[The development and prognosis of acute psychotic disorders (polymorphic delirium flushes)]

Abstract

The DSM IV classification of brief psychotic disorders and schizophreniform disorders is unsatisfactory because of its purely temporal criteria for diagnosing acute psychotic disorders, which are seen as a preliminary diagnosis to schizophrenia. We thus decided to use a more inclusive concept, with greater diagnostic possibilities, that of the bouffee delirante polymorphe (BDP) or non-specific delusional episode of Magnan, and then analyze its clinical use. This study examines the use of this diagnosis in a walk-in clinic for patients referred to the ER of a general hospital for acute psychiatric pathology. Over an 18-month period, out of 331 hospitalizations, 91 admissions corresponded to the diagnosis of BDP, with median age of 29 years and a median length of stay of 10 days. The initial diagnosis was of needs only approximate and became more specific with longer length of stay, results of response to therapeutic management, more exact phenomenology of the BDP, more information about the days preceding the episode, and a better knowledge of previous psychiatric episodes. Also useful were the immediate triggering circumstances: intellectual deficit, possible absorption of toxic substances, psychologically traumatic events. The subsequent time course showed the following pathologies in order of decreasing frequency: acute psychotic episodes of schizophrenia, delusional manic episodes, acute paranoid episodes, delusional depressive episodes. Finally, there were bona fide acute psychotic episodes meeting the criteria of BDP, which remained isolated or possibly repetitive and of short duration, partly because of pharmacotherapeutic treatment, but also because of an intrinsically favorable prognosis. Such cases are habitually labeled in the literature reactional psychosis, and should be in our opinion considered separate from schizophrenia.