Acute and transient psychotic disorders: Manifestations, diagnosis and treatment

July 28, 2022

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Acute and transient psychotic disorder is a short-term psychotic episode that lasts only a few months. Characteristic of the disease is that the time from normal to marked psychotic state takes only 2 weeks or less.

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What are acute and transient psychotic disorders?

Acute and transient psychosis is one of the most common types of psychosis. This term refers to a short-term form of psychosis that may go into complete remission after only 2–3 months. The disease is characterized by the time from normal to marked psychotic state in only 2 weeks or less.

Most cases of acute and transient psychotic disorder occur after being confronted with one or more traumatic events. The disease usually completely heals after about 2-3 months, even some cases recover quickly after only a few days to a few weeks. However, there are also some cases of persistent progressive disease that causes many complications and seriously affects health.

Similar to other forms of psychosis, the etiology of the disease is unclear. Disease progression is strongly dependent on etiology and risk factors. Diseases arising from environmental factors will have a much better prognosis because of patients with severe genetic factors and abnormal personality characteristics.

Causes of acute and transient psychosis

Acute and transient psychotic disorder is a change from a normal state to a marked psychotic state within 14 days or less. Similar to other mental illnesses, experts cannot pinpoint the exact cause of the condition. However, most illnesses begin after one or more traumatic events.

Identified causes and factors associated with acute and transient psychotic disorders:

Heredity, familial factors: Acute and transient psychotic disorder is one of the diseases with the potential to be inherited. In addition, experts also found that about 20-33% of patients with this condition have a family history of acute psychosis, schizophrenia, bipolar disorder, depression, etc.
Stress: The change from a normal mental state to a psychotic state often has the role of psychological trauma (stress). About 20-30% of patients develop psychosis after experiencing traumatic events such as divorce, bankruptcy, bereavement, traffic accident, war, etc.
Personality: Certain personality traits may increase the risk of acute and transient psychotic disorders such as schizoid personality disorder, sensitive personality, weakness, vulnerability, anxiety, and pessimism … People with the above personality traits are more likely to experience psychosis after dealing with trauma.

In fact, acute and transient psychotic disorders do not occur due to a specific cause or factor. Experts believe that this pathology is the result of a combination of factors.

How to recognize acute and transient psychosis?

Acute and transient psychotic disorder with very obvious symptoms. Significant psychosis lasting for 2–3 months or less with significant effects on work, school, and social relationships.

Signs of acute and transient psychosis:

Psychotic states (hallucinations, paranoia) come on suddenly and last for 2-3 months or less. However, there are also cases where the symptoms are persistent and persistent.
Unlike other psychotic diseases, acute and transient psychotic disorders cause hallucinations and delusions with varied and frequently changing content. The severity of symptoms also changed markedly on the same day.
The hallucinations, paranoia may be accompanied by mood disorders such as panic, sadness, pessimism, depression, agitation, excitement or limited range of emotional expression, etc.
In some cases, there may be language and thinking disorders (difficulty speaking, barely speaking or talking excessively), perceptual disturbances (visual hallucinations, hallucinations, stupor), confusion behavior (disorganized behavior, agitation, strange behavior, etc.)
Accompanied by physical symptoms such as fatigue, loss of appetite, low fever, insomnia, sadness, irritability, etc.

Currently, acute and transient psychotic disorders are divided into several clinical categories. According to ICD-10, this pathology is divided into the following types:

Acute and transient psychotic disorder without symptoms of schizophrenia (F23.0)
Acute psychotic disorder with schizophrenic symptoms (F23.1)
Schizophrenia-like acute psychotic disorder (F23.2)
Acute psychotic disorder predominantly paranoid (F23.3)
Other acute and transient psychotic disorders (F23.8)
Acute and transient psychotic disorder unspecified (F23.9)

Symptoms of acute and transient psychotic disorders are easily recognizable. However, because they are dominated by hallucinations and paranoia, patients rarely actively seek medical attention. To avoid unfortunate consequences, the family should pay attention to the symptoms so that the patient can be examined and treated promptly.

Are acute and transient psychotic disorders dangerous?

Acute and transient psychotic disorders usually have a good prognosis. Most patients experience rapid remission after treatment – especially those who are easily adaptable and attuned to their surroundings. At the same time, there is the active support of the family during treatment and post-treatment care.

In contrast, individuals with isolated, isolated personalities (schizoaffective personality disorder) and whose onset is strongly related to genetic factors often have a poor prognosis. In these cases, the disease can progress persistently causing personality changes or develop into mood disorders, delusional disorders, etc.

In addition, experts also found that patients with acute and transient psychotic disorders related to psychological trauma often have a better prognosis. When stress is under control, the patient’s health will gradually return to normal. In contrast, cases of disease that do not have an extrinsic trigger often have a poor prognosis and are more likely to have a chronic progression.

Diagnosis of acute and transient psychosis

Acute and transient psychotic disorders have obvious symptoms but are not highly typical and are easily confused with other psychological and psychiatric disorders. Currently, doctors use the ICD-10 diagnostic criteria to confirm and differentiate this pathology. In addition, some laboratory tests are also very helpful in ruling out other possibilities.

Steps to diagnose acute and transient psychotic disorders:

Clinical diagnosis
Basic tests such as biochemical tests, hematology, microbiology, drug tests, urinalysis, serological tests to diagnose syphilis, etc.
Imaging diagnostics, functional exploration such as cranial MRI, cranial CT, transcranial doppler ultrasound, electrocardiogram, electroencephalogram, cerebral blood flow, abdominal ultrasound, cardiopulmonary radiograph, etc.
Psychological tests such as personality test MMPI, EPI, psychological test Zung, BDI, HAD, MMSE, …

These techniques will help confirm the diagnosis of acute and transient psychotic disorder, and at the same time rule out the possibility of occurrences such as psychosis due to alcoholism, stimulants, organic psychosis, and schizophrenia. paralysis, persistent delusional disorder, mood disturbance, etc.

Treatment modalities for acute and transient psychotic disorders

Acute and transient psychotic disorders have a sudden, pronounced onset of symptoms that should be treated as soon as possible. Similar to psychosis, this disorder is treated primarily with chemotherapy and psychotherapy.

1. Pharmacotherapy

Pharmacotherapy plays an important role in acute and transient psychotic disorders. Using drugs to help quickly reduce positive symptoms such as agitation, hallucinations, paranoia, etc. The preferred option is monotherapy, multi-therapy is only applied in case of poor response or no response.

Using drugs is highly effective, but there are many potential risks and risks. Therefore, the treatment process needs to be closely monitored to promptly detect and manage side effects.

The following classes of drugs are used in the treatment of acute and transient psychotic disorders:

Classical Antipsychotics: Classical antipsychotics have been around since the 1950s with the main mechanism being the inhibition of dopamine at the D2 receptor. The advantage of the drug is that it has a quick effect, so it should be used in the acute phase. The classic antipsychotic drugs used to treat acute and transient psychotic disorders include Thioridazine 50mg (dose 100-300mg/day), Haloperidol 1.5mg (5-30mg/day dose), Levomepromazine 25mg (dose). 25-250mg/day), Chlorpromazine 25mg )50-250mg/day).
Atypical antipsychotics: Atypical antipsychotics come after typical antipsychotics. The drug acts on both dopamine D2 along with serotonin, histamine H1, muscarin, alpha 1. This group of drugs is used for outpatient treatment because of fewer side effects than older drugs. Common atypical antipsychotics include Ariprazol, Quetiapine, Olanzapine, Risperidon, etc.
Long-acting neuroleptics: Long-acting neuroleptics are indicated for patients who do not adhere to daily medication intake. This medication will be given by injection, spaced 2 to 4 weeks apart. Commonly used long-acting neuroleptics include Fluphenazin, Haldol decanoate, Fluphenazin, Aripiprazole, etc.
Other drug groups: Depending on the symptoms of each case, the doctor may prescribe a combination of drugs such as anxiolytics, antidepressants, beta-blockers, mood-modulating drugs, and drugs. liver support and drugs, pills to nourish nerve cells.

In addition to the above drugs, patients can also be given additional vitamin and mineral supplements to improve their health. For those who cannot eat and drink as usual, it is necessary to feed intravenously and monitor at the hospital.

During the use of the drug, patients and their families should pay attention to unusual manifestations in order to promptly detect side effects of the drug. About 3-6 months, patients need periodic monitoring of blood biochemical tests to detect adverse effects early.

2. Electric shock, transcranial magnetic stimulation

Besides medication, some patients will be treated with electric shock and transcranial magnetic stimulation. Electroconvulsive shock is a method of using controlled electric current to create small vibrations in the brain, thereby helping to regulate neurotransmitter levels and reduce symptoms of psychosis.

Electric shock helps improve symptoms such as suicidal behavior due to hallucinations, paranoia, tonicity, agitation, etc., especially in cases that do not respond to drugs. In addition, patients with persistent hallucinations may be prescribed transcranial magnetic stimulation.

3. Psychotherapy

Psychotherapy is effective for negative symptoms. This method does not give quick results, but it plays an important role in preventing recurrence of the disease. The goal of psychotherapy is to help patients overcome the psychological crisis, stabilize their spirits, and balance their lives.

Depending on each specific case, the specialist will find the appropriate intervention direction. Psychotherapeutic approaches indicated for patients with acute and transient psychotic disorders include:

Individual, group, family psychotherapy
Occupational therapy
Mental rehabilitation

In addition, the patient will be applied more physical therapy to restore function. Thereby, it is possible to limit the risk of disease recurrence and help patients improve their long-term quality of life.

Prevention of acute and transient psychotic disorders

Currently, the exact cause of acute and transient psychotic disorders is unknown. Therefore, the best way to prevent disease is to limit stress in life, and at the same time build a good character to increase adaptability and tolerance to stress.

Measures to help prevent acute and transient psychotic disorders include:

Limit stress in life by sharing with those around you, knowing how to organize, manage time and equip yourself with relaxation measures. For highly traumatic events, early psychotherapy is recommended to avoid long-term damage.
Practice independence, assertiveness, and strength to limit sensitivity and dependence. The above personality traits will help individuals easily adapt to the environment and learn to overcome unfavorable conditions in life.
In case of family history of schizophrenia, bipolar disorder, depression, psychosis, etc., it is necessary to monitor the health of family members for timely detection and treatment.
For those who have suffered from acute and transient psychotic disorders, the family needs to monitor their health and psychological status. Direct patients to a healthy lifestyle, avoid overwork, limit stress, actively treat body diseases (if any), etc. to reduce the risk of recurrence.

Acute and transient psychotic disorders are fairly common psychotic disorders. The disease has a pretty good prognosis if it is treated early and cared for properly. To limit complications, the family should pay attention to taking care of the patient’s physical and mental health.

John Alen

John Alen was born in 1971 and is a doctor in the healthcare and psychology fields with many years of experience. He is currently working at easyhealthylive.com, a leading health and psychology blog. Having studied at Y1 National Medical University named after IM Sechenov, John Alen is using his knowledge and experience to help improve the physical and mental health of people in the United States.