Introduction

            The hallmarks of brief reactive psychosis are that it follows a significant stressor in the patient’s life and symptoms last less than one month.

It is a rare disorder that occurs most often in adolescence and early adult-hood. It may be most common in persons in low socioeconomic groups and in patients with previously existing personality disorders. Persons who have experienced disasters or major cultural changes may also be at high risk.

Causes:

A significant psychosocial stressor is a causative factor for this disorder. However, many patients with the disorder have preexisting personality disorders, which may have both biological and psychological bases. Although schizophrenia has not been found to be more common in the relatives of persons with brief reactive psychosis, mood disorders may be more common among them. Psycho-dynamic formulations highlight inadequate coping mechanisms and the possibility of secondary gain in these patients. It has been hypothesized that the psychosis represents a defense, wish fulfillment, or escape related to the specific stressor.

Clinical Features:

The clinical signs and symptoms are similar to those seen in schizophrenia. Emotional volatility, outlandish dress or behavior, screaming and muteness, disorientation, and impaired recent memory may be present. The patient may be unable initially to relate the detail of the precipitating event but later may be able to relate the details.

Course And Prognosis:

            There are no prodromal symptoms before the precipitating stressor. The onset of symptoms is usually abrupt, following the stressor by as little as a few hours. The length of the acute and residual symptoms is often just a few hours or days and is always less than one month. Occasionally, depressive symptoms follow the resolution of the psychotic symptoms. Suicide is a concern during both the psychotic and the post psychotic depressive phases.

Treatment:

            Hospitalization may be necessary for the diagnosis and treatment of the psychosis. The support of the hospital environment may be enough to help the patient recover. Low dose of antipsychotic may be necessary in the first week of the treatment but can be withdrawn as early as possible. Individual, family and group psychotherapy addresses the significance of the specific stress and bolsters established coping mechanisms and encourages new ones. These help the patient cope with the loss of self esteem and confidence. Hypnotic medications may be useful during the first two to three weeks of the disorder.

Introduction

            If a patient’s delusions (false beliefs) have developed out of a close relationship with another person who had previously similar delusions, the new patient is said to be having an Induced psychotic disorder. Induced Psychotic Disorder is rare, and most commonly involves only two Persons.

Induced psychotic disorder is of three types, type one is in which the patient had the same delusion at the same time coincidentally; type two is in which two persons shared aspect of their delusion with each other ; type three is in which there was one dominant person and second more submissive person who absorbed the more dominant person’s delusion.

Induced psychotic disorder is very rare. It is more common in women than men. It may also be more common in low than in high socioeconomic group. Patients with physical disabilities, such as stroke and deafness, may also be at increased risk because of the dependency relationships that can exist for such people. Over 95% of cases involve husband and wife or mother and child. Two brothers, a brother and a sister and a father and a child have been reported less frequently.

Causes:

The cause of this disorder is defined as having a psychological basis. The key ingredients include a dyad of dominant person and a submissive person, a relationship that is closely knit and relatively isolated from the outside world, and mutual gain for both person as. The dominant person has an already established mental disorder with delusion as a symptom. It is hypothesized that the dominant person maintains some contact with the real world` through the submissive one, who then has induced psychotic disorder. The submissive person, in turn, gains the acceptance of the dominant person, whom the submissive person may admire. This admiration for the dominant person may lead to a hatred for that person as well. Such hatred may be turned inward by the submissive person, producing depression and even suicide.

The recipient or passive partner in this psychotic relationship has much in common with the dominant partner because of many shared life experiences, common needs and hopes, and most important, a deep emotional rapport with the partner.

One interpretation of the observation that this disorder affects family members is that there is a genetic basis. A modest amount of data suggests that there is an increased family history of schizophrenia in the relatives of the affected persons.

Clinical Features:

The key symptom is the unquestioning acceptance of the delusion of another person. The delusions themselves are often somewhat in the realm of possibility and usually not as bizarre as in schizophrenia. The content of the delusions is often persecutory (false belief that some one is trying to harm him) or hypochondriac (false belief that he has some physical illness). There may be ideation about suicide or homicide pact, information that must be carefully elicited.

Course And Prognosis:

            Separation of the passive partner with induced psychotic disorder from the dominant one usually results in a rapid and dramatic reduction of symptoms. Recovery rates may be as low as 10 percent. If symptoms continue after separation.

Diagnosis:

            The diagnostic criteria for induced psychotic disorder include the presence of induced delusions that are similar in content to the delusions of the dominant person. The affected person must not have had a psychotic disorder before the inducement of the delusion.

Treatment:

            The initial step in treatment is the separation of the affected person from the source of the delusions, the dominant partner. Significant support may be needed by the patient to compensate for the loss of this person.

The person with induced psychotic disorder should be observed for remission of the delusional symptoms. Antipsychotic drugs can be used if the delusional symptoms have not abated in one or two weeks. Psychotherapy with nondelusional members of the patient’s family should be under taken, and psychotherapy with both the patient with induced psychotic disorder and the dominant partner may be indicated later in the course of treatment. In addition, the mental disorder of the dominant partner should be treated.

Introduction

            Postpartum psychosis is a clinical syndrome that occurs after child birth and is characterized by delusions (false beliefs) and severe depression. Thoughts of wanting to harm the newborn infant or oneself may occur and represent a real danger.

Epidemiology:

Postpartum psychosis occurs in 1 to 2 per 1,000 deliveries. The disorder is fundamentally a disease affecting women, although exceedingly rare cases of postpartum psychosis have been reported in fathers. The risk of a postpartum psychosis is increased if the patient or her mother had a previous postpartum psychiatric illness or if there is a history of a mood disorder in the patient or her family.

Causes:

Most patients with this disorder have an underlying mental illness, most commonly a mood disorder and less commonly schizophrenia. A few cases result from an organic mental syndrome associated with perinatal event. (e.g., infection, drug intoxication, and blood loss). The sudden fall in hormone levels immediately after pregnancy may contribute to the disorder, but treatment with those hormones has not been successful.

Conflicting feeling of the mother about her mothering experience may cause psychosis. Some women may not have wanted to become pregnant; others may feel trapped in an unhappy marriage by motherhood. Marital discord during pregnancy is associated with an increased incidence of illness, husband feels displaced by the child and competitive for the mother’s love and attention.

Clinical Features:

The symptoms usually occur about the third postpartum day. The patient begins to complain of insomnia, restlessness, and feelings of fatigue and shows liability of mood with bouts of tearfulness. Later symptoms include suspiciousness, evidence of confusion, incoherence, irrational statement, and obsessive concerns about wanting to care for the baby, of not loving the baby, and in some cases, of wanting to do harm to the baby, to self or both. Delusional material may involve the idea that the baby is dead or defective. The birth may be denied, and thoughts of being unmarried, virginal, persecuted, influenced, or perverse may be expressed. Hallucinations may occur with similar content and may involve voices telling the patient to kill her baby.

Course And Prognosis:

             The onset of frank psychotic symptoms is usually preceded by prodromal signs, such as insomnia, restlessness, agitation, liability of mood, and mild cognitive defects. Once the full blown psychosis occurs, the patient may be a danger to herself or to her newborn, depending on the content of her delusion and agitation. Patients may kill themselves, or the baby. A favorable outcome is associated with a good Premorbid adaptation, the absence of depression or schizophrenia, and a supportive family network. Subsequent pregnancies are associated with an increased risk of having another episode; however, most episodes occur to primiparas.

Diagnosis:

            The main diagnostic feature of this disorder is the association with postpartum period. Most cases begin within 30 days of giving birth. Symptoms of cognitive impairment associated with mood changes particularly depression, delusions, and hallucinations (hearing voices which do not exist) with content related to the infant or mother. A Premorbid history of the patient’s attitudes about pregnancy and conception, whether the baby was planned, attitudes of the father toward the birth, marital problems, and anticipated life-style changes may be helpful.

Treatment:

            Postpartum psychosis is a psychiatric emergency. Antidepressants are the treatment of choice for depressed postpartum patients. Suicidal patients may require transfer to a psychiatric unit to help prevent a suicide attempt. For patients who suffer manic illnesses, lithium therapy, alone or in combination with an antipsychotic agents are indicated. If mother is on medicines breast feeding may be stopped.

It is usually advantageous for the mother have contact with her baby if she so desires. But these visits must be closely supervised, especially if the mother is preoccupied with doing harm to the infant.

Psychotherapy is indicated after the period of acute psychosis is over. Therapy is usually directed at the areas of conflict that have become evident during the period of evaluation. Therapy may involve helping the patient to accept the mothering role or to accept her angry, jealous feelings toward the child as they relate to her thwarted need to depend on her own mother, changes in environment may help to reduce stress. Most studies report high rates of recovery from the acute phase of illness.