Cycloid Psychoses Revisited: Case Reports, Literature Review, and Commentary

Abstract

Emil Kraepelin proposed to separate psychiatric disorders with psychotic features into two major categories, dementia praecox (later schizophrenia) and manic-depressive insanity (later bipolar disorder and major depression). Over the past century, there have been many efforts to categorize conditions that do not fit readily in either group. These conditions include many cases of acute psychotic illnesses of limited duration, with recovery between recurrences. For some of these conditions, Karl Kleist proposed the term cycloid psychosis: acute features were psychotic, as in schizophrenia, but the course was episodic, as in manic-depression. His concept was later elaborated by Karl Leonhard and Carlo Perris, and validated by modern studies. Leonhard described three overlapping cycloid subtypes (anxiety-beatific, excited-inhibited confusional, and hyperkinetic-akinetic motility dysfunction forms); Perris proposed a more unitary syndrome with operational diagnostic criteria; and recent investigators have considered relatively affective versus thought-disordered subtypes. The cycloid concept is not explicitly included in standard international diagnostic schemes, but both DSM-IV and ICD-10 have broad categories for acute, recurrent psychotic disorders, whose validity remains insecure. We present two cases of probable cycloid psychosis, review the history of the concept, and propose that it be reconsidered as a clinically useful category whose validity and utility for prognosis and treatment can be further tested.

Capgras' Syndrome in First-Episode Psychotic Disorders

“…The relatively high prevalence of Capgras phenomenon found in acute, transient, and unspecified psychotic illnesses with rapid onset and including cycloid features (Table 1) accords with Leonhard’s observation that both in confusion-motility and anxious-beatific forms of cycloid psychoses, misidentification phenomena often emerge along with paranoid ideas of reference, perceiving ominous meaning in indifferent events, as well as derealization, depersonalization and perplexity [56,59,60]. In general, the present findings, based on standardized methods of evaluation of a large number of patients at two sites early in the course of a broad range of psychotic disorders, associated Capgras misidentification phenomenon with relatively acute psychotic disorders or with major depression with psychotic features, more than with schizophrenia, chronic-delusional, schizoaffective, or bipolar disorders.…”

A case of cycloid psychotic disorder

“…However, some cases reported suggest that the cycloid psychoses may not require long-term maintenance pharmacological treatment 2 .…”

“…Cycloid psychoses are characterized by polymorphic symptomatology with intraphasic bipolarity, a remitting and recurrent course and favorable prognosis 1,2 . Despite its clinical relevance, the cycloid psychoses concept has been relatively neglected in current psychiatric nosological systems 2 .…”

Cycloid psychoses: Leonhard´s descriptions revisited

“…In DSM-IV as well as ICD-10, a maximum duration of 1 to 3 months is required which excludes a priori the cycloid psychoses that are characterized by highly variable duration and frequently relapsing course 18,35,[48][49][50][51] . As can be inferred from Figure 1c, the concordance rate between LCP and P&B is also rather moderate which may be due to the onset and age criteria, in that the onset criterion in P&B comprises a time interval of hours to days, while in LCP this is not quantified.…”