Bipolar Disorders: Mixed States, Rapid-Cycling, and Atypical Forms

215 Acute and transient psychotic disorderpatients who met the criteria of schizoaffective psychoses (mostly schizomanics)were diagnosed as cycloid. Patients identified as cycloid showed a significantlybetter short-term and long-term outcome than did other psychotic patients.Although the knowledge about epidemiology of cycloid psychotic disorder isstill scanty, Perris assumed that 10–15% of psychotic patients are cycloid.Bouffée déliranteBoufféedélirante is another important synonym given by the WHO for ATPD. It canbe regarded as the French root of ATPD and brief psychoses. The modern concept ofboufféedélirante of francophonic psychiatry is based on operational criteria, includingsudden onset, specific symptomatology, and the evolution of the disorder(Pichot, 1986a; Pullet al., 1983). The concept of the bouffée délirante has beeninfluential in French psychiatry for more than a century (Appia, 1964; Pichot1986a, b). In the 1880s, Valentin Magnan (1835–1916) described for the first timea psychopathological condition named syndromes épisodiques des dégénérées or boufféedélirante des dégénérées. The concept created by Magnan was completed by hispupils Legrain and Saury (Legrain, 1886;Saury,1886; Magnan and Legrain, 1895).It was Henri Ey who renewed interest in the entity of boufféedélirante, which herefined and contrasted to a more narrowly defined concept of schizophrenia (Ey,1954). In this theoretical framework, the bouffée délirante, among other acutepsychoses, displays a level of destructuration intermediate to manic-depressiveillness and schizophrenia. Hallmarks of this intermediate level of psychopathologicaldisturbance are oneiroid phenomena (Ey, 1954). It is this intermediate levelof disturbance that explains the benign prognosis of the bouffée délirante. Thediagnosis conforms with the desire of many French psychiatrists to put more weighton course than on symptomatology and to separate the acute psychoses fromschizophrenia (Pull et al., 1984). Hence, the French psychiatric school, even afterthe incorporation into its nosology of Kraepelinan dementia praecox and later ofBleulerian schizophrenia, has retained the category bouffée délirante asan independent mental disorder (Pichot, 1982). Bouffée délirante has its place inFrench psychiatry, as documented by its inclusion in the classification system of theInstitut National de la Santé et de la Recherche Médicale (INSERM, 1969) and theformulation of operational criteria by Pull et al. (1983, 1984, 1987) andthe continuing publication of case reports, theoretical articles, and clinical studies.The term, however, is not always used very strictly by French psychiatrists (e.g., it hasalso been applied to substance-induced delirious states: Devillières et al., 1996).The operational criteria that have been developed by Pull and his colleagues(1983) are shown in Table 9.8.The frequency of patients found with bouffée délirante was much lower whenapplying the criteria used by Pull and coworkers (1983) than was the frequency of