Chapter

Acute and transient psychotic disorders

J. Garrabé and F.-R. Cousin

in New Oxford Textbook of Psychiatry

Second edition

Published on behalf of Oxford University Press

Published in print February 2012 | ISBN: 9780199696758
Published online October 2012 | e-ISBN: 9780191743221 | DOI: http://dx.doi.org/10.1093/med/9780199696758.003.0081
Acute and transient psychotic disorders

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The heterogeneous group of acute and transient psychotic disorders are characterized by three typical features, listed below in descending order of priority: ♦ suddenness of onset (within 2 weeks or less); ♦ presence of typical syndromes with polymorphic (changing and variable) or schizophrenic symptoms; ♦ presence of associated acute stress (stressful events such as bereavement, job loss, psychological trauma, etc.). The onset of the disorder is manifested by an obvious change to an abnormal psychotic state. This is considered to be abrupt when it occurs within 48 h or less. Abrupt onset often indicates a better outcome. Full recovery occurs within 3 months and often in a shorter time (a few days or weeks). However, a small number of patients develop persistent and disabling states. The general (G) criteria for these acute disorders in DCR-10 (Diagnostic Criteria Research of ICD) are as follows. G1 There is acute onset of delusions, hallucinations, incomprehensible or incoherent speech, or any combination of these. The time interval between the first appearance of any psychotic symptoms and the presentation of the fully developed disorder should not exceed 2 weeks. G2 If transient states of perplexity, misidentification, or impairment of attention and concentration are present, they do not fulfil the criteria for organically caused clouding of consciousness as specified for F05, criterion A. G3 The disorder does not satisfy the symptomatic criteria for manic episode (F30), depressive episode (F32), or recurrent depressive disorder (F33). G4 There is insufficient evidence of recent psychoactive substance use to satisfy the criteria for intoxication (F1x.0), harmful use (F1x.1), dependence (F1x.2), or withdrawal states (F1x.3 and F1x.4). The continued moderate and largely unchanged use of alcohol or drugs in the amounts or with the frequency to which the individual is accustomed does not necessarily exclude the use of F23; this must be decided by clinical judgement and the requirements of the research project in question. G5 There must be no organic mental disorder (F00–F09) or serious metabolic disturbances affecting the central nervous system (this does not include childbirth). (This is the most commonly used exclusion clause.) A fifth character should be used to specify whether the acute onset of the disorder is associated with acute stress (occurring 2 weeks or less before evidence of first psychotic symptoms): ♦ F23.x0 without associated acute stress and ♦ F23.x1 with associated acute stress. For research purposes it is recommended that change of the disorder from a non-psychotic to a clearly psychotic state is further specified as either abrupt (onset within 48 h) or acute (onset in more than 48 h but less than 2 weeks). Six categories of acute psychoses are presented in ICD-10, and we shall discuss them in order.

Chapter.  4796 words. 

Subjects: Psychiatry

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