P-1064 - Cycloid psychoses: Leonhard's descriptions revisited

Abstract

Introduction: Cycloid psychoses (CP) as described by Leonhard comprise the subtypes anxiety-happiness, confusion and motility psychoses. CP presents with an acute onset and have a favourable prognosis. The operational criteria by Perris and Brockington (P&B, 1981) are partly incorporated in ICD-10 as acute polymorphic psychosis (APP). The DSM-IV category Brief Psychotic Disorder (BPD) includes all psychoses with short duration. Objectives: Establishing concordance of Leonhard´s CP with DSM-IV and ICD-10 categories. Aims: This study was aimed to investigate the clinical characteristics of CP and to determine the prevalence of CP in patients with psychotic disorders. Methods: 80 patients with psychotic disorders were assessed by means of CASH, PANSS and CGI at baseline and after six weeks of treatment. CP's were identified according to Leonhard's descriptions. Furthermore, patients were classified using DSM-IV, ICD-10 and P&B criteria. Results: A diagnosis of Leonhard's CP was present in 12 patients. Overlap between Leonhard's and P&B-CP was modest. ICD-10 and DSM-IV classification showed considerable heterogeneity. Diagnoses of ICD-APP and DSM-BPD were mostly assigned to CP patients. Concordance between Leonhard's CP and these categorical diagnoses was small. Leonhard CP patients showed, compared to non-CP patients, more atypical symptoms like perplexity, pananxiety and psychomotor disturbances. Conclusions: The estimated prevalence of CP in patients with psychotic disorders is 15 percent. Although identification of CP is of heuristic value, this is not warranted by current classification systems or operational criteria. Thorough clinical evaluation of psychotic disorders is required, especially in patients presenting with perplexity, psychomotor disturbances or severe anxieties.

Mood Disorder or Psychotic Disorder? Yes: A Case Report on Cycloid Psychosis

“…That group also found that the diagnoses that were most similar to cycloid psychosis were the International Classification of Diseases, 10th Revision (ICD-10) diagnoses of schizoaffective disorder and acute and transient psychotic disorder, and the DSM-IV diagnosis of brief psychotic disorder. When compared with these 3 disorders, the Perris and Brockington criteria were found to have the highest concordance rate with the original 3-subtype description of cycloid psychosis delineated by Karl Leonhard, supporting the concept as clinically useful and distinct 17 . We break down these 3 disorders, using DSM-5 and ICD-10 criteria where available for clinical relevance, 18,19 and compare them with the Perris and Brockington diagnostic criteria of cycloid psychosis in Table 2 4,20,21 .…”

“…When compared with these 3 disorders, the Perris and Brockington criteria were found to have the highest concordance rate with the original 3-subtype description of cycloid psychosis delineated by Karl Leonhard, supporting the concept as clinically useful and distinct. 17 We break down these 3 disorders, using DSM-5 and ICD-10 criteria where available for clinical relevance, 18,19 and compare them with the Perris and Brockington diagnostic criteria of cycloid psychosis in Table 2. 4,20,21 Unlike brief psychotic disorder, a mood component can fulfill the criteria for cycloid psychosis, and the duration of the episode is not limited to less than 1 month.…”

Cycloid psychoses in the psychosis spectrum: evidence for biochemical differences with schizophrenia

“… 32 , 33 PANSS cognitive score was calculated according to the procedure as described by Lindenmayer et al 34 To establish diagnosis of CP, a symptom checklist according to Leonhard was completed by NvdK and a clinician (MKF Schneider) trained in establishing diagnoses according to Leonhard. 26 , 30 , 35 Final diagnoses were made in a so-called Longitudinal Evaluation of All Data (LEAD) conference, in which all possible and probable cases of CP were discussed with two experts in the field of CP (GS and WV). 36…”

“… 21 – 23 CP, as such, are not included in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), although pananxiety, perplexity, and motility disorders have been demonstrated in a substantial percentage of patients. 24 – 30 An overview of the characteristics of schizophrenia and CP is presented in Table 1 .…”

A case of cycloid psychotic disorder

“…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 .…”