Brief and Acute Psychoses: The Development of Concepts

Abstract

This paper reviews the conceptual history of brief and acute psychoses. As psychotic disorders of usually dramatic symptomatology but nevertheless with a usually benign course, brief and acute psychoses have the air of a paradox. Thus, they have posed specific problems in regard to nosology, diagnostics and aetiology. Despite a strong convergence of the descriptive elements, the historical concepts of brief and acute psychoses have yielded different answers to the questions raised. Kahlbaum and Kraepelin set the stage on which brief and acute psychoses appeared "atypical". The concept of "bouffée délirante" used degeneration theory as a background for nosological and aetiological allocation. Similarly, the concepts of cycloid psychoses, reactive (psychogenic) psychoses, emotional psychoses and atypical psychoses have provided diverging but interrelated ways to delineate brief and acute psychoses, to determine their nosological status and to explain the coexistence of severe disorder and favourable prognosis. Modern classifications, namely the acute and transient psychotic disorder of ICD-10 and the brief psychotic disorder of DSM-IV, reflect the varied history of the concept.

Elevated Bilirubin in Acute and Transient Psychotic Disorder

“…More importantly, diff erent aetiology of acute psychoses and schizophrenia has been proposed and might account for diff ering bilirubin levels. Concepts of acute remitting psychoses (among those acute brief psychosis, acute and transient psychotic disorders, non-aff ective remitting psychosis, and cycloid psychosis) have only received growing interest during the last decades [17] , leading to its introduction into ICD-10. There has been a limited number of studies investigating possible aetiological diff erences between ATPD and schizophrenia by diff erentiating patterns in brain activity [15, 18 -20] , motor behaviour [22] and fever [4,5] .…”

Features of acute and transient psychotic disorders

“…In creating this category, the authors of ICD-10 took account of a number of national concepts for such psychotic disorders, including cycloid psychosis in German psychiatry, bouffée délirante in French psychiatry, psychogenic or reactive psychosis in Scandinavian psychiatry, the remitting schizophrenia in American psychiatry, or the atypical psychosis in Japanese psychiatry (see contributions in Marneros and Tsuang 1986;Pillmann and Marneros 2003;. Several subgroups are defined in ICD-10, including Acute Polymorphic Psychotic Disorder With/Without Symptoms of Schizophrenia, Acute Schizophrenia-like Psychotic Disorder and Predominantly Delusional ATPD.…”

Nonschizophrenic Psychotic Disorders: The Case of Cycloid Psychoses

“…In addition, subjective symptoms like perplexity and ecstasy are not operationalized in the ICD-10 diagnostic criteria for research [9]. Unfortunately, Leonhard’s meticulous descriptions of psychopathology vanished in the WHO classification system, although the concept of CP is accounted for in a large number of publications [10, 11, 12]. …”