ATPD is defined in the ICD‐10 as a polymorphic, predominantly delusional, or schizophreniform psychotic condition characterized by an acute onset (≤2 weeks) and rapid remission (expected within 1–3 months), which is often associated with acute stressful life events. A woman in her 30s was brought to the emergency department in an acute psychotic state. Her mental health had deteriorated rapidly following her attendance to Reiki training two weeks ago (Reiki is a form of alternative medicine called energy healing). She presented as agitated, confused and had disorganised thoughts. She had paranoid, referential, misidentification and bizarre delusions.

This paper reports the case of a 37-year-old woman with stress-induced new-onset psychosis instigated by Reiki practise.

A female patient is described who developed an acute and transient psychosis with polymorphic symptomatology after meditating. Physical examinations, paraclinical testing, and neuroimaging excluded an organic cause of symptoms.

In this case, we wanted to present an example of acute and transient psychosis episodes in which individuals with low psychosis threshold experienced recipient factors such as insomnia, dopaminergic agent (modafinil), practising reiki and meditation.While the family history of the patient, fragile personality structure suggest that the threshold of psychosis may be low; physical fatigue, insomnia, which is common in all 3 episodes, may have triggered acute psychosis.

Our patient recovered completely within 1week after a brief admission and treatment with haloperidol. The real question here is whether the patient needs psychotropic medication for life.

No significant relationships.

This study explores psychopathological aspects of acute and transient psychotic disorders (ATPD), a diagnostic category introduced with ICD-10, to elucidate its relationship with schizophrenia and schizoaffective psychoses.

We recruited all consecutive inpatients fulfilling the ICD-10 criteria of ATPD (F23) during a 5-year period as well as control groups with “positive” schizophrenia (PS) and bipolar schizoaffective disorder (BSAD) matched for gender and age at index episode. For the evaluation of psychopathological parameters during index episode a standardized symptom list was used. Prepsychotic (prodromal) symptoms were also assessed.

During the prepsychotic period few differences between the groups were detected. The most important difference between ATPD and the other two other psychotic disorders regarding phenomenology of the full-blown episodes was a higher frequency of “rapidly changing delusional topics”, “rapidly changing mood” and anxiety in ATPD.

ATPD show a characteristic psychopathological picture consistent with earlier concepts such as cycloid psychoses and bouffée délirante. Nevertheless, psychopathology alone is not enough to establish ATPD as an independent nosological entity.

Acute and transient psychotic disorders (ATPD) are characterized by an acute onset and a remitting course, and overlap with subgroups of the clinical high-risk state for psychosis. The long-term course and outcomes of ATPD are not completely clear.

Electronic health record-based retrospective cohort study, including all patients who received a first index diagnosis of ATPD (F23, ICD-10) within the South London and Maudsley (SLaM) National Health Service Trust, between 1 st April 2006 and 15th June 2017. The primary outcome was risk of developing persistent psychotic disorders, defined as the development of any ICD-10 diagnoses of non-organic psychotic disorders. Cumulative risk of psychosis onset was estimated through Kaplan-Meier failure functions (non-competing risks) and Greenwood confidence intervals.

A total of 3074 patients receiving a first index diagnosis of ATPD (F23, ICD-10) within SLaM were included. The mean follow-up was 1495 days. After 8-year, 1883 cases (61.26%) retained the index diagnosis of ATPD; the remaining developed psychosis. The cumulative incidence (Kaplan-Meier failure function) of risk of developing any ICD-10 non-organic psychotic disorder was 16.10% at 1-year (95%CI 14.83–17.47%), 28.41% at 2-year (95%CI 26.80–30.09%), 33.96% at 3-year (95% CI 32.25–35.75%), 36.85% at 4-year (95%CI 35.07–38.69%), 40.99% at 5-year (95% CI 39.12–42.92%), 42.58% at 6-year (95%CI 40.67–44.55%), 44.65% at 7-year (95% CI 42.66–46.69%), and 46.25% at 8-year (95% CI 44.17–48.37%). The cumulative risk of schizophrenia-spectrum disorder at 8-year was 36.14% (95% CI 34.09–38.27%).

Individuals with ATPD have a very high risk of developing persistent psychotic disorders and may benefit from early detection and preventive treatments to improve their outcomes.