongoing reassessment and updated coding. This may involve:

• Regular follow-up appointments: Schedule periodic check-ins to monitor for symptom recurrence, assess functioning, and identify any emerging signs of other disorders.
• Early screening for emerging psychosis: Use tools like the Yale PRIME Early Psychosis Screen to assess risk for developing chronic psychotic disorders. This brief, validated questionnaire can help identify attenuated psychotic symptoms in adolescents and young adults, supporting early intervention and more precise diagnostic decision-making over time.
• Comprehensive reassessments: Conduct thorough evaluations at key time points, such as 6 months and 1 year after the initial episode, to determine appropriate diagnosis and risk.
• Collaborative documentation: Work closely with other healthcare providers to gather information about the client's symptoms, functioning, and response to treatment over time.

As clients recover from an acute psychotic episode, psychotherapy plays an important role in promoting long-term stability and reducing the risk of future episodes. Key areas to address in therapy include:

• Trauma-informed care: Many individuals with F23 have also experienced significant stressors or traumatic events. Addressing these experiences through evidence-based trauma interventions can help clients process their emotions and develop healthy coping strategies.
• Cognitive rehabilitation: Psychotic episodes can sometimes impact cognitive functioning, such as attention, memory, and problem-solving skills. Incorporating cognitive remediation techniques into therapy can help clients rebuild these skills and improve their overall functioning.
• Relapse prevention: Teaching clients and their support system to recognize early warning signs of psychosis and create a plan for if and when a relapse happens., 

Documentation and Ethical Considerations

Accurate and timely documentation plays a vital role when working with clients experiencing brief psychotic disorder. Charting should include detailed information about the onset, duration, and resolution of psychotic symptoms, as well as any interventions provided and the client's response to treatment. This documentation not only ensures continuity of care but also protects the clinician in case of legal or ethical challenges.

Communicating the diagnosis of F23 to clients and their families requires a balance between clarity and reassurance. While it's important to provide accurate information about the nature of the disorder and its potential course, clinicians should also emphasize the time-limited nature of the condition, possibility of full recovery, and the risk of future, similar episodes. This approach can reduce fear and stigma, foster realistic hope, and encourage engagement in ongoing care and monitoring. 

Managing the emotional impact of a psychotic disorder diagnosis requires sensitivity and skill. Clients and their loved ones may experience significant anxiety, confusion, and stigma related to the label of psychosis. Clinicians can help by:

• Normalizing the experience: Help clients and families understand that psychosis—whether brief or recurring—is a mental health condition, not a personal failure or permanent identity. Emphasize that while most people with brief psychotic disorder recover fully, some may experience future episodes or go on to develop a longer-term condition. Normalize this possibility without instilling fear, framing psychosis as something that can be understood, treated, and managed over time. 
• Providing psychoeducation: Offer clear, concise information about the nature of psychosis, its causes, and available treatments to clarify the condition.
• Encouraging open communication: Create a safe, non-judgmental space for clients and families to express their concerns and ask questions about the diagnosis and treatment process.

Protecting client autonomy remains a key ethical consideration when working with individuals experiencing acute psychosis. While the presence of psychotic symptoms may temporarily impair a client's decision-making capacity, clinicians should strive to involve clients in treatment decisions as much as possible. This may involve:

• Assessing capacity: Regularly evaluate the client's ability to understand and make informed choices about their care.
• Using advance directives: Encourage clients to develop psychiatric advance directives during periods of stability, outlining their treatment preferences in case of future episodes.
• Collaborating with support systems: Work closely with family members, friends, and other healthcare providers to gather input and ensure decisions align with the client's values and goals.

At the same time, clinicians must balance the principle of autonomy with their duty to protect clients from harm. When clients pose a significant risk to themselves or others due to acute psychosis, involuntary treatment may be necessary. In these cases, clinicians should follow established legal and ethical guidelines, documenting the rationale for their decisions and ensuring the least restrictive interventions are used to address the immediate crisis.

Resources and Professional Development

Keeping up with the latest research and best practices is important for clinicians working with clients experiencing brief psychotic disorder. Several resources can help deepen your understanding of F23 and improve your skills in assessment, treatment, and long-term management.

Both the ICD-10 and DSM-5 offer valuable guides for understanding the diagnostic criteria and coding for psychotic disorders. Familiarizing yourself with these resources can help you accurately identify and document cases of F23 and related conditions.

Continuing education opportunities in early psychosis intervention and psychopharmacology are widely available through professional organizations, conferences, and online learning platforms. Look for training programs that focus on:

• Cognitive Behavioral Therapy for Psychosis (CBTp): Learn techniques to help clients manage symptoms and improve functioning.
• Early intervention strategies: Develop skills in identifying and treating early signs of psychosis to promote better outcomes.
• Psychosocial rehabilitation: Gain training in rehabilitation models that support clients in rebuilding daily functioning, social connections, and vocational or educational goals after a psychotic episode.

Recommended readings on acute psychosis can expand your understanding of the condition and its various presentations. Some key topics to explore include:

• Cultural interpretations of psychosis: Learn how different cultural backgrounds can shape the experience and expression of psychotic symptoms.
• Differential diagnosis: Sharpen your skills in distinguishing F23 from other psychotic disorders, mood disorders, and substance-induced conditions.
• Trauma and psychosis: Explore the complex relationship between traumatic experiences and the development of psychotic symptoms.

Working with a multidisciplinary team can provide valuable opportunities for ongoing learning and collaboration. Seek out case consultations, peer supervision, and team meetings to share knowledge, discuss challenging cases, and refine your approach to treating clients with F23.