What is Acute Psychosis?

Acute Psychosis

Acute psychosis is characterized by development of delirium, hallucinations, and jumbled speech. A sharp striking delusion with quick changes in the structure occurs in the individual who suffers from acute psychosis after a short preliminary period of anxiety, insomnia, and confusion. Acute psychosis lasts for a short time, usually from one to two weeks.

In the nineteenth century, Emil Kraepelin, a German psychiatrist, first attempted to categorize functional psychosis based on longitudinal course and prognosis. He had come up with two classifications: manic-depressive psychosis and dementia praecox. However, a number of authors expressed their disagreement with Kraepelin’s dichotomous classification for they found a third classification of the condition which was named acute or subacute polymorphic psychosis. This third psychosis was associated with stress, had changing symptomatology, and was a condition that patients can recover from completely.

There are two types of acute psychosis – one that is associated with stress, and another that is not associated with stress. Some authors have also pointed out that “acute schizophrenia episode” should not be encompassed under schizophrenia and commented that it was quite different from schizophrenia and manic-depressive psychosis. 40% of patients with acute onset psychosis reportedly do not fit into the diagnosis of schizophrenia or depression.

To standardize the definition of acute psychosis, modern diagnostic systems such as the International Classification of Diseases (ICD), and the Diagnostic and Statistical Manual (DSM) included the condition as “Acute and Transient Psychotic Disorder” (ICD-10), and “Brief Psychosis”(DSM-IV). DSM – IV classified acute psychosis more specifically than ICD-10. Thus, every “Brief Psychosis” could be diagnosed as “Acute and Transient Psychotic Disorder” but not the other way around.
The condition is classified as follows:

  • Acute polymorphic psychotic disorder without symptoms of schizophrenia
  • Acute polymorphic psychotic disorder with symptoms of schizophrenia
  • Acute schizophrenia-like psychotic disorder
  • Other acute predominantly delusional psychotic disorders

Symptoms of Acute Psychosis

The following are the two diagnostic criteria for acute psychosis set by the two modern diagnostic systems.

Diagnostic criteria for “Acute and Transient Psychotic Disorders” (F23) according to ICD-10.

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.

G2. If transient states of perplexity, misidentification, or impairment of attention and concentration are present, they do not fulfill the criteria for organically caused clouding of consciousness as specified for F05.-, criterion A.

G3. The disorder does not meet the symptomatic criteria for manic episode
(F30.-), depressive episode (F32.-), or recurrent depressive disorder (F33.-).

G4. There is insufficiency of recent psychoactive substance use to fulfill the criteria for intoxication (F1x.0), harmful use (F1x.1), dependence (F1x.2), or withdrawal states (F1x.3 and F1x.4). 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 F23; this must be decided by clinical judgment and requirements of the research project in question.

G5. Most commonly used exclusion clause. There must be no organic mental disorder (F00-F09) or serious metabolic disturbances affecting the central nervous system (this does not include childbirth).

* indicates required

Diagnostic criteria for 298.8 Brief Psychotic Disorder

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

  1. delusions
  2. hallucinations
  3. disorganized speech (e.g., frequent derailment or incoherence)
  4. grossly disorganized or catatonic behavior

Note: Do not include a symptom if it is a culturally sanctioned response pattern.

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.
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 is within 4 weeks postpartum.

Causes of Acute Psychosis

Socio-demographic factors: Studies have shown that Acute and Transient Psychosis is 10 times more common in developing countries as compared with industrialized nations. Females and people from rural areas are more likely to manifest acute psychosis. The age of onset of acute psychosis is similar to schizophrenia in men, but younger in females when compared to the onset of schizophrenia.

Stress: Findings from various studies demonstrated higher frequency of stress preceding the onset of acute psychosis compared with schizophrenia. Individuals with acute psychosis are found to experience significantly less amount of stress prior to the onset of their acute psychotic illness when they have a positive family history of psychiatric disorder in their first degree relatives.
Premorbid personality, familial relations and other biological factors are also considered to be associated with acute psychosis.

Treatment of Acute Psychosis

The main goals of treatment of psychosis are to decrease the symptoms, maintain or increase the cognitive abilities of the patient, minimize the side-effects of medication, reduce secondary morbidity, prevent relapse and enhance the quality of life. It is important that the patient is given antipsychotic medications in addition to appropriate training and therapy to improve their psychosocial skills.

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