Anxitey-happiness psychosis

Also named anxiety-elation or anxiety-bliss psychosis. A kind of cycloid psychosis.

Proposed criteria

These proposed criteria are probably not definitive. We work hard to make them operative and validated. They are inspired from those put forward by the team of Würzburg, those of Sigmund (1998, 1999) and DRC Budapest-Nashville (Pethö 1988). They were not complemented inputs seminars Gerald Stöber and may be updated from day to day by a wiki page.

Click here to see the present state of the wiki page. Only members are allowed to directly modify the criteria but we encourage any contribution (send a mail).


To make a diagnosis:

  • Evolution criteria has to be fullfilled
  • Criteria for one or both pole have to be met regarding this episode and ALL the former (if many test >= 3 with one of a different pole)
  • None of the exclusion criteria can be met

Criteria of rank A are requiered for the diagnosis.
Criteria of rank B are not requiered but if prensent give further confidence in the diagnosis (shifted to the right).
Clinical symptoms compatible with the diagnosis are just informative and are not part of the criteria.

Evolution criteria

  • Acute onset (<2 weeks) or subacute (1-3 months)
  • Single episode, or other episodes of same or oposite polarity
  • Complete symptomatic recovery with full insight
    • Accentuated personality even when symptom free
    • Switch common during the episode (but can last only a few minutes)

Clinical criteria during the episode

Anxiety pole

  • Pan-anxiety and / or marked pervasive inner tension (reported and / or behavior, facial expression)
  • Ideas of reference or delusional intuition (diffuse threat), in relation with and proportional to the affect
  • Delusional perceptions, hallucinations (auditory, coenesthetic + +, visual), emerging as a consequence to delusional ideass, and supporting them
    • Concern about death without suicidal ideas
    • Suspicion
    • Delusional ideas of guilt and inferiority

    Happiness pole

    • Feeling of extreme happiness, ecstasy (reported and / or behavior, facial expression)
    • Altruistic delusional ideas (to make others happy ...) in relation with and proportional to the affect
    • Perceptual mistakes, illusions in relation to the affect and delusions (auditory, coenesthetic, visual), supporting the affect and the delusion
      • Exaggerated self-esteem because of a feeling of omnipotence, but does not put himself forward (altruistic)

    Various, compatible with the diagnosis but WITHOUT being indicative for it

    • Loosening of associations in the organization of speech (unconcentrated, discursive), the patient returns to the same delusional themes
    • May appear as psychomotor disorders (mutism, stupor) but this behavior is secondary to extreme emotions (facial and body expression)
    • Clouding of consciousness up confusion may occur transiently in all bipolar phenotypes (MDP, cycloid psychoses, unsystematized schizophrenias)
    • Frequent change of global experience: delusional mood or trema, apophany, apocalyptic (Konrad)
    • Sleep and food intake are often reduced during the episode
    • Post-psychotic depression frequently occurs

    Not secondary to

    • Drug intoxication or withdrawal
    • An organic disease
    • A reactive psychosis (reaction to a severe stressor)

    Clinical (symptom that can not be observed)

    • Psychotic symptoms without affective disorder
    • Mixed symptomes in the restricted meaning (i.e. presence of two poles in the same time and in the same psychic sphere, in this case no hyperkinetic body part with akinetic ones)
    • Staring in the middle position
    • True catatonic symptoms according to WKL, i.e. parakinesia, true negativism (i.e. with ambitendance), waxy flexibility (with posture mantenance) ...
    • Persistence after the episode of a language disorder or illogic reasoning (experimental psychic test)
    • Organized paranoia, persecutory delusions with designated persecutor passional delusion as erotomania, jealousy
    • Other mood disorders (mania or melancholia) arising out of the post-episode.
      • Significant reduction of facial expressions (unless trated by significant dose of antipsychotics)

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