14 - Various atypical psychotic disorders

Various atypical psychotic disorders

© SPMM Course does not negate diagnosis. It is also called symbiotic psychosis or folie a deux. It is more common in couples and often involves nonbizarre delusions. Schizoaffective disorder is placed with F20 (psychoses) not F30 (affective disorders). In schizoaffective illness, both schizophrenic and mood symptoms are seen simultaneously in approximately equal proportion. The presence of mood-incongruent delusions is suggestive but not in itself sufficient to diagnose schizoaffective disorder; at least one typical schizophrenic symptom must be present. (Note - Affect neutral delusions are also included as incongruent delusions). The aetiology is assumed to be intermediate to that of schizophrenia and affective disorder. There are 2 subtypes: schizoaffective manic or depressive subtypes. Schizodepressive episodes are associated with a family history of schizophrenia and are usually less florid. The response to treatment is variable and may develop chronic negative symptoms. The depressive symptoms are more likely to signal a chronic course compared to manic presentations. In manic variant symptoms are florid but recovery is within weeks. Schizomanic episodes are associated with a family history of affective disorders. These patients respond well to mood stabilisers and recover rapidly. Various atypical psychotic disorders These disorders are recognized but not categorised separately in ICD-10. Bouffée délirante: The classical description of bouffée délirante was given by Legrain. Psychosis  of  sudden  onset,  ‘like  a  bolt  from  the  blue’; Polymorphous delusions and hallucinations of any kind; Clouded consciousnesses associated with emotional instability; Absence of physical signs, i.e. the disorder is not caused by any organic mental disorder; Rapid return to the premorbid level of functioning; and Relapses may occur, but individual episodes are separated by symptom-free intervals. The episodes develop in a predisposed individual and are caused by psychosocial factors (which also determine the content and form of the disorder), have a greater tendency to recover and seem never to end in deterioration. Process schizophrenia: The concept of process schizophrenia was first described by Langfeldt (1939). Langfeldt differentiated between two groups of psychoses usually diagnosed as schizophrenia: a group with  poor  prognosis,  labelled  ‘genuine’  or  ‘process’  schizophrenia,  and  a  group  with  good  prognosis,   labelled    ‘schizophreniform’  psychosis. (But later studies  that  reclassified  Langfeldt’s  100  cases  concluded   that  most  of  the  ‘schizophreniform  psychoses’  turned  out  to  be  affective  disorders  with  psychotic  features). The  term  ‘cycloid  psychoses’ was coined by Leonhard (1957) to describe endogenous psychotic syndromes characterized by a sudden onset, an admixture of symptoms belonging to the affective DSM-5 AND SCHIZOAFFECTIVE DISORDER A major mood episode (not merely mood symptoms) must be present for a majority (not  merely  ‘substantial  duration’) of the disorder’s  total  duration  after  Criterion  A   has been met. Diagnosis takes a more longitudinal perspective compared to DSM-IV

© SPMM Course disorders and of symptoms belonging to schizophrenia and phasic course. Leonhard subdivided the cycloid psychoses into three forms: motility psychoses, confusional psychoses and anxiety–blissfulness psychoses. Cycloid psychoses predominate in severe postpartum psychiatric disorders and are more common among women. Perris described the diagnosis as follows; psychotic episodes of sudden onset, mostly unrelated to stress, with good immediate outcome but with a high risk of recurrence, characterized by mood swings (from depression to elation) and at least two of the following: various degrees of perplexity or confusion; delusions  (of  reference,  influence  or  persecution)  and/or  hallucinations  not  congruent  with  mood; motility disturbances (hypo or hyperkinesia); occasional episodes of elation and states of overwhelming anxiety (pananxiety).