Reactive Psychosis Research Articles

Complex PTSD in Digital Age: Case of Ukrainian Refugees – Victims of War Crimes

Patients with Guillain-Barré syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP) have mental health sequelae that impact their quality of life. The burden of mental health disorders in these patients is poorly established. To review the literature on the frequency and risk of mental disorders in GBS and CIDP. A systematic review was conducted to identify primary studies that reported mental health outcomes in patients with GBS and CIDP. Screening, full-text review, data extraction and quality assessment were performed in duplicate, with discrepancies resolved by a third party. This systematic review included 19studies. Three studies reported mental health diagnoses using the International Classification of Diseases or Diagnostic and Statistical Manual of Mental Disorders criteria: up to 82%, 67%, 25% and 22% of patients following GBS were diagnosed with anxiety, depression, brief reactive psychosis and post-traumatic stress disorders, respectively. The risk of anxiety disorders following GBS normalized after 3 months, but the risk of depressive disorders remained elevated for 2 years. Although 30%-50% of patients with CIDP described mental health symptoms, no studies reported mental health diagnoses. Active disease and neuropathic pain were associated with more depressive symptoms in patients with CIDP. Many patients following GBS or with active CIDP experience symptoms that may fulfill the criteria for mental health diagnoses, but the paucity of literature suggests that mental health disorders are underdiagnosed and undertreated in this population. These patients are at higher risk of developing mental health disorders, thereby emphasizing the need for timely mental health care and assessment of their disease-specific risk factors.

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.

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

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.

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 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.

Reactive psychosis (RP) is a trauma-induced category whose meaning has varied in relation to the role attributed to lived experiences or vulnerable personality. It has long been described in different countries, but seldom investigated under the influence of symptom-based psychiatric classifications. This article aims to examine the development of RP since the early 20th century, outline how it has been incorporated in modern diagnostic classifications, and set out empirical findings. It is likely that variations in terminology and diagnostic practice have affected estimates of the frequency and hampered the validity of RP in earlier studies. To enhance reliability, RP underwent several changes in successive Diagnostic and Statistical Manual of Mental Disorders and ICD versions and was eventually replaced with descriptive categories for short-lived psychotic disorders. Clinical observations during the COVID-19 pandemic attest the durability of RP, but the current categories prove unhelpful in identifying it and have failed to encourage research.

Brief reactive psychosis….again! - Clinical case report

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

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.

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.

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.

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.

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.

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

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

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.