If you’re wondering why you haven’t ever heard of cycloid psychosis, it could be because it’s not included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the diagnostic tool published and periodically updated by the American Psychiatric Association.

“Cycloid psychosis has mainly been described in the European literature, and is not taught in medical schools in the United States,” explains Rif S. El-Mallakh, MD, co-author of an article entitled “Cycloid Psychosis” that appeared in the American Journal of Psychiatry. “It’s not a widely recognized psychotic illness but in most studies, it seems to be clinically and biologically distinct from both severe mood disorders and schizophrenia.”

The term “cycloid marginal psychosis” was first introduced in 1926 to describe cases that didn’t meet the typical presentation of schizophrenia or bipolar affective disorder. Among the conditions were many cases of acute psychotic illnesses that featured a limited duration and a recovery between recurrences. Although the acute features are psychotic, resembling schizophrenia, the course is episodic, as in bipolar disorder, the article noted.1

The clinical features associated with cycloid psychosis include acute stress, disorganized thought, frequently occurring sleep disturbances, and prodromal symptoms, Dr. El-Mallakh says.  Cycloid psychosis, which has a rapid and full recovery between episodes, doesn’t quite fit into a clear diagnostic category, he explains.

“Patients exhibiting this pattern would clinically be assigned to DSM-5’s unspecified psychosis category or brief psychotic disorders,” he writes in the article. “In the psychiatric literature, this type of illness is frequently referred to as ‘cycloid psychosis.’ Most researchers see this category of psychotic illness as a distinct diagnosis from schizophrenic or affective disorders.”

Some experts feel it’s important to differentiate between cycloid psychosis and other mental illnesses such as schizophrenia. “Even among budding psychiatrists, there seems to be a lack of awareness of this unique disorder,” noted Devender Singh Yadav, the author of an article in the Indian Journal of Psychological Medicine. 

“Cycloid psychosis recognition has an important implication in the assessment, investigation, treatment, and effective management of recurrent confusional states with alteration of psychomotor activity and brief psychotic episodes,” the author wrote. “This will help both clinicians and researchers alike.”1

Cycloid Psychosis Symptoms

Cycloid psychosis begins very suddenly, Dr. El-Mallakh explains. “One of the key things about it is that you can be fine today and really psychotic tomorrow and then, within four days of being on medication, the psychosis can resolve,” he says.

The condition can present with symptoms that are similar to schizophrenia, schizoaffective disorder, or posttraumatic stress disorder, Dr. El-Mallakh notes, but it has some key features: the rapid onset, the rapid offset, the generally excellent inter-episode function, and the way that it can recur from time to time.

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Cycloid psychosis, which is more common in young women, rarely presents with hallucinations but delusions are common, Dr. El-Mallakh says. “The person may have paranoia but they don’t generally think someone is after them,” he explains. “They are paranoid and psychotic, and they are also anxious because they are paranoid.”

While it is not thought to be more common in individuals with a family member who has it, cycloid psychosis has not been studied as much as other forms of psychosis. “The exclusion of cycloid psychosis from mainstream diagnostic compendia has hampered research in this category of patients,” Dr. El-Mallakh notes.

Treatment Options

Electroconvulsive therapy (ECT) is an effective treatment for cycloid psychosis but so is medication, Dr. El-Mallakh says. “Treatment with an antipsychotic agent is beneficial in the acute phase, though it is not clear if this will prevent a recurrence,” he says. The mood stabilizer lithium seems to help prevent a recurrence, he says.

“Cycloid psychosis is not diagnosed in the United States, due to differences in the way the DSM was developed, in contrast to the ICD System and others, but the condition as described certainly fits into the bipolar spectrum, and any person who has these symptoms should be considered for a trial with a mood stabilizer,” says Timothy B. Sullivan, MD, Chair of Psychiatry and Behavioral Sciences at Northwell Health/Staten Island University Hospital in Staten Island, New York.

As with any mental illness, cycloid psychosis could be triggered by disruptions in the daily rhythm of life, says Dr. Sullivan.  “A physical illness, changes in your social life, even a change of seasons can be triggers for some people,” he says.

Individuals with cycloid psychosis can be mistakenly diagnosed with schizophrenia, Dr. Sullivan explains, and when this happens, they may be treated solely and too aggressively with antipsychotic medications. This masks the problem, though, he says. “What they may need are mood stabilizers, rather than the high doses of antipsychotics that are also given to persons with manic illness states in the absence of appropriate mood stabilizer therapy,” he says.

Another problem is that when individuals are given an antipsychotic medication they may be told to stay on it for a while without tapering. “This is very debilitating,” Dr. Sullivan says. “The antipsychotic medication may impair initiative and motivation, and make the person feel like a heavy blanket has been thrown over them. Medications should be adjusted over time as illness symptoms and functioning changes.”

Long-Term Outlook

In general, cycloid psychosis is less serious and life-altering than schizophrenia.3 “Cycloid psychosis generally responds quite well and quickly to treatment, and nearly always responds better than both schizophrenia and affective disorders,” Dr. El-Mallakh says. “It generally has a good outcome and patients are usually able to function well in their lives.”

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Last Updated: Jul 25, 2019