Reactive psychoses revisited

Objective and Method: This paper describes the overlap between reactive (ps ychogenic) psychosis and other brief psychotic episodes, and explores the g radual disappearance of reactive psychoses as a distinct nosological entity from international classifications. Clinical and conceptual issues concern ing reactive psychosis are examined on the basis of a critical review of ma jor classical and modern papers. A brief illustrative case history is also provided. Results: Reactive psychoses are conceptualised as severe disturbances of me ntal state, on occasion chameleon-like in their shifting form and content, arising in response to a stressful event or life situation. Reactive psycho ses have an abrupt onset and usually run their course to complete resolutio n in a matter of days or weeks. Precipitants include overwhelming fear, thr eat of imminent destruction, social isolation (as can occur with imprisonme nt, immigration or deafness), bereavement and intense sexual or interperson al conflicts. The emergence of a reactive psychosis usually occurs against the background of a predisposing vulnerability in terms of personality diso rder, organic impairment, or a history of sensitising experiences, occasion ally operating in combination. Conclusions: The increasing failure to recognise reactive psychoses diminis hes clinical psychiatry because it removes an important opportunity for und erstanding mental disorder in terms of an integration, and totalisation, of developmental history, psychological makeup, social context and current re alities, and in so doing lessens our awareness of the links between psychos is and our common humanity.