Skip to main content Accessibility help
×
Home

Beyond the Kraepelinian dichotomy: acute and transient psychotic disorders and the necessity for clinical differentiation

  • Andreas Marneros (a1)

Summary

The concept of acute and transient psychoses is, together with that of schizoaffective disorders, a challenge by the Kraepelinian dichotomy. Although these conditions have some similarities to schizophrenia, they differ significantly from schizophrenia regarding onset, duration, prognosis, gender and premorbid adaptation. They show some similarities with bipolar disorders. They do not fit into the dichotomous concept.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Beyond the Kraepelinian dichotomy: acute and transient psychotic disorders and the necessity for clinical differentiation
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Beyond the Kraepelinian dichotomy: acute and transient psychotic disorders and the necessity for clinical differentiation
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Beyond the Kraepelinian dichotomy: acute and transient psychotic disorders and the necessity for clinical differentiation
      Available formats
      ×

Copyright

References

Hide All
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM – IV). Washington, APA.
Kraepelin, E. (1920) Die Erscheinungsformen des Irreseins. Zeitschrift für die gesamte Neurologie und Psychiatrie, 62, 129.
Marneros, A. & Pillmann, F. (2004) Acute and Transient Psychoses. Cambridge: Cambridge University Press.
Marneros, A. & Tsuang, M. T. (eds) 1986) Schizoaffective Psychoses. Berlin, Heidelberg, New York: Springer.
Marneros, A., Tsuang, M. T., Andreasen, N. C. (eds) (1995) Psychotic Continuum. Berlin, Heidelberg, New York: Springer.
Strömgren, E. (1986) Reactive (psychogenic) psychoses and their relations to schizoaffective psychoses. In Schizoaffective Psychoses (eds Marneros, A. & Tsuang, M. T.), pp. 260271. Berlin, Heidelberg, New York: Springer.
World Health Organization (1992) The ICD – 10 Classification of Mental and Behavioural Disorders. Clinical Descriptions and Diagnostic Guidelines. Geneva: WHO.

Beyond the Kraepelinian dichotomy: acute and transient psychotic disorders and the necessity for clinical differentiation

  • Andreas Marneros (a1)

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Beyond the Kraepelinian dichotomy: acute and transient psychotic disorders and the necessity for clinical differentiation

  • Andreas Marneros (a1)
Submit a response

eLetters

Acute psychotic presentations and acute psychosis

Anju Kuruvilla, Reader
02 August 2006

We read with interest the editorial on acute psychosis (Marneros, 2006).We agree that the concept of acute psychosis challenges the traditional Kraepelinan dichotomy. Clinical experience suggests that this group is heterogeneous with the only similarity being the acuteness of onset. On longitudinal follow up they separate into different categories; many resolve rapidly, some resolve only to recur again in a similar fashion, while others present differently over time to be reclassified as schizophrenia or mood disorders.

It is therefore difficult to identify demographic or other characteristics that define this group. The majority of patients who received the label in our series were young adults (mean age 29.75 years, s.d.=10.95) and male (52%) (Thangadurai et al, 2006).This is in contrast to that reported by Marneros (2006) who reported a later age of onset and a predominance of women. A large group of our patients were later diagnosed to have affective disorder (9.2%), schizophrenia (26.4%) or recurrent episodes of acute psychosis (11.5%), and others did not present with psychotic symptoms over the follow up period suggesting that it is clearly difficult to predict their response to medication, course and outcome. However, it is well known that acuteness of onset is a good prognostic factor in both schizophrenia and mood disorders.

We would like to argue that the concept of acute psychosis is necessary since many patients may present within a short time of the onsetof their illness, at which point the clinical features may not allow them to be categorized into any of the more classical disorders. Although many patients recover, some relapse with similar acute psychotic presentations,a significant proportion also develop schizophrenia and mood disorders. The difficulty in reaching a diagnosis at the time of the initial presentation is because it is often difficult to recognise the classic syndromes at the onset of the illness. However, these can be identified over time as they develop the syndrome later. Thus, acute psychoses can bea presentation of the more traditional syndromes. They can also be separate clinical entities which may or may not recur over time. Assuming that those who present with acute psychosis conform to a homogenous group does not fit in with clinical reality.

... More

Conflict of interest: None References: Marneros, A. (2006) Beyond the Kraepelinian dichotomy: acute and transient psychotic disorders and the necessity for clinical differentiation. British Journal of Psychiatry,189, 1-2. Thangadurai, P., Gopalakrishnan, R., Kurian, S., Jacob, K.S. (2006). Diagnostic stability and status of acute and transient psychotic disorders. British Journal of Psychiatry, 188, 293.

Write a reply

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *