Nonaffective Acute Psychoses: Uncertainties on the Way to DSM-V and ICD-11

Abstract

Since the early 20th century, a group of non-affective psychoses with acute onset and brief duration have been described in different countries and under various names, including cycloid psychosis, bouffée délirante, and reactive psychosis. These psychoses share a number of characteristics, including benign course, greater prevalence in women than men and in developing countries than industrialized countries, and high prevalence of premorbid psychological and physiological stressors. However, the variations in names and minute details of symptomatology have overshadowed the basic similarities across these various descriptions. Confusion in classification persists in the two contemporary diagnostic systems, the DSM-IV and the ICD-10. We believe that most cases of these psychoses could be captured under a broad, unified category of non-affective psychosis with acute onset and brief duration, and urge the authors of the upcoming revisions of the DSM and ICD to create such a category. A unified diagnostic category for these disorders would reduce unnecessary fragmentation in the diagnostic systems and assist in the progress of research on these rare conditions.

Acute polymorphic psychotic disorder: Differences from other acute and transient psychoses

“…These results, though limited by the retrospective design, lack of structured assessments and small sample size, suggest that that APPD resembles other ATPDs in most aspects. In other words, the proposal to reduce ATPD to the APPD category alone may be premature (Nugent et al, 2011). Our results are in line with earlier research suggesting that APPD is a heterogeneous diagnostic category with variable outcomes (Jager et al, 2003;Abe et al, 2006) and highlight the need for larger scale, prospective studies of the acute psychotic disorders before meaningful changes to their classification can be made.…”

Excess mortality of acute and transient psychotic disorders: comparison with bipolar affective disorder and schizophrenia

“…Distinguishing ATPDs from longer lasting psychotic disorders will prove useful in making predictions of treatment and outcome, as the clinical guidelines for first‐episode psychosis recommend the usage of neuroleptic medication for 1–2 years after remission of psychotic symptoms . There may also be variations in course and outcome of psychotic disorders between industrialized countries and developing ones, where acute psychoses have lower rates of relapse and seem more often influenced by cultural and social factors, though seldom fulfil the criteria for ATPDs .…”

Epidemiology, Course and Outcome of Acute Polymorphic Psychotic Disorder: Implications for ICD-11

“…The polymorphic subtype refers to the French concept of bouffée délirante [4], and Kleist [5] and Leonhard's [6] cycloid psychoses, featuring varied and rapidly shifting delusions, hallucinations, perceptual changes, agitation, perplexity and emotional turmoil. Because of differences in onset, duration and symptomatology, ATPDs extend beyond the DSM-IV category of ‘brief psychotic disorder' [7]. …”