Reactive Psychosis Research Articles

Historical and conceptual features of acute polymorphic psychosis: a myth of European psychiatry from bouffée délirante to ICD-11 acute and transient psychotic disorder.

This paper deals with the history and epistemology of acute polymorphic psychosis. We undertook a comparative study of short-lived psychotic disorders used in different European countries since the late nineteenth century. The theory of degeneration offered a speculative basis to conceptualization of conditions such as bouffée délirante, cycloid psychosis and reactive psychosis, but it seems likely that different factors contributed to the profusion of clinical concepts with adverse effects on both nomenclature and classification. The resulting picture suggests that earlier nosological concepts tend to converge on common descriptive features and challenge the diagnostic categories for short-lived psychotic disorders listed in modern symptom-based psychiatric classifications.

A nosological approach to brief psychotic disorders and acute and transient psychoses

IntroductionAcute and transient psychoses (International Classification of Diseases) and Brief Psychotic Disorders (Diagnostic and Statistical Manual of Mental Disorders) constitute heterogeneous nosological groups, which have undergone successive reformulations in the past decades, remaining doubts regarding their diagnostic validity and independence.ObjectivesThis work aims to review the nosological evolution of these complex and neglected groups.MethodsA review of the literature was conducted using PubMed and The Cochrane Library. The following terms were used: “acute and transient psychoses”; “brief psychotic disorders”; “cycloid psychosis”; “reactive psychosis”.ResultsSince the early 20th century, a group of non-affective psychoses with acute onset and brief duration have been described in different countries and under various names, such as bouffeé delirante, reactive psychosis or cycloid psychosis, denominations still present in ICD-9. In presente-day classifications, as ICD-10 and DSM-IV, an effort was made to homogenise the various regional and national concepts creating the group of ‘Brief Psychoses’ (DSM) or ‘Acute and Transient Psychotic Disorders’ (ICD). The marked heterogeneity and low diagnostic stability of these groups, mainly based on temporal criteria, has posed significant obstacles to further research and conceptualization. Given these difficulties, the latest revision of the International Classification of Diseases (ICD-11) brought about a substantial change, restricting this diagnosis to polymorphic psychotic conditions of acute onset and rapid resolution, subgroup with greater diagnostic stability and characteristics distinct clinical features.ConclusionsThe relevance of a better clarification for this nosological group is evident in the successive changes over the last century. ICD 11, once again, substantially changed the diagnostic criteria and the scope of this nosological entity, leaving doubts about the independent nature of this group, its connection to schizophrenia, as an attenuated form (more common in women and in developing countries), or even as a form of psychosis that is closer to affective disorders (due to its clinical evolution). Although little explored, this issue remains a source of doubt and interest, calling into question the Kraepelinian dichotomy for the so-called endogenous psychoses.Disclosure of InterestNone Declared

Emergency care for psychogenic paranoids in modern environment

The work presents data on the main modern variants of reactive paranoids. Clinical manifestations, differential diagnostic criteria, features of the dynamics, modern approaches to treatment of this pathology are described. The possibility of distinguishing modern variants of psychogenic paranoids is emphasized, taking into account the existing pathomorphosis of manifestations of this pathology. Currently, the most common forms are paranoids of attitude, persecution, litigious, somatogenic-reactive, induced, deprivation variants of psychogenic delusions. The patterns for the development of delusional psychogenic disorders are presented. The manifestations of attitude and persecution paranoid are described, with emphasis on the reflection of psychotraumatic experiences in patients’ statements and behavior. When considering litigious reactive psychosis, the importance of paranoid personality traits is emphasized, which contribute to the formation of a “struggle for justice” with a psychotic interpretation of real events. Information is given about the emergence of a relatively new variant of somatogenic-reactive paranoid in patients with combat injuries. Psychogenic deprivation hallucinosis with paranoid interpretation of experiences in premorbidly healthy individuals is described. Differential diagnosis of reactive paranoids and similar pathology is carried out. A special place is given to emergency care for psychomotor agitation of patients with the need to comply with the requirements of current legislation in psychiatry. Recommendations are given for further treatment of patients after relief of acute conditions, with the need to add psychocorrective measures to restore mental health.

Psychotic decompensation in the course of SARS-COV-2 infection - case report

Introduction: SARS-CoV-2 is a single-stranded RNA virus belonging to the group of coronaviruses. Among patients infected with the COVID virus, neuropsychiatric symptoms are observed, such as dizziness and headaches, anxiety, depression, as well as delusions and hallucinations. Psychotic symptoms have been observed in patients infected with SARS-CoV-2 without a prior psychiatric history. Aim: The purpose of this study was to present a case of a patient with neuropsychiatric symptoms, most likely caused by a past COVID infection, and to present possible pathophysiological mechanisms explaining neuropsychiatric symptoms in the course of SARS-CoV-2 infection. Material and methods: Literature review was carried out using electronic databases: PubMed, Google Scholar, using the following keywords: SARS-COV-2, neuropsychiatric symptoms, reactive psychosis, cytokine storm, limiting the search scope to 2019-2023. Publications in English were used. The patient's medical records, results of laboratory and imaging tests and descriptions of psychological tests were used to describe the case. Case description: A 27-year-old patient, not previously treated psychiatrically, with a recent COVID-19 infection, who developed acute, quickly passing psychotic symptoms in the form of persecutory delusions and visual and auditory hallucinations in a short period of time. Discussion: The effect of the SARS-CoV-2 virus on the central nervous system is not fully understood - the literature presents several possible mechanisms underlying the neuropsychiatric manifestations of SARS-CoV-19 infection, which include viral infiltration into the central nervous system, dysregulation of the cytokine network and excitotoxicity and translocation of intestinal microbes. Keywords: SARS-COV-2, neuropsychiatric symptoms, reactive psychosis, cytokine storm

Acute and transient psychotic disorders: A review of Indian research.

Acute and transient psychotic disorder (ATPD) was recognized as separate from other psychotic disorders and described in the International Classification of Diseases (ICD) tenth revision for the first time. A lot of research on ATPD has been conducted in India over the last six decades, but a review focusing exclusively on Indian research on ATPD is not available. This paper aims to review the literature on ATPD emerging from India. A combination of search terms "Acute and Transient Psychosis," "acute psychosis," "non-affective psychosis," "non-affective psychotic disorder," "reactive psychosis," "first-episode psychosis," and "India" were searched on various search engines like PUBMED, Medknow, Hinari, and Google Scholar. We also did a hand search for additional relevant articles, including published abstracts of the Indian Journal of Psychiatry from 2007 to 2023. Relevant papers were selected. The prevalence of ATPD varies across different study settings, and it tends to have an abrupt to acute onset, and is primarily associated with stress. Few studies have assessed the subtypes of ATPD, and symptom profile has been inconsistently reported. There is a lack of trials on the effectiveness or efficacy of antipsychotics in ATPD patients. In a large proportion of patients initially diagnosed with ATPD, the diagnosis remains stable, with recurrence varying from 10% to 46.6% based on the duration of follow-up. There is a need for more multicentric studies, studies with larger sample sizes, and consistency in data about risk factors. There is a need to evaluate symptom profile, course, outcome, and treatment outcomes in patients with ATPD using validated instruments to improve our understanding. Further, there is a need for comparative studies to evaluate the risk factors for ATPD.

Le potentiel thérapeutique du cannabidiol chez les sujets présentant un trouble du spectre psychotique : une revue systématique de la littérature sur les essais contrôlés randomisés

ObjectivesPsychotic disorders, particularly schizophrenia, are frequent psychiatric disorders and are difficult to treat with current pharmacological treatments. There is therefore a need to find new medications. In this systematic review, we study the therapeutic potential of cannabidiol in randomized controlled trials in subjects with a psychotic spectrum disorder. MethodsWe conducted a systematic review following the PRISMA Guidelines, on the subject between the date of inception of the databases and June 25th 2022 on PubMed, Google Scholar and Cochrane Library. Only randomized controlled trials (RCT) meeting the inclusion criteria were selected. The research equation was: “(cannabidiol OR CBD) AND (schizophrenia OR psychotic disorders OR Schizophreniform Disorder OR Schizoaffective Disorders OR Brief Reactive Psychoses OR prodromal states OR clinical high risk OR schizoid personality disorder OR schizotypal personality disorder OR paranoid personality disorder) AND (randomized controlled trial) AND (therapeutics OR symptoms) NOT (dronabinol) NOT (child)”. ResultsTen studies were included. We synthesize data in subjects with schizophrenia, UHR or related psychotic disorder, of the antipsychotic action of cannabidiol on clinical symptoms (PANSS), the action of cannabidiol on cognition and global functioning, its tolerance and side effects, and finally the action of cannabidiol on cerebral areas or cortisol in subjects at Ultra high risk of psychotic transition during experimental tasks. We highlight heterogeneous results, due to the variability of doses and durations of treatments. The antipsychotic action of CBD is observed for doses higher than 600mg. Cannabidiol moderates the modifications of activations of the cerebral areas in subjects at ultra-high risk of psychotic transitions compared to healthy subjects. Concerning cognition, cannabidiol is inefficient for doses lower than 1000mg and in the short term. Regarding tolerance and side effects, cannabidiol was well tolerated with very few side effects (which seem to be limited to sedation and gastrointestinal disorders). ConclusionsThis work has highlighted heterogeneous results that indicate a limited effectiveness of cannabidiol in psychosis spectrum diseases and schizophrenia, requiring more randomized controlled trials to conclude.

The Origins of Madness : Former prisoners of war in psychiatric care in the Hungarian Stalinist era

By the Second World War, the neurotic symptoms of “shell shock” were replaced by “combat exhaustion” which became an umbrella term for different depressive states and neuroses with organic conditions. While in the Western countries it became more common to compensate former victims for psychological harms too, in the Soviet dom- inated regions the experience of being a prisoner of war was dominated by ideological principles in the public sphere. Pavlovian doctrines for example denied the duality of reactive and somatogenic psychoses, placing psycho-traumas secondary to neurologi- cal features. In this study, the medical history of six former prisoners of war is discussed who were treated in Lipótmező in the early 1950’s. A comparison of Holocaust and POW survi- vors shows that the latter included people of lower social status and a higher prevalence of psychotic disorders. Illness became apparent to patients or their relatives at an early stage, but psychiatric intervention came relatively late. “Captivity” was an umbrella term, and they did not specialize the location, so only other sources might help us in the identification.

A Case of Brief Psychotic Disorder: An Unintended Consequence of COVID-19 Virus

Brief psychotic disorder is a sudden onset of psychosis in a patient for a duration of more than a day and less than a month. The DSM-5 defines brief psychotic disorder as a psychotic condition involving the sudden onset of at least one psychotic symptoms such as delusions, hallucinations, disorganized thought processes, disorganized speech and/or behaviors. This condition can also be associated with impaired memory of recent events, screaming, mutism, outlandish dressing, or behaviors. Acute psychotic symptoms can be associated with emotional lability often triggered by substance abuse or severe and acute stress such as the loss of a loved one. Patients ultimately receive the diagnosis of schizophrenia if the symptoms persist for a duration longer than six months. Brief psychotic disorder is often diagnosed in teenage patients, but it is less commonly seen in the females. Although the exact pathophysiology of brief psychotic disorder has not been determined, historically and similarly to schizophrenia it has been strongly linked to familial history. In some cases, it has been preceded by a traumatic and stressful event. Brief psychotic disorder has also been theorized to be the cause of maladaptive defense mechanism to escape a stressor. In this case report, we present a fifteen-year-old female patient who abruptly lost her mother to COVID-19, her adaptation few months following the loss and her eventual reactive psychosis as well as management challenges.

Brief Psychotic Disorder during COVID-19 Infection: Marked Stressor or Neuropsychiatric Symptoms?

Background: COVID-19 virus outbreak appeared in December 2019 and was announced as a pandemic by the World Health Organization (WHO) in March 2020. Recent cases of reactive psychosis in the context of the COVID-19 pandemic have been reported. However, there has been observed reduced interest in cases of acute psychosis affecting patients with COVID-19. Here, we present a clinical case of a female patient who showed a brief psychotic disorder during symptomatic infection with COVID-19. Methods: We discuss the differential diagnosis of brief psychotic disorder with marked stressor and neuropsychiatric symptoms of COVID-19 infection. Although the stress factor appeared to be linked to the acute psychosis onset in our COVID-19 positive patient, the diagnosis of a psychotic disorder due to the viral coronavirus infection is worthy of being reported and discussed. Results : The stress factor appears to be linked to the onset of acute psychosis in this COVID-19 positive patient; the diagnosis of a psychotic disorder due to the viral coronavirus infection is worth to be mentioned. Thus, we suggest that a new psychosis case associated with COVID-19 infection due to potential immune-mediated neuropathogenesis would justify further investigation. Conclusion: Through this case report, we highlight the need for vigilant monitoring of neuropsychiatric symptoms in individuals with COVID-19 infection.

Extended intensive care correlates with worsening of surgical outcome after elective abdominal aortic reconstruction

The aim of this study was to evaluate the impact of extended postoperative intensive care on short- and long-term patient outcome after elective abdominal aortic surgery and to assess the risk factors for patient survival after extended intensive care unit (ICU) treatment. The data of 231 patients that underwent open or endovascular abdominal aortic surgery were retrospectively analysed with regard to extended postoperative intensive care, defined as ICU treatment for more than 24 consecutive hours. Pre- and intraoperative factors were evaluated. The endpoints of the study were postoperative complications, mortality, and long-term follow-up. Univariate and multivariate Cox proportional regression analyses were performed to identify risk factors of worse overall survival. Extended postoperative intensive care was needed in 84 patients (63 after open and 21 after endovascular surgery). The period of ICU treatment was similar in both groups. Only the wound complications (31.8% vs. 9.5%, P=0.0498; OR 4.42 [0.94-20.84]) and the rate of acute kidney injury (82.5% vs. 57.1%, P=0.0352; OR 3.55 [1.20-0.46]) were more frequent after open surgery, whereas brief reactive psychosis (38.1% vs. 14.3%, P=0.0281; OR 0.27 [0.09-0.84]) was more frequent after endovascular surgery. ICU stay of ≥8 days correlated with significantly lower survival rates compared to a shorter ICU stay (P=0.0034), independent of open or endovascular techniques. Other multivariate risk factors for worse survival were the absence of preoperative aspirin medication, a Body Mass Index (BMI) of <25, chronic renal insufficiency, and coronary artery disease. Endovascular therapy was a positive predictive factor of short ICU stay of ≤3 days. The outcome after extended intensive care following elective aortic surgery is strongly dependent on the length of ICU stay.

COVID 19 and Psychiatric Morbidity

The COVID 19 virus was first identified in Wuhan in China in 2019. It spread to the entire world subsequently and gave rise to a global pandemic. Although the virus is primarily known to cause respiratory symptoms, there are instances of gastrointestinal symptoms as well as neurological sequelae. The main route of neurotropism is ACE2 receptors expressed in neurons and neuroglia. The SARS-CoV-2, similarly to other respiratory viruses, could gain access to CNS through several routes, for example by migrating through axons of the olfactory nerve.[1]The virus infects and damages the brainstem where respiratory center is located. The inflammatory response, so commonly described in COVID 19 infections, also damages the blood brain barrier causing further destruction to central nervous system through inflammatory chemicals. These massive changes to the brain milieu may be responsible for various neuropsychiatric sequelae like delirium, dementia, stroke as well as form the organic basis of psychiatric conditions like major depressive disorder, anxiety disorder and reactive psychosis. Similarly, massive psychosocial upheavals caused by the overwhelming global pandemic including change in lifestyle and socialization, being forced to stay indoors for weeks together due to lockdowns, financial consequences of unemployment and downslide of economy have all lead to increase in anxiety, depression and even suicidality. This is bound to increase further as time passes and economy takes a further beating. Prolonged stay in intensive care units, fear of imminent death, loss of loved ones all of a sudden- all these have caused increased incidences of post traumatic stress disorder. Overall, the COVID 19 is poised to increase the burden of neuropsychiatric conditions manifold. Longitudinal studies must be undertaken to gain clarity and further understanding on the neuropsychiatric sequelae of COVID 19 and their mechanism.

Reactive psychoses in the context of the COVID-19 pandemic: Clinical perspectives from a case series.

IntroductionThe world is currently undergoing an extremely stressful scenario due to the COVID-19 pandemic. This unexpected and dramatic situation could increase the incidence of mental health problems, among them, psychotic disorders. The aim of this paper was to describe a case series of brief reactive psychosis due to the psychological distress from the current coronavirus pandemic.Materials and methodsWe report on a case series including all the patients with reactive psychoses in the context of the COVID-19 crisis who were admitted to the Virgen del Rocío and Virgen Macarena University Hospitals (Seville, Spain) during the first two weeks of compulsory nationwide quarantine.ResultsIn that short period, four patients met the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for a brief reactive psychotic disorder. All of the episodes were directly triggered by stress derived from the COVID-19 pandemic and half of the patients presented severe suicidal behavior at admission.ConclusionsWe may now be witnessing an increasing number of brief reactive psychotic disorders as a result of the COVID-19 pandemic. This type of psychosis has a high risk of suicidal behavior and, although short-lived, has a high rate of psychotic recurrence and low diagnostic stability over time. Therefore, we advocate close monitoring in both the acute phase and long-term follow-up of these patients.

Reactive psychoses in the context of the COVID-19 pandemic: Clinical perspectives from a case series

IntroductionThe world is currently undergoing an extremely stressful scenario due to the COVID-19 pandemic. This unexpected and dramatic situation could increase the incidence of mental health problems, among them, psychotic disorders. The aim of this paper was to describe a case series of brief reactive psychosis due to the psychological distress from the current coronavirus pandemic. Materials and methodsWe report on a case series including all the patients with reactive psychoses in the context of the COVID-19 crisis who were admitted to the Virgen del Rocío and Virgen Macarena University Hospitals (Seville, Spain) during the first two weeks of compulsory nationwide quarantine. ResultsIn that short period, four patients met the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for a brief reactive psychotic disorder. All of the episodes were directly triggered by stress derived from the COVID-19 pandemic and half of the patients presented severe suicidal behavior at admission. ConclusionsWe may now be witnessing an increasing number of brief reactive psychotic disorders as a result of the COVID-19 pandemic. This type of psychosis has a high risk of suicidal behavior and, although short-lived, has a high rate of psychotic recurrence and low diagnostic stability over time. Therefore, we advocate close monitoring in both the acute phase and long-term follow-up of these patients.

An Integrative Model and Dynamic Nosology of Personality Disorder: Part 2: Symptom-based pharmacotherapy.

This paper presents an integrative model of personality and personality disorder which incorporates psychoanalytic concepts with modern neuroscience. In addition, a dynamic, personalized, and context - and time-sensitive diagnosis of personality disorder is introduced. The authors cogently argue that all clinical variants of personality disorder share the same common deficit: fragmented basic units of experience at the nonconscious core of the mind (aka "partial object relations"). The fragmentation propagates through mental faculties (thought, motivation, emotion), as they self-organize into subsystems of personality, e.g., one's sense of self, identity, character, moral values, rendering them polarized into extreme and thus adaptively suboptimal. The syndrome of personality disorder arises as a nonconscious compensatory maneuver of the fragmented mind to organize itself through a defensive but unrealistic self-image (e.g., narcissistic, schizoid, antisocial, etc.), giving rise to a host of unique symptoms. Symptomatic pharmacotherapy of personality disorder is best organized around four empirically derived domains of symptoms, shared by all variants to a variable degree: i) mood and anxiety dysregulation; ii) impulsivity, aggression, and behavior dyscontrol; iii) emotional disinterest and detachment; and iv) cognitive distortions and brief reactive psychoses. Pharmacotherapy targeting the above domains is nonspecific, as medications affect multiple domains simultaneously. Modest empirical evidence and considerable clinical benefits continue to support the use of medications in the overall symptomatic treatment of personality disorder.

La théorie de la dissociation structurelle de la personnalité pour conceptualiser et traiter la psychose dissociative : deux études de cas

ObjectivesWe present the theory of the structural dissociation of the personality as a way to conceptualize dissociative psychosis and illustrate this with two case studies. This theory was developed to help understand trauma related disorders, i.e. dissociative disorders. In line with Janet's work, this theory states that a traumatic event can lead to a division (dissociation) of the personality in two or more parts: an apparently normal part of the personality deals with daily life activities and avoids the traumatic memories, and one or more emotional parts of the personality stay fixated on the traumatic experience and can reach a certain autonomy as in dissociative identity disorder. Dissociative psychosis is understood as the intrusion of emotional parts into the apparently normal part, which gets overwhelmed, with psychotic-like intrusions. In the most severe cases, an emotional part takes over the executive role over a long period of time. Patients/methodsThe first case study is a male patient suffering from repetitive (at least once a year) psychotic episodes with a normal nonpsychotic functioning between episodes. Main psychotic symptoms are mystic delusions, verbal auditory hallucinations and disorganized thinking. Hypnotherapeutic interventions allowed an evaluation of a possible structural dissociation, which then led to the diagnostic of dissociative psychosis. A psychotherapy based on the theory of structural dissociation was then engaged. The second case study is a female patient with depersonalization disorder and a dissociative psychosis several weeks after the traumatic birth of her twin children. Psychotic symptoms were mystic, referential and persecutory delusions. ResultsIn the first case, after three years of adapted psychotherapy, the patient showed no relapse of dissociative psychosis and did not need any hospitalization. A single risk of relapse was avoided with one session of adapted hypno-imaginative interventions. In the second case, after three sessions of hypnotherapeutic treatment based on the theory of the structural dissociation of the personality, the patient was symptom free, also at two and half years follow up. ConclusionsThe theory of the structural dissociation of the personality is useful in conceptualizing dissociative psychosis. Hypnotherapeutic and hypno-imaginative interventions with a light trance and adapted to this theory can be useful in the treatment of such a disorder. Such interventions can help clinicians enter the patient's inner world to better understand the meaning of the symptoms and then suggest a resolution for the trauma related emotional parts involved in the expression of the psychotic-like symptoms. We discuss the necessity of an official diagnostic for this disorder that could be better named reactive dissociative psychosis or reactive dissociative disorder with psychotic features. Clinicians need to be aware of this specific diagnostic that may benefit from specific psychotherapeutic interventions, probably better adapted than those needed for real psychotic disorders.

Pulmonary thromboembolism and sudden death in psychiatric patients: Two cases reports

Introduction. Pulmonary thromboembolism occurs usually by running a thrombus from the deep veins of the legs rarely periprostatic or periuteric veins. Virchow's triad of necessary conditions for the occurrence of thrombosis involves disruption of blood flow, disruption of blood chemistry and damage to the vessel wall. Venous thrombosis is often associated with the implementation of antipsychotic therapy. Case report. We reported two cases of sudden death of psychiatric patients who were in both cases fixed during hospitalization. The first case was a 26-year-old woman treated a year with the diagnose of postpartum reactive psychosis. She was hospitalized because of mental state worsening with a dominant depressed mood, visual and auditory hallucinations. Her therapy was determined by diazepam, clozapine, haloperidol and lamotrigine. Suddenly, the patient died on the fifth day of hospitalization. The autopsy showed massive thromboembolism of the pulmonary artery branches. Toxicological analysis revealed the presence of therapeutic doses of antipsychotics. The second case was a-45-yearold men, a long-time alcoholic. On admission, the diagnosis of delirium tremens was established, and diazepam and haloperidol were administered. On the fifth day of hospitalization, he suddenly died. The autopsy showed thromboembolism of the branch of the pulmonary artery. Toxicological analysis established the presence of nordiazepam in urine (0.06 mg/L). Both patients were fixed during hospitalization. Conclusion. Both presented psychiatric patients were younger than 50 years, were not overweight, did not have changes of the venous blood vessels. Nowadays, when the issue of medical responsibility often arises in these and similar cases of sudden death in patients treated in psychiatric clinics, the questions on medical malpractice could be expected.

Acute and transient psychoses: clinical and nosological issues

SummaryThis article examines the clinical, epidemiological and nosological aspects of short-lived psychotic disorders as currently classified under ‘acute and transient psychotic disorders' in ICD-10 and ‘brief psychotic disorder’ in DSM-5. After describing earlier diagnostic concepts such as bouffée délirante, cycloid psychosis, reactive psychosis and schizophreniform psychosis, we present an overview of the literature and discuss implications for classification, diagnosis and treatment of these conditions, pointing out differences from longer-lasting psychotic disorders.

Autism Spectrum Disorder and Psychosis: A Case Study

While apparently relatively common, there is often little clinician awareness of the risk of psychosis for people with autism. A comprehensive review of the peer-reviewed literature and a presentation of a case study. There is a paucity of research available to determine the prevalence of the experience of psychosis in people with autism. There is significant boundary overlap between autism spectrum disorder and schizophrenia spectrum disorder. This article provides a comprehensive review of the research and a case study of a 16-year-old male with autism who experienced a brief reactive psychosis.

Atypical psychosis – historical and current perspective

IntroductionClinical concepts regarding atypical psychosis such as the French bouffeé délirante, the German cycloid psychosis, and the Scandinavian reactive and schizophreniform psychoses are now under the category of F23 ‘Acute and transient psychotic disorders’ (ATPD) of the tenth revision of the International Classification of Mental and Behavioural Disorders (ICD-10).AimsThe authors’ aim is to highlight the clinical and scientific relevance of atypical psychosis from the historical concepts to the current perspective.MethodsA Pubmed database search using as keywords “atypical psychosis”, “acute and transient psychotic disorders”, and “brief psychotic disorder” and retrieved papers were selected according to their relevance.ResultsDifferent psychiatric schools, often of a regional or national character, have provided concepts for transient psychotic states. The acute and transient psychotic disorders of ICD-10 and the brief psychotic disorder of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) reflect the diversity of the history of such concepts. The available evidence suggests that case identification and follow-up is difficult in ATPD due to the heterogeneous and infrequent nature of this clinical phenomenon. Furthermore ATPD has a low diagnostic stability and there are few studies focused on brief psychotic disorders.ConclusionsThe present definition of acute and transient psychotic disorders and brief psychotic disorder, while taking into account the history of the concepts involved, leave many questions open to further studies.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Messy and Tidy

Messy and Tidy Jack L. B. Gohn (bio) It is tempting to pass off one’s impressions of this year’s Contemporary American Theater Festival in Shepherdstown, West Virginia, as a take on the Current State of the American Play. But they aren’t. When you compare this season to past seasons, two of which (2012 and 2014) have been discussed in these pages, it’s clear that CATF changes each year. Artistic trends change, too, but not that quickly. In reality, those differences are just results of the new golden age of American playwriting in which we live. With golden ages, you get lots of talent and lots of diverse work. And that’s the only generalization I care to offer this year. No racial diversity this time around, though. I remarked, a year ago, on how the Festival had featured three black playwrights among the five showcased, and on the large number of African American performers. This year, all the plays were by white authors, and there were no African American performers at all. This had the secondary effect of taking race completely out of the thematic interplay among the works on display. But that left plenty else: mental illness, creativity, repression, rebellion, the twisted bond of parent and child, extreme fashion, and the nature and durability of marriage. And we had a wide range of genres and emotional temperatures. Not quite the range of the players in Hamlet (“tragedy, comedy, history, pastoral, pastoral-comical, historical-pastoral” etc.) but close. Two of the shows were about artists—of sorts. One concerned artists of the imagination. This was Johnna Adams’s World Builders: A Love Story. Adams is hardly the first playwright to experience at firsthand the connection between mental illness and creativity. She acknowledges her bipolar disorder but says she would not have had a playwriting career without it. She is hardly alone; O’Neill, Strindberg, Ibsen, and Williams were all bipolar. Nor is she the first to suggest that madness may be inspirational to an artist. DeQuincey, Poe, and Coleridge, among others, have drawn that connection. But surely few have painted the connection in quite the bright colors that World Builders does. Both the characters in World Builders, Whitney (Brenna Palughi) and Max (Chris Thorn), have been distracted by their disorder from the real world and the actual human connections available to them with friends and family, and obsess instead about imaginary worlds of their own making. Whitney’s world is a dynamic, bustling science fiction epic with, as she brags, “seven colony worlds that Earth’s survivors fled to,” which now contain “seventy-two alien-human hybrid races.” Her fantasy embraces “forty-seven major characters and one hundred and thirty minor characters.” In particular, she revels in the love story of Mikor and Selestina, a prince and princess who meet when his pirate flagship encounters her intergalactic space yacht. In other words, in her mind Whitney is helming a fictive universe even more complex than that of Game of Thrones (a comparison Adams herself draws in an interview in the program), though it seems a happier and more swashbuckling place than Westeros. [End Page 124] Max’s fantasy world is quite different and far more ominous, clearly owing much to the disturbing material of Silence of the Lambs. But their worlds, however artistic and creative, are also places of some danger, because for their creators they have supplanted the real world, to the point where mere human contact is of next to no interest to either of them. Hence their families have forced them into a locked ward at the Johns Hopkins Hospital, where they are on a controlled trial of a medicine that will rid them of, in Whitney’s words: “[O]ur schizoid personality disorders. Anti-social tendencies. Brief reactive psychoses. Autoerotic fixations. Dissociative and narcissistic behavior.” The trouble is, the medicine is working, simultaneously freeing them up to fall in love and sundering them from their fantasy worlds. Thus the second half of the (intermissionless) play is taken up with a number of questions that boil down to comparing the value of a sane life with love but without creativity and an insane...