Excited-inhibited confusion psychosis

Also named excitation-retardation psychosis with confusion.

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

Inhibited confusion psychosis

  • Inhibition of thought, emptiness rather than mere slowness, may extend to mutism, almost clouding of consciousness with difficulty in understanding what is happening around them
  • Preservation of motor automatic reflex, reactive and simple mouvement on command, but scarcity of movements requiring reflection: confusion, reactive stupor
  • Ideas of reference and of significance, in connection with a failure to understand what is happening.
  • False perceptions or hallucinations (mostly auditory), secondary to the lack of understanding
    • Helplessness
    • Feeling of unreality
    • Diffuse anxiety in connection with the misunderstanding of what they are living.

Excited confusion psychosis

  • Logorrhea ± pressure of speech and acceleration of thought
  • Incoherence of thematic choice : irrelevent answers, jumping from one theme to the other from sentence to sentence. Distinct from digressive flight of idea in that each thought is held for a while before making a new digressive choice of theme.
  • Superficial and changing ideas of reference or idea of significance
  • Fragmentary and fugitive hallucinations due to the disorder of thought
    • Frequent elation of mood
    • Fugitive and non absurde false recognition of people
    • Disorganized behavior in relation to the thought disorder ± agitated
    • No distractibility relation with the surrounding.

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

  • Clouding of consciousness up confusion may occur transiently in all bipolar phenotypes (MDP, cycloid psychoses, unsystematized schizophrenias)
  • Frequent difficulty in remembering the episode
  • Frequent intense emotional changes (switch)
  • Apparent psychomotor disorders (mutism, stupor) should be interpretable as secondary to the inhibition of thought (facial expression of perplexity)
  • 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

Exclusion criteria

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)

  • 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)
  • Positive symptoms without affectivity
  • 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.
    • Hypomimic (unless under neuroleptic)

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