What are Acute and Transient Psychotic Disorders?
Currently, this diagnosis is the most common during the first hospitalization of the patient in the diagnostic department. The frequency of diagnosis ranges from 4 to 6 cases per 1000 population per year.
Causes of Acute and Transient Psychotic Disorders
Acute transient psychotic disorders can be associated with stress, such as loss, a situation of violence, imprisonment, mental pain, over-exertion, such as long waiting periods, exhausting travel. In this sense, acute and, in part, protracted reactive psychoses belong to this group. However, they can begin endogenously, determined by internal experiences. In this case, this diagnosis is “cosmetic” for the manifestations of schizophrenia or the first attack of schizoaffective disorder. It is appropriate to make such a diagnosis only with a duration of violations of not more than 3 months.
Symptoms of Acute and Transient Psychotic Disorders
After a short initial period with the phenomena of anxiety, anxiety, insomnia and confusion, acute sensual delirium arises with rapid changes in the structure of delirium. Acute psychosis lasts from one to two weeks. The ideas of relationships, meanings, persecution, dramatization, false recognition and the delirium of the double (Kapgra) arise against the background of a mythological, symbolic interpretation of the environment, the patient himself is in the center of events. Frequent experiences of inspiration of animals, plants, inanimate objects, individual inclusion of ideas of influence. Hallucinatory experiences, auditory truths and pseudo-hallucinations are not persistent and quickly succeed each other. Amnesia is absent, although the patient does not immediately talk about the experience, as if gradually recalling it. The affect of happiness, fear, surprise, confusion and bewilderment. The feeling of “dreaminess” of experiences.
The psychoses of this group are often associated with stress, therefore, when diagnosing, they indicate whether psychosis is associated with stress or not. The acute transient psychoses associated with stress were previously designated as reactive. It is conventionally believed that a factor that precedes psychosis in less than 2 weeks is considered a stressor. Nevertheless, clinical criteria for communicating with a stressor are also important, which include: the sounding of a stressful situation in the clinical picture, for example, stalking after a real stalking, and the gradual extinction of this sound after the stressor is stopped. The role of a stressor can be situations of separation and divorce, economic collapse and loss of social prestige, news of a disaster or an observed catastrophe.
Diagnosis of Acute and Transient Psychotic Disorders
The acute development of delirium, hallucinations, incoherent and torn speech, the duration of the development of the full picture is up to 2 weeks.
It should be differentiated from the manifestation of schizophrenia, schizoaffective disorder, psychotic disorders with dependence on psychoactive substances, organic schizophrenia-like disorders. From the clinic of schizophrenia and schizoaffective disorder, only subsequent dynamic observations can differentiate this psychosis, since transient psychosis is only an episode. Psychoses, depending on psychoactive substances, usually occur with a changed consciousness, that is, a clinic of delirium, in a psychosis visual hallucinations predominate. Psychosis is noted after the withdrawal of a psychoactive substance, with alcohol abuse it is more often confined to evening time. It is possible to identify intoxication history. Organic schizophrenia-like disorders also include symptoms of an exogenous circle (amnestic, quantitative disorders of consciousness, asthenic), the organics are specified as a result of additional research methods. Logically, the entire diagnosis of this group looks like this: 1 month – confident diagnosis, up to 3 months – controversial diagnosis, more than 3 to 6 months – review of the diagnosis, usually for schizophrenia, organic disorder or schizoaffective disorder.
Treatment of Acute and Transient Psychotic Disorders
In the treatment it is necessary to use detoxification therapy, antipsychotics in medium and sometimes in maximum doses. The usual combinations are combinations of chlorpromazine and haloperidol, haloperidol and triftazine, or a combination of one of the larger antipsychotics and tranquilizer. Due to the high risk of re-psychosis, some time after discharge (2-3 weeks), usually in the evening, the patient should take maintenance doses of antipsychotics.