Acute and Transient Psychotic Disorders F23 - ICD10 Description, World Health Organization
A heterogeneous group of disorders characterized by the acute onset of psychotic symptoms such as delusions, hallucinations, and perceptual disturbances, and by the severe disruption of ordinary behaviour. Acute onset is defined as a crescendo development of a clearly abnormal clinical picture in about two weeks or less. For these disorders there is no evidence of organic causation. Perplexity and puzzlement are often present but disorientation for time, place and person is not persistent or severe enough to justify a diagnosis of organically caused delirium. Complete recovery usually occurs within a few months, often within a few weeks or even days. If the disorder persists, a change in classification will be necessary. The disorder may or may not be associated with acute stress, defined as usually stressful events preceding the onset by one to two weeks.
F23.0 Acute polymorphic psychotic disorder without symptoms of schizophrenia
An acute psychotic disorder in which hallucinations, delusions or perceptual disturbances are obvious but markedly variable, changing from day to day or even from hour to hour. Emotional turmoil with intense transient feelings of happiness or ecstasy, or anxiety and irritability, is also frequently present. The polymorphism and instability are characteristic for the overall clinical picture and the psychotic features do not justify a diagnosis of schizophrenia (F20.-). These disorders often have an abrupt onset, developing rapidly within a few days, and they frequently show a rapid resolution of symptoms with no recurrence. If the symptoms persist the diagnosis should be changed to persistent delusional disorder (F22.-).
An individual diagnosed with brief psychotic disorder needs to meet all of the following criteria:
Presence of one (or more) of the following symptoms. At least one of these must be delusions, hallucinations, or disorganized speech:
Disorganized speech (e.g., frequent derailment or incoherence).
Grossly disorganized or catatonic behavior.
Note: Do not include a symptom if it is a culturally sanctioned response.
Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual full return to premorbid level of functioning.
The disturbance is not better explained by major depressive or bipolar disorder with psychotic features or another psychotic disorder such as schizophrenia or catatonia, and is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
With marked stressor(s) (brief reactive psychosis): If symptoms occur in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the individual's culture.
Without marked stressor(s): If symptoms do not occur in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the individual's culture.
With postpartum onset: If onset is during pregnancy or within 4 weeks postpartum.
With catatonia: The clinical picture is dominated by three (or more) of the following symptoms:
Stupor (i.e., no psychomotor activity; not actively relating to environment).
Catalepsy (i.e., passive induction of a posture held against gravity).
Waxy flexibility (i.e., slight, even resistance to positioning by examiner).
Mutism (i.e., no, or very little, verbal response [exclude if known aphasia]).
Negativism (i.e., opposition or no response to instructions or external stimuli).
Posturing (i.e., spontaneous and active maintenance of a posture against gravity).
Mannerism (i.e., odd, circumstantial caricature of normal actions).
This disorder has a sudden onset of at least 1 psychotic symptom (i.e., delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior). These psychotic episodes last less than 1 month, and are followed by a full recovery. This disorder can occur in the presence or absense of a major stressor. Diagnosis can only be made if other medical or psychiatric disorders have been excluded. In developed countries, it is rare to have a brief first psychotic episode lasting a few weeks that doesn't eventually reoccur as either schizophrenia or bipolar disorder. However, in the developing world, brief psychotic disorder with a benign prognosis is more common.
In the developed world, first psychotic episodes are treated with antipsychotic medication. When the patient totally recovers, antipsychotic medication is slowly phased out. If the psychosis returns off medication; the diagnosis must be changed. A first psychotic episode with impaired executive functioning and no anxiety usually predicts the later development of schizophrenia; whereas the presence of anxiety usually predicts the later development of bipolar disorder.
Cognitive behavioral therapy (CBT) was not effective in reducing symptoms in schizophrenia, or in preventing relapse in bipolar I disorder. Vitamins, dietary supplements, cognitive training and cognitive rehabilitation have all proven to be ineffective in the treatment of psychotic disorders..
Which Behavioral Dimensions Are Involved?
The ancient Greek civilization lasted for 1,300 years (8th century BC to 6th century AD). The ancient Greek philosophers taught that the 5 pillars of their civilization were: wisdom, courage, helping others, self-control, and justice. Psychiatry named the opposite of each of these 5 ancient themes as being a major dimension of psychopathology (i.e., irrationality, negative emotion, detachment, disinhibition, and antagonism). (Psychology named these same factors the "Big 5 dimensions of personality": "intellect", "neuroticism", "extraversion", "conscientiousness", and "agreeableness")