Psychotic episodes characterized by sudden onset of polymorphous psychotic symptoms and fast resolution have been a subject of interest of many psychiatrists throughout the History. Controversies about the diagnostic criteria and nomenclature of cycloid psychoses persist nowadays, what has hampered its study. In last years, several reports associating this disease with autoimmune pathologies have been published, revealing a possible association between them.

To contribute to the knowledge of cycloid psychoses, reporting a case of motility psychoses and exploring its possible association with autoimmune diseases.

Case report and literature review.

A 48-years-old woman presents a history of eleven admissions at the Psychiatry nursery in the last nineteen years, due to psychotic episodes. Usually, these episodes follow a default in psychopharmacological therapeutic, and are characterized by rapid onset of psychomotor agitation, with prominent nonpurpuseful exuberant movements, incoherent speech, mood oscillations and polythematic delusion. Between these decompensations, she recover her normal functioning, being medicated with lithium and an antipsychotic. During one of her admissions, at 2015, she developed fever and a stuporous state. The magnetic resonance and lumbar puncture were normal, the electroencephalogram revealed generalized lentification. Autoimmunity investigation evidenced positive antithyroid antibodies (with normal thyroid function) and the echography validated the diagnosis of Hashimoto’s thyroiditis.

This case report reveals a possible relationship between cycloid psychoses and Hashimoto’s thyroiditis. We need to share more knowledge to understand if it represents a comorbidity or a pathogenic process with the same etiology, what will influence the treatment of these patients.

No significant relationships.

Ever since the end of the 19th century that descriptions of acute and transient psychosis (ATP) have been found in the literature. Psychiatrists from different countries gave different names for these types of episodes, throughout the ages. Those early descriptions were an important part of the development of the concept of acute and transient psychotic disorders (F23: ICD-10).

This review aims to provide historical background of the development of different concepts to describe ATP.

Non-systematic review of literature on acute and transient psychotic disorders, bouffee delirante, brief psychotic disorder, atypical psychosis.

In 1876, K.Westphal introduced the term akute primäre Verruckheit, refering to a sudden paranoia associated with delusion ideas and hallucinations. In 1895, Magnan described Bouffée delirante, characterized by a recorrent, sudden psychosis with polymorphic symptoms. Later (1924), the term cycloid psychosis was introduced by K.Kleist: phasic psychosis with good prognosis. Different concepts appeared throughout history: psychogenic psychosis (Wimmer,1916); atypical psychosis (Mitsuda,1942), holodisfrenia (Barahona,1957). Nowadays, the classification systems include many of these concepts in the same categories: Schizophreniform disorder, Brief psychotic disorder (DSM-5), and ATP (F23 in ICD-10).

All throughout the History of Psychiatry, there was an evolution of concepts associated to ATP. They were strongly influenced by different time epochs. It is important to have context on the historical background of the concepts used in the contemporaneous Psychiatry. Diagnosis is challenging due to their heterogeneous presentation. There are not many studies available, because of ATP’s low diagnostic stability.

No significant relationships.

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.

When we talk about cycloid psychosis we have doubts about their nosological enclave; whether they should be considered as a subform of schizophrenia or as independent psychoses.Some solutions were proposed, such as the thesis of mixed psychoses (Kretschmer) or that of intermediate forms (Bleuler, Schneider). Cycloid psychoses and bouffée delirante are recognized in ICD-10 under the name of acute polymorphic disorder without symptoms of schizophrenia (F23.0) and with symptoms of schizophrenia (F23.1).

Clinical case

We present the case of a 16-year-old patient with no psychiatric history, with medical background of epilepsy; she was in fllow-up by Neurology and in treatment with valproate.Neurology indicates to stop treatment; it is then whwn the patient begins to appear disoriented, confused, with significant anguish and lability and regressive behaviors.She has sudden mood swings (from laughing to crying); sudden changes in emotional reaction (from distress to anger) and sudden changes in behavior (from agitation to prostration); verbiage with pressure of speech and dysprosodia; delusional ideation and incongruous affect; visual, auditive and kinesthetic hallucinations with important repercussion. We request blood and urine tests, drug test, EEG, cranial MRI.

She presents fluctuating, polymorphic and unstable affective and psychotic symptoms. What is the most appropriate diagnosis? We treat the patient with antipsychotic, mood stabilizer and anxiolytic treatment.

Psychopathology in early ages is not so clearly defined and it can take very different forms. The diagnosis of cycloid psychosis can be useful as well as necessary to describe certain patients with similar characteristics and different from other groups.

No significant relationships.

Acute and Transient Psychotic Disorder (ATPD) is a group of rare psychotic disorders characterized by acute onset, symptom fluctuation and short duration typically followed by complete recovery. Throughout the time, there have been different attempts to classify these disorders (Bouffée Délirante, Cycloid Psychosis, etc.); nevertheless, in the current date, ATPD encompasses a broad spectrum of heterogenous clinical presentations with low diagnostic stability over time.

To describe a case of ATPD, highlighting the variability of its’ psychopathological phenomena and establishing a comparison with historical descriptions of this nosological entity.

Clinical case report and brief review of literature.

V, 20-year old male without psychiatric history, presents in the emergency room exhibiting fluctuant psychopathology over the preceding two weeks – initially with depressive mood, anhedonia, apathy, bizarre behaviors and soliloquies; afterwards, showing paranoid delusional ideation; total insomnia in the previous 2-3 days; finally, showing grandiose delusional ideation; and throughout the episode, revealing pseudohallucinatory verbal activity assuming multiple identities. Several stress factors were identified in close time-relation with the onset of these symptoms. V. started risperidone 2mg 2id and quetiapine 100mg id and was discharged 2 weeks later, fully recovering from these psychopathological phenomena. V. remains asymptomatic at 6 months of follow-up.

Historically, some classifications of this disorder focus on etiological factors, others on clinical evolution and course, and yet another group on separation from the Kraepelinian duality (schizophrenia and bipolar disorder). ATPD is a diagnosis with high clinical heterogeneity and low stability over time, which can have implications in follow-up and long-term outcome.

The pathogenesis of atypical psychoses, in particularly those characterized by polymorphic psychopathology, is hypothesized to be related to disturbances in amino acid metabolism.

In the present study, the role of the amino acid serine was investigated in patients with acute transient polymorphic psychosis.

Patients were loaded with serine and with the amino acids glycine and alanine as controls and subsequently evaluated for the development of psychopathological symptoms. In addition, plasma levels of amino acids were measured.

In a subgroup of patients suffering from atypical psychoses, this biochemical challenge resulted in the reappearance of psychedelic symptoms in particular. Furthermore, significantly lower plasma concentrations of serine were found. In vitro experiments revealed a disturbance in the one-carbon metabolism. In another group of patients the loading provoked vegetative symptoms and fatigue.

Disturbances in amino acid metabolism may be involved in the emergence of certain psychotic disorders.

For at least 125 years the discussion about the clinical relevance of catatonic symptoms in psychiatry continues. It started from the original description by Kahlbaum and was revived by modern factor analytical studies, that identified the catatonic dimension in about 10% of newly admitted patients.

Over a period of 2 years, four patients with an acute episodic psychosis and prominent catatonic symptoms were examined.

A clinical description is given of the psychopathology and classification is performed according to the various diagnostic instruments.

All patients showed a circular fluctuation of their psychoses, with motor symptoms ranging from the excited to the inhibited pole within one episode. Their clinical pictures also comprised mood swings and anxieties as well as hallucinatory and delusional experiences, whereas the course of disease was characterized by complete recovery without residual symptoms.

The significance of catatonic symptoms is not recognized in the current taxonomies despite the fact that this has major pharmacological treatment implications.