Acute Polymorphic Psychotic Disorder

ICD-10 Diagnostic Criteria for Acute and Transient Psychotic Disorders

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.

ICD-10 Diagnostic Criteria for Acute and Transient Psychotic Disorders

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 delirium, not induced by alcohol and other psychoactive substances.

ICD-10 Diagnostic Criteria for Acute and Transient Psychotic Disorders

G3. The disorder does not meet the symptomatic criteria for manic episode, depressive episode, or recurrent depressive disorder.

ICD-10 Diagnostic Criteria for Acute and Transient Psychotic Disorders

G4. There is insufficient evidence of recent psychoactive substance use to fulfil the criteria for intoxication, harmful use, dependence, or withdrawal states. The continued moderate and largely unchanged use of alcohol or drugs in amounts or with the frequency to which the individual is accustomed does not necessarily rule out the use of acute and transient psychotic disorders; this must be decided by clinical judgment and the requirements of the research project in question

ICD-10 Diagnostic Criteria for Acute and Transient Psychotic Disorders

G5. Most commonly used exclusion clause. There must be no organic mental disorder or serious metabolic disturbances affecting the central nervous system (this does not include childbirth).

ICD-10 Diagnostic Criteria for Acute and Transient Psychotic Disorders

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):
Without associated acute stress With associated acute stress
For research purposes, it is recommended that change of the disorder from a nonpsychotic to a clearly psychotic state is further specified as either abrupt (onset within 48 hours) or acute (onset in more than 48 hours but less than 2 weeks).

Acute polymorphic psychotic disorder without symptoms of schizophrenia

A. The general criteria for acute and transient psychotic disorders must be met. B. Symptoms change rapidly in both type and intensity from day to day or within the same day. C. Any type of either hallucinations or delusions occurs, for at least several hours, at any time from the onset of the disorder. D. Symptoms from at least two of the following categories occur at the same time:
1. emotional turmoil, characterized by intense feelings of happiness or ecstasy, or overwhelming anxiety or marked irritability; 2. perplexity, or misidentification of people or places; 3. increased or decreased motility, to a marked degree.

E. If any of the symptoms listed for schizophrenia, criterion G(1) and (2), are present, they are present only for a minority of the time from the onset; i.e., criterion B of acute polymorphic psychotic disorder with symptoms of schizophrenia is not fulfilled. D. The total duration of the disorder does not exceed 3 months.

Acute polymorphic psychotic disorder with symptoms of schizophrenia

A. Criteria A, B, C, and D of acute polymorphic psychotic disorder must be met. B. Some of the symptoms for schizophrenia must have been present for the majority of the time since the onset of the disorder, although the full criteria need not be met, i.e., at least one of the symptoms in criteria G1(1)a to G1(2)c. C. The symptoms of schizophrenia in criterion B above do not persist for more than 1 month.

Summary
APPD is a very variable condition with hallucinations, delusions, emotional turmoil, intense transient feelings such as ecstasy or anxiety but the criteria for the major psychotic illnesses are not fulfilled. Also, there are symptoms of schizophrenia that are present such as thought broadcasting, delusions of control, passivity, and hallucinations or catatonic behavior.

Summary
They may or may not be associated with a marked precipitating stressor and are defined as such, with associated acute stress or without associated acute stress. There may be prodromal symptoms before the florid onset or it may be observed as abrupt(i.e. within 48 hours) or over a longer period of up to two weeks, the symptoms remitting completely usually within 3 months.

Brief Psychotic Disorder

Introduction
In brief psychotic disorder, the patient experiences a full psychotic episode that is short-lived. It can be temporally related to some stressor or occur post- partum, but is also seen without any apparent antecedent.

Epidemiology
The exact incidence and prevalence = unknown generally considered uncommon among younger patients (20s and 30s) > among older patients sex and sociocultural determinants?
higher incidence in women and persons in developing countries low socioeconomic classes those who have experienced disasters or major cultural changes (e.g., immigrants) The age of onset in industrialized settings may be higher than in developing countries Persons who have gone through major psychosocial stressors may be at greater risk for subsequent brief psychotic disorder

Etiology
Unknown borderline, schizoid, schizotypal, or paranoid qualities may have a biological or psychological vulnerability a family history of schizophrenia or mood disorders in their families? presence of inadequate coping mechanisms possibility of secondary gain for patients with psychotic symptoms a defense against a prohibited fantasy, the fulfillment of an unattained wish, or an escape from a stressful psychosocial situation

DSM-IV-TR Diagnostic Criteria for Brief Psychotic Disorder

A. Presence of one (or more) of the following symptoms:
delusions hallucinations 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 pattern.

DSM-IV-TR Diagnostic Criteria for Brief Psychotic Disorder

B. 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. C. The disturbance is not better accounted for by a mood disorder with psychotic features, schizoaffective disorder, or schizophrenia and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

DSM-IV-TR Diagnostic Criteria for Brief Psychotic Disorder

Specify if: With marked stressor(s) (brief reactive psychosis): if symptoms occur shortly after and apparently in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the person's culture Without marked stressor(s): if psychotic symptoms do not occur shortly after, or are not apparently in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the person's culture With postpartum onset: if onset within 4 weeks postpartum

Diagnosis and clinical features

As with other acutely ill psychiatric patients, the history necessary to make the diagnosis may not be obtainable solely from the patient. Although psychotic symptoms may be obvious, information about prodromal symptoms, previous episodes of a mood disorder, and a recent history of ingestion of a psychotomimetic substance may not be available from the clinical interview alone.

Diagnosis and clinical features

In addition, clinicians may not be able to obtain accurate information about the presence or absence of precipitating stressors. Such information is usually best and most accurately obtained from a relative or a friend

Diagnosis and clinical features

labile mood, confusion, and impaired attention may be more common at the onset of brief psychotic disorder than at the onset of eventually chronic psychotic disorders. Characteristic symptoms include:
emotional volatility strange or bizarre behavior screaming or muteness impaired memory for recent events

Diagnosis and clinical features

Hallucinations:
Auditory Visual Tactile Olfactory

Diagnosis and clinical features

Delusions:
Types
Bizzare Non-bizzare Mood-congruent Mood-incongruent

Diagnosis and clinical features

Delusions:
Content
Control Persecutory Grandiose paranoid Religious Nihilistic Jealousy Reference Thought broadcasting, thought insertion Guilt Somatic Erotomania

Diagnosis and clinical features

Bizarre behavior:
Aggressive/agitated odd clothing or appearance odd social behavior repetitive-stereotyped behavior