What is Acute and transient psychotic disorders – Currently, this diagnosis is the most common with the first hospitalization of a patient in the emergency department. The frequency of diagnosis ranges from 4 to 6 cases per 1000 population per year.
What triggers/Causes of Acute and transient psychotic disorders:
Acute transient psychotic disorders may be associated with stress, such as loss, a situation of violence, imprisonment, mental pain, overstrain, for example, during a long wait, exhausting journey. In this sense, this group includes acute and, in part, prolonged reactive psychoses. However, they can begin and endogenously, determined by internal experiences. In this case, this diagnosis is “cosmetic” for themanifestations of schizophrenia or the first attack of schizoaffective disorders. It is appropriate to make such a diagnosis only if the duration of the violations is not more than 3 months.
Symptoms of Acute and transient psychotic disorders:
After a short initial period with signs of anxiety, anxiety, insomnia and confusion, acute sensual nonsense arises with rapid changes in the structure of the delusions. Acute psychosis lasts from one to two weeks. Ideas of attitude, meaning, persecution , dramatization, false recognition, and delusions of the double (Capgra) arise against the background of the mythological, symbolic interpretation of the surroundings, the patient himself is at the center of events. Frequent experiences spiritualization of animals, plants, inanimate objects, the separate inclusion of ideas of influence. Hallucinatory experiences, true auditory and pseudo-hallucinations are not persistent and quickly replace each other. Amnesia is absent, although the patient does not immediately tell about the experience, as if gradually recalling it.Affect of happiness, fear, surprise, confusion and bewilderment.
The psychosis of this group is often associated with stress, so when diagnosing it is indicated whether psychosis is associated with stress or not. Acute transient psychoses associated with stress, previously designated as reactive. It is conditionally considered that a stressor is a factor that precedes psychosis in less than 2 weeks. Nevertheless, clinical criteria of communication with a stressor are also important, including: sounding in a clinical picture of a stressful situation, for example, pursuit after a real pursuit, and gradual extinction of a given sound after the termination of the stressor. Situations of separation and divorce, economic collapse and loss of social prestige, news of a catastrophe, or an observed catastrophe may be in the role of a stressor.
Clinical example: Patient H., 42 years, the owner of a large company. During the period of economic crisis and sudden devaluation, he lost most of his fortune. I did not sleep for three nights, but his efforts to straighten the situation came to naught. I noticed that he was being watched by lenders and the tax police. In order to cover his tracks, he left Moscow for Kiev, threw his car on an unknown street and began to move on trains. However, the pursuers noticed in the cars. He left at the stations of small stations, threw his documents, burned his passport in the toilet. He turned to his friend with a request to hide it. He noted the connection between the numbers of cars, the number and date of his birth, he decided that he had revealed the group that was following him. I heard their talks on a mobile phone. Experienced fear, anxiety, confusion. The condition was stopped after the second injection of aminazine and haloperidol .
Diagnosis of Acute and transient psychotic disorders:
The acute development of delusions, hallucinations, disjointed and broken speech, the duration of the development of the full picture up to 2 weeks.
Differential diagnostics
It is differentiated from the manifestation of schizophrenia, schizoaffective disorders, psychotic disorders with substance dependence, organic schizophreniform disorders.
From the clinic schizophrenia andschizoaffective disorder this psychosis can be differentiated only by subsequent dynamic observations, since transient psychosis is only an episode. Psychoses with addiction to psychoactive substances usually occur with altered consciousness, that is, the clinic of delirium, visual hallucinations predominate in psychosis. Psychosis occurs after the abolition of the psychoactive substance, with the abuse of alcohol, it is often timed to the evening time. Is able to identify intoxication history.
Organic Schizophrenia-like Disorders also include the symptoms of the exogenous range ( amnesic , quantitative disorders of consciousness, asthenic), organics refined 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 – revision 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, neuroleptics in medium and sometimes in maximum doses. Common combinations are aminazine and haloperidol , haloperidol and triftazine, or a combination of one of the larger antipsychotics and tranquilizer. Due to the high risk of recurrent psychosis, some time after discharge (2-3 weeks), usually in the evening, the patient must take maintenance doses of neuroleptics.