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

217 Acute and transient psychotic disorderStrömgren (1986), the reactive/psychogenic psychoses include emotional syndromes(depressions, excitations), syndromes with disturbance of consciousness(delirious states, dissociative states, twilight states, fugues), and paranoid (delusional)states (sensitive delusions of reference, litigious paranoia, incarcerationpsychoses, delusional psychoses in the deaf, and delusional psychoses in otherforms of sensory deprivation). The original broad concept of reactive psychoses isstill being used in Scandinavia, where up to 13–30% of all psychiatric admissionsare diagnosed with reactive psychosis (Dahl, 1986; Opjordsmoen, 2001). Theconcept has been strongly advocated by Strömgren (1986, 1987). More recently,Ungvari has pleaded for the acceptance of an independent category reactivepsychoses (Ungvari and Mullen, 2000; Ungvari et al., 2000).Dream-like states, independent of organic conditions and not identical toschizophrenia, have been described by Mayer-Gross (1924) in Germany.Schizophrenia-like emotional psychoses were described by Staehelin (1931,1946) and Labhardt (1963) in Switzerland, and emotional psychoses by Störringand by his pupil Boeters in Germany (Störring et al., 1962; Störring, 1969; Boeters,1971). Psychiatrists in Spain, Portugal, Italy, Greece, Hungary, Bulgaria, andRussia described states very similar to those mentioned above (overview inPerris, 1986). They shared clinical and prognostic features with the abovedescribeddisorders.What are acute and transient psychotic disorders?The creation by the WHO of the category of ATPD in the ICD-10, as well as thecreation by the American Psychiatric Association of a category of brief psychosis inDSM-IV, reflects the efforts to gather other psychotic disorders referring in someextent from classical schizophrenia and of course of affective disorders. Bothsystems include them in the ‘‘schizophrenic spectrum.’’ But the WHO, in spiteof creating this new category, remains uncertain about its accuracy:The nomenclature of these acute disorders is as uncertain as their nosological status [ ...]Systematic clinical information that would provide definitive guidance on the classification ofacute psychotic disorders is not yet available, and the limited data and clinical tradition thatmust therefore be used instead do not give rise to concepts that can be clearly defined andseparated from each other. (WHO, 1992).This is quite true, but also a challenge for research on the topic. That became yetanother reason to design and carry out the HASBAP.The most systematic and voluminous study on the topic – the HASBAP – gavesome answers to essential questions which can be found in the first book writtenon the topic (Acute and Transient Psychoses by Marneros and Pillmann, 2004).