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Psychotic Disorders
Presented By : Dr. Karrar
Husain
Moderator : Dr. M. Amir
Usmani
HISTORICAL BACKGROUND
Cycloid psychosis
A psychotic disorder with acute onset and good prognosis
but frequent recurrences, characterized by confusion,
mood-incongruent delusions, hallucinations, overwhelming
anxiety, deep feelings of happiness or ecstasy, motility
disturbances of akinetic or hyperkinetic type, a particular
concern with death, mood swings, and rapid change in
symptoms within an episode.
Two variants : confusional - contrasting phases of confused
excitement and stupor
: motility psychosis - contrasting phases
of hyperkinesis and akinesis.
Bouffe dlirante
A psychotic disorder with acute onset without previous
psychiatric history. The episode remits completely with no
residual symptoms.
The term, but not the concept, was adopted by the DSM-III as
a nonaffective psychotic syndrome with schizophrenic
symptoms but a duration of less than 6 mos.
Oneirophrenia
Hysterical psychosis
Symptoms
include
hallucinations,
depersonalization, and disorganized behavior.
delusions,
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NOSOLOGICAL ISSUES
Aims:
(i) Whether schizophrenia existed in different parts of the world?
(ii) What were the common/differing clinical presentations?
(iii) What was the course and outcome among different cultures?
1.
2.
a)
b)
c)
d)
disorders
are
rare
in
Susser E, Varma VK, Malhotra S, Conover S, Amador XF. Delineation of acute and
transient psychotic disorders in a developing country setting. BrJ Psychiatry
1995a;167:216-9.
Susser E, Fennig S, Jandorf L, Amador X, Bromet E. Epidemiology, diagnosis and course
A summer peak
Susser E, Varma VK, Malhotra S, Conover S, Amador XF. Delineation of acute and
transient psychotic disorders in a developing country setting. BrJ Psychiatry
1995a;167:216-9.
Susser E, Fennig S, Jandorf L, Amador X, Bromet E. Epidemiology, diagnosis and course
of
brief psychoses.
Am Misra
J Psychiatry
1995b;152:17438. PJ. Onset of acute psychotic
Malhotra
S, Varma VK,
AK, Das
S, Wig NN, Santosh
states in India: A study of sociodemographic, seasonal and biological factors. Acta
CLINICAL DESCRIPTION
1.
2.
3.
F23.3
Other
acute
predominantly
delusional
psychotic disorder
A. The general criteria for acute and transient psychotic
disorders (F23) must be met.
B.
Relatively stable delusions and/or hallucinations are
present, but they do not fulfil the symptomatic criteria for
schizophrenia (F20.0 - F20.3).
C.
The disorder does not meet the criteria for acute
polymorphic psychotic disorder (F23.0).
D. The total duration of the disorder does not exceed three
months.
CULTURAL VARIANTS
DIFFERENTIAL DIAGNOSIS
recurrence rate was found to be of 46.6% on 8-year followup study, and 35% on 5-year follow-up study.
Rozario A, Malhotra S, Basu D. Acute and Transient Psychotic disorders: A
follow-up study. Unpublished MD thesis: PGIMER, Chandigarh; 1999.
Malhotra S, Gupta N, Gill S. Recurrence in acute and transient psychosis:
Paper presented at the 13th World Congress of Psychiatry. Cairo,
Egypt;2005 Sept. 10-15
TREATMENT
Short-term treatment
Acute psychotic syndromes require early hospitalization in
either an inpatient psychiatric unit or a crisis centre. They
are psychiatric emergencies.
The decision to admit to hospital is taken in order to make a
careful clinical evaluation, to separate the patient from his
or her environment, to provide a reassuring setting, and to
prevent any suicidal or aggressive tendencies.
Sociotherapy
(occupational
or
intensive)
and
psychotherapy (realityadaptivesupportive) are indicated
depending on the state of the patient and his environment,
with individual, family or rehabilitation care.
Continuation treatment
The effectiveness of psychopharmacotherapy is usually
manifested in the first 6 weeks, with improved sleep,
regression of agitation, recovery from anxiety and delusion,
and finally disappearance of the psychotic features.
Care must be taken to distinguish between a postneuroleptic depression and the development of a
(schizo)affective disorder.
Prevention of recurrence
The possibility that psychotic symptoms may re-emerge
has to be borne in mind during the first 2 years of followup. Low-dosage pharmacotherapy must be maintained for 1
or 2 years after recovery. During this long-term follow-up,
periodic assessment and effective clinical care with social
and psychological therapy are essential.
New Oxford Textbook of Psychiatry
SUMMARY
REFERENCES
paradigmatic
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