Successful ECT in a case of Leonhard's cycloid psychosis

Mood Disorder or Psychotic Disorder? Yes: A Case Report on Cycloid Psychosis

Cycloid psychosis is a disorder defined by episodic, acute psychoses involving thought, affect, and motor disturbances with polymorphous symptomatology followed by periods of full remission. Antipsychotics, benzodiazepines, and electroconvulsive therapy have been used empirically in acute treatment. This disorder has faced nosologic challenges and is not yet identified as a diagnostic entity by the Diagnostic and Statistical Manual of Mental Disorders (DSM). Questions remain as to whether cycloid psychosis is a primary psychotic or primary affective disorder, given that its course and episodicity are like that of affective disorders, while its clinical manifestations include prominent psychotic symptoms. This report describes the case of a 38-year-old male with classic features of cycloid psychosis and highlights the unique characteristics that distinguish cycloid psychosis from other similar diagnoses.

Emerging cycloid psychosis episodes during COVID-19 pandemic: a case series

AIMS

Cycloid psychosis (CP) is a clinical entity characterized by sudden onset of psychotic polymorphic symptomatology and fluctuant course. It has a reported rate of psychosocial precipitating factors ranging 30-65%. The aim of the study was to describe all cases of CP, admitted in our Psychiatry ward, during the first two months of the COVID-19 pandemic.

METHOD

In this retrospective and observational study, we reported a sample of eight patients who were treated as inpatients in the psychiatric ward of our hospital during the first two months of COVID-19 pandemic (mid-March to mid-May 2020) and compared it with previous years. All our patients fulfilled all four Perris & Brockington criteria for CP. We reported the sociodemographic, clinical and biological parameters.

RESULTS

In our sample, all of the patients had maladaptive personality traits; the major external stressing factor was COVID-19; all our patients had short prodromal symptomatology, short Duration of Untreated Psychosis (DUP) and high score at the Positive Scale at Positive and Negative Syndrome Scale (PANSS-P) at hospital admission with the majority showing psychotic symptoms related to the actual COVID-19 pandemic. The predominant treatment during admission was olanzapine and a short time to full remission of psychotic symptoms was observed in all patients.

CONCLUSION

We found an increase in the admission of patients with CP during the first two months of the actual pandemic. Stress caused by the COVID-19 situation has possibly incremented the frequency of stress-related disorders and it has also influenced its clinical presentation.

Improvement of cycloid psychosis following electroconvulsive therapy

BACKGROUND

The treatment of choice for cycloid psychosis has traditionally been electroconvulsive therapy (ECT), but there is a lack of studies on its effectiveness.

AIMS

The primary aim of this register study was to determine the rates of remission and response after ECT for cycloid psychosis. The secondary aim was to examine possible predictors of outcome.

METHODS

Data were obtained from the National Quality Register for ECT in Sweden. The study population was patients (n = 42) who received ECT for acute polymorphic psychotic disorder without symptoms of schizophrenia or for cycloid psychosis between 2011-2015 in 13 hospitals. Remission and response rates were calculated using Clinical Global Impression-Severity (CGI-S) and -Improvement scores, respectively. Variables with possible predictive value were tested using Chi-square and Fisher's exact test.

RESULTS

The response rate was 90.5%. The remission rate was 45.2%. Of 42 patients, 40 improved their CGI-S score after ECT (p < 0.001). The mean number of ECT treatments was 2.5 for non-responders and 7.0 for responders (p = 0.010). The mean number of ECT treatments did not differ significantly between remitters and non-remitters (7.2 vs 6.1, p = 0.31). None of the other investigated potential predictors was statistically significantly associated with outcome.

CONCLUSIONS

ECT is an effective treatment for cycloid psychosis. Future studies need to compare the outcome of ECT to that of other treatment strategies.

CLINICAL IMPLICATIONS

The high response rate with ECT indicates that cycloid psychosis is a clinically useful diagnosis.

Electroconvulsive Therapy in Functional Hallucination: Scope and Challenges

Functional hallucinations are hallucinations triggered by a stimulus in the same modality and cooccur with it. They are rare in occurrence; however, their rarity has no significance as psychopathology till date. Also, very little is known about the treatment of such hallucinations. Electroconvulsive therapy (ECT) has been tested for several psychiatric illnesses and has a few relative contraindications; however, it has not previously been used in treating functional hallucinations. We report on a female patient with paranoid schizophrenia who experienced functional hallucinations continuously despite the use of adequate risperidone, which controlled other symptoms. She was treated with ECT which resolved the functional hallucinations. The case highlights the need to ponder on the significance of the phenomenon as well as treatment of this psychopathology by ECT. It also underscores ECT as a treatment option for this kind of hallucination.

Cycloid psychosis

This article reviews the concept, nosological status, diagnostic features, associated clinical characteristics, and the etiopathological variables involved in cycloid psychosis. The concept of cycloid psychosis is based on sound psychopathological and course underpinnings, and despite the inclusion of some cycloid features in the current diagnostic systems such as ICD-10 and DSM-IV, these systems do not capture well the diagnostic construct of this disorder. Cycloid psychosis is a valid clinical constructs that can be easily differentiated from the boundary disorders on clinical grounds. It seems to be heterogeneous from the etiopathological point of view, in that a variety of factors seems to be involved to a different degree in most of the patients. Future studies should examine putative subtypes of the disorder in relation to etiological, pathophysiological and clinical variables.

Successful use of ECT as the sole modality of treatment in a case of motility psychosis

Episodic psychoses characterized by predominant abnormalities of movement are called motility psychoses in Leonhard's classification of endogenous psychoses. They have been treated with a variety of methods, including ECT and lithium. Here we describe a case of motility psychosis that was successfully managed with ECT as the only modality of treatment.