It must be emphasised that this is by no means an exhaustive list of stressful life events, because the events which trigger brief reactive psychosis tend, due to the individualistic nature of human psychology, to be extremely personalized. BRP may be the first breakdown for someone with a chronic psychiatric disorder but only time will tell whether the disorder will be brief or lifelong, whether BRP or a chronic condition that is controlled well enough by medication that symptoms do not return.The condition usually resolves spontaneously within a time span of weeks to months, with the severity of the symptoms reducing continuously over the period in question. A primary goal of treatment is to prevent patients who are either suicidal or homicidal from harming themselves or others during the episode. Cause/pathophysiology
The exact cause of brief psychotic disorder is not known. One theory suggests a genetic link, because the disorder is more common in people who have family members with mood disorders, such as depression or bipolar disorder. Another theory suggests that the disorder is caused by poor coping skills, as a defense against or escape from a particularly frightening or stressful situation. These factors may create a vulnerability to develop brief psychotic disorder. In most cases, the disorder is triggered by a major stress or traumatic event. In females, a low estrogen state (which may occur premenstrual, postpartum, or perimenopausal) can trigger sudden, short-lived psychosis. The psychosis is often linked to an underlying bipolar or schizophrenic condition.
Long-term use of topical steroids can lead to secondary infection with fungus or bacteria (see tinea incognito), skin atrophy, telangiectasia (prominent blood vessels), skin bruising and fragility.The use of the finger tip unit may be helpful in guiding how much topical steroid is required to cover different areas of the body. Adverse effects
Hypothalamic–pituitary–adrenal axis (HPA) suppression
Cushings syndrome
Diabetes mellitus
Osteoporosis
Topical steroid addiction
Allergic contact dermatitis (see steroid allergy)
Steroid atrophy
Perioral dermatitis: This is a rash that occurs around the mouth and the eye region that has been associated with topical steroids. Ocular effects: Topical steroid drops are frequently used after eye surgery but can also raise intraocular pressure (IOP) and increase the risk of glaucoma, cataract, retinopathy as well as systemic adverse effects. Tachyphylaxis: The acute development of tolerance to the action of a drug after repeated doses. Significant tachyphylaxis can occur by day 4 of therapy. Recovery usually occurs after 3 to 4 days rest. This has led to therapies such as 3 days on, 4 days off; or one week on therapy, and one week off therapy. Delivery-related adverse effects
Other local adverse effects: These include facial hypertrichosis, folliculitis, miliaria, genital ulcers, and granuloma gluteale infantum. Long-term use has resulted in Norwegian scabies, Kaposis sarcoma, and other unusual dermatosis. Safety in pregnancy
A 2015 meta-analysis of observational studies of pregnancies found no association between mothers use of topical steroids and type of delivery, APGAR score, birth defects, or prematurity. Classification systems
Seven-class System
The U.S. utilizes 7 classes, which are classified by their ability to constrict capillaries and cause skin blanching.