Psychogenic Psychosis Revisited: A Follow up Study

Although brief and acute psychoses are usually dramatic in presentation, they usually have benign course. Studies investigating clinical features and changes in diagnosis between psychotic episodes have differed in design. However, some consistent findings have emerged. This study seeks to clarify and extend these features by describing and comparing clinical diagnostic stability in a group of subjects with first episode psychosis diagnosed as acute psychotic disorder (psychogenic psychosis) followed up for 6 years.

The study comprises a retrospective evaluation of case records of 161 patients admitted for the first time with first episode psychosis. Among this group a subgroup of 69 psychogenic psychoses were followed up with special reference to stability of diagnosis within a period of 6 years.

Forty-six patients (67.6%) were male, 22 (32.4%) were female and data were missing in one case-record. There was no significant statistical difference between gender and diagnosis. The mean age was 27.5 years (13-45 years). There were criteria, which distinguish acute psychotic disorder (psychogenic psychosis). These criteria include acute onset with short duration of untreated psychosis, precipitating factors, adjusted pre-morbid personality, no family history of mental disorder, short duration of admission, full recovery in most of cases, with no further admission. Nearly 80% of the patients have never been admitted again in 6 years time.

Our findings show a high level of agreement with the original concept of psychogenic psychosis; however, these bear little relationship to the DSM-IV (1994) and ICD-10 (WHO, 1993) criteria for brief or acute psychotic disorder.