The concept of cycloid psychosis has a long tradition in European psychiatry since it was introduced by Kleist in 1926. Nevertheless, this concept is not included explicitly in modern classifications, leading to a controversial discussion about its utility in current psychiatry.

Starting from a case study, we intend to review the evolution of cycloid psychosis concept and analyze its role in modern psychiatry.

Non-systematic review of the literature and report of a case study.

Following Kleist’s work, Leonhard described the three overlapping subtypes, and later Perris developed the first operational diagnostic criteria. Since then, this entity has shown a high diagnostic stability, validity and a good predictive diagnostic and prognostic value. We report a case of a 30-year-old woman, previous heathy, without regular medication, living with her parents and 5-year-old son, until she emigrated alone to Switzerland. After 10 days abroad, she was sent back to Portugal, and after organic disease and drug misuse exclusion, she was admitted in our inward with a clinical picture of perplexity, anxiety, thinking and behavioral disturbance with persecutory and poisoning delusions, auditory hallucinations, and total insomnia. Following rapid and full recovery, she was discharged 14 days later while being medicated with Paliperidone 3 mg/day and Lorazepam 4 mg/day, which was abandoned by her 2 months later, without relapse of the symptoms.

The current lack of a satisfactory system for categorizing acute, and remittent psychoses seems to be reason enough to remain awareness of this unique diagnostic entity, which is worthy of further investigation.

No significant relationships.

Since the declaration of the COVID-19 pandemic, several studies have demonstrated its considerable psychological impact. The isolation and social distancing, the increased fear of being infected or infecting others and the insecurity generated by the economic impact, could contribute to an increase in the incidence of mental health issues, such as psychotic disorders.

The aim is to discuss four clinical cases in order to provide further evidence on this matter.

We report on three females and one male with no personal psychiatric history who were admitted to a tertiary hospital during the first three months after the declaration of the pandemic. The average age was 44,25 ± 14,97 years.

All patients met the International Statistical Classification of Diseases (ICD-10) criteria for acute and transient psychotic disorder. All of the episodes were triggered by the stress generated from the COVID-19. Complementary tests were unremarkable. They all tested negative for SARS-CoV-2. Rapid discharge with favorable response to relatively low doses of antipsychotics was possible with a mean length of stay of 7,25 ± 2,86 days. In two of the cases the delirious content was predominantly marked by the coronavirus itself.

It has been suggested that the intense psychosocial stress associated with a new life-threatening disease and national lockdown restrictions could be triggers for new-onset psychotic disorders. Some authors have reported cases similar to ours, which means that we could be experiencing and increase in the incidence of psychotic disorders due to the exceptional circumstances we are living around the world.

The ICD-10 acute and transient psychotic disorders (ATPD, F23) without symptoms of schizophrenia are considered predominantly reactive psychotic disorders or affective pathology. However, negative symptoms of schizophrenia may be revealed in some of these cases after the psychotic reduction.

To investigate the association between the developmental characteristics of psychosis and the negative symptoms detection after the psychotic reduction of ATPD without symptoms of schizophrenia.

68 adult inpatients with ATPD without symptoms of schizophrenia (F23.0) were examined. Negative symptoms were assessed with the PANSS negative symptom subscale (PANSS-NSS). The sample was divided into two groups: with PANSS-NSS score>14 (n=12) and with PANSS-NSS score≤14 (n=56), respectively. Clinical-psychopathological, psychometric and statistical methods were applied.

The results of the study are presented in Table 1.

*p<0,001

The probability of negative symptoms detection in ATPD without symptoms of schizophrenia is relatively strongly associated with the family history of schizophrenia, poor premorbid social adaptation and functional decline prior to the psychotic onset.

No significant relationships.