2017 Resarch Forum

PSY: C-3

Applicant: Bruce Fox JD MD Principal Investigator: Sarayu Vasan MD MPH

A probable case of cycloid psychosis

Sarayu Vasan MD MPH, Bruce Fox JD MD, Kelsey Stevens MD, Sara Abdijadid DO MS

INTRODUCTION: Karl Kleist coined the term “cycloid psychosis” in 1926, referring to cases of acute onset psychosis with recovery between recurrences. The cases did not meet criteria for schizophrenia, bipolar disorder or depressive disorder. The disorder is episodic, as in bipolar disorder; the acute symptoms are psychotic, as in schizophrenia. Cycloid psychosis, as described by Leonhard, is defined as endogenous psychosis, neither a mood disorder nor schizophrenia. He categorized the diagnosis into three classes: motility psychosis, confusion psychosis, and anxiety-blissfulness psychosis. Brockington and Perris (1982) published diagnostic guidelines for cycloid psychosis as a separate entity, reporting the condition did not equal schizoaffective disorder, despite prevalence of mood symptoms. PURPOSE: This case report values the concept of cycloid psychosis, emphasizing its importance in medical literature and in clinical practice. The authors present a case study of cycloid psychosis in a 50 year old Hispanic female with minimal functional impairment between episodes. CASE: The patient meets the criteria for cycloid psychosis; patient had a series of brief psychotic episodes lasting from a few hours to days over a period of not less than 7 years. Patient’s symptoms varied with each episode: some included prominent mood symptoms, other with primarily psychotic symptoms, and once episode with catatonic features. Patient returned to her baseline functioning between episodes, despite a history of medication non-adherence. DISCUSSION: With the onset of the operational diagnostic criteria, the nosological validity of cycloid psychosis was questioned. Was cycloid psychosis its own entity or a spectrum between schizophrenia and bipolar disorder? ICD-10 recognizes “acute and transient psychotic disorder” and DSM-V identifies “schizophreniform disorder” and “brief psychotic disorder.” Both of these classification systems account for acute psychotic syndromes; however, cycloid psychosis is distinct, which supports the theory that this should be categorized as its own disorder. Research began to slow, society became conflicted in the definition, believing this was a variant of either schizophrenia or bipolar disorder. In 2003, Peralta and Cuesta tested the concordance of cycloid psychosis with schizophrenia and mood disorders. Out of the 660 psychotic patients, 68 were diagnosed with cycloid psychosis (Perris’ diagnostic criteria). The accumulated evidence suggests that cycloid psychosis is a separate class; DSM V fails to mention the disorder as a separate diagnostic criterion. CONCLUSION: This disorder produces no residual decline in daily functioning; should medication with significant side effects should be prescribed following discharge? Unlike schizophreniform, it is unlikely to progress to schizophrenia. Cycloid psychosis should be re-examined for clinical diagnostic accuracy; further studies are needed to determine the treatment course of maintenance therapy versus treatment of the acute episode.