Acute and transient psychotic disorders

The existence of acute short-term psychoses with an extremely severe course and complete remission was recognized and well described by almost all the major psychiatrists of the pre- Krepelin era ^[2] . After the allocation of a group of endogenous psychoses and its dichotomy by E. Kraepelin in 1899, dementia precox — manic-depressive psychosis — various acute psychoses fell into both of these categories. However, Emil Kraepelin himself argued that there is a “considerable group of disorders” ^[2] that cannot be classified by this principle.

With the advent in 1908 of E. Bleiler ’s concept of “ schizophrenia ” and the improvement of Kraepelin’s classification, the problem of acute, short and transient (transient) psychoses with a favorable prognosis has not yet been solved ^[2] .

Concepts in opposition to Kraepelin and Bleiler led to the identification of a special group of psychoses that are different from schizophrenia and BAR and, in part, schizoaffective disorder , which in the respective countries had the name traditional for the national school of psychiatry ^[2] :

1. Cycloid Psychoses : Germany ;
2. fr. Bouffée délirante ( delusional outbreak): France ;
3. Reactive or psychogenic psychoses : Scandinavian countries ( Denmark , Finland , Iceland , Norway , Sweden );
4. Atypical psychoses : Japan ;
5. Certain forms of reactive psychoses (for example, reactive paranoid , paranoid reaction ): USSR ^{[3] [4]} .

Other historical names for acute and transient psychotic disorders:

1. Acute (undifferentiated) schizophrenia, acute schizophrenic episode;
2. Onyrophrenia ;
3. Psychogenic (paranoid) psychosis;
4. Schizophrenic reaction ;
5. Schizophrenia with a favorable prognosis.

General diagnostic guidelines for acute and transient psychotic disorders in the International Classification of Diseases of the 10th revision ( ICD-10 ) ^[5] :

• acute onset (up to two weeks), with the development of hallucinations , delirium , incoherent or torn speech , which appear in isolation or in any combination;
• if confusion , false recognition or impaired attention is present, they do not meet the criteria of organically conditioned confusion ;
• no correspondence to a depressive episode , manic episode or recurrent depressive disorder ;
• psychotic disorder is not associated with the use of a psychoactive substance ;
• organic brain disease and serious metabolic disorders affecting the central nervous system (except childbirth ) are excluded.

The fifth sign in the classification indicates the relationship between the acute onset of psychotic disorder and acute stress that occurs within 2 weeks before the development of acute psychotic symptoms (that is, F23.x0 - without combination with acute stress, F23.x1 - in combination with acute stress).

The following subcategories are distinguished: ^[6]

• F 23.0 Acute polymorphic psychotic disorder without symptoms of schizophrenia ( and included).
• F 23.1 Acute polymorphic psychotic disorder with symptoms of schizophrenia (delusional outbreak and cycloid psychosis with schizophrenic symptoms are included).
• F 23.2 Acute schizophrenia-like psychotic disorder (included schizophrenic reaction, acute schizophrenia, neurophrenia, short-term schizophreniform disorder / psychosis).
• F 23.3 Other acute predominantly delusional psychotic disorders ( psychogenic paranoid psychosis , acute paranoid, paranoid reaction included).
• F 23.8 Other acute and transient psychotic disorders (including persecutory hypochondria ).
• F 23.9 Acute and transient psychotic disorder, unspecified (including reactive psychosis, including short-termNOS ).

Acute and transient psychotic disorders can be associated with stress , such as a situation of violence, loss of a loved one, imprisonment , overstrain, mental pain ^[7] .

According to the HASBAP study, acute and transient psychotic disorders account for 4% of the total group of inorganic psychoses and affective disorders (in ICD-10 - headings F 2. and F 3. ) ^[2] . If you exclude affective disorders, their part will be 8.5% ^[2] .

A group of diseases is much more often diagnosed in women (female: male ratio = 78.6%: 21.4%) ^[2] . This significantly distinguishes acute and transient psychotic disorders from schizophrenia, for which the risk of development in men and women does not differ ^[8] .

This diagnosis is the most common during the initial hospitalization of the patient in the admission and diagnostic department ^[7] .

• Tiganov A.S., Snezhnevsky A.V. , Orlovskaya D.D. and others. Guide to Psychiatry / Ed. A. S. Tiganova . - M .: Medicine , 1999 . - T. T. 1. - 712 p. - 10,000 copies. - ISBN 5-225-02676-1 .