Abstract
To the Editor
The French nosological concept of bouffée délirante (literally ‘delusional flush or rush’) may define a subgroup of non-affective, acute remitting psychoses with an especially favourable prognosis (Pillmann et al., 2003). To date, relatively little published literature is available about this entity outside France and francophone populations. We wish to contribute a rather intriguing case report of bouffée délirante reactive to a stressful life event.
This was the first presentation to a mental health service for a premorbidly high-functioning 23-year-old vetinary science student, who migrated to Australia from Sri Lanka with their family and who practises Buddhism. The patient had a preoccupation with animals, particularly their late pet dog. From the age of 4 years to the dog’s death almost 1 year previously, they shared a close relationship with their dog to the exclusion of spending time with their peers. The patient presented with a 5-day history of ruminating about the imminent anniversary of their dog’s death and a 3-day history of psychotic symptoms that appear to have begun following a lecture about the ‘human–animal bond’, which the patient found highly distressing.
At initial presentation, the patient was agitated and confused. They described derogatory, second-person auditory hallucinations, delusions of reference from rap songs and social media, as well as persecutory delusions regarding poisoning of their food and people seeking to harm both them and their family. They described derealization and attempted to hang themselves with a view of reunion with their deceased dog. No evidence of a major mood disorder was apparent. The patient had no history of alcohol, prescribed or illicit psychoactive drug use, and no general medical conditions were identified clinically or using laboratory and imaging investigations. The patient’s symptoms completely remitted within 3 days. He was provided with supportive care, several days of benzodiazepine medication and low-dose olanzapine for 2 months.
Non-affective acute remitting psychoses with dramatic phenomenology and favourable prognosis have long been recognized as clinical entities, though nosology and operational criteria vary widely between classification systems (Nugent et al., 2011). While neither necessary nor sufficient for the diagnosis, stressful life events in the period immediately preceding onset have been recognized as a common feature of these diagnoses across time and geographical regions (Susser et al., 1995). A sizeable proportion of cases cannot be meaningfully categorized using the two most widely used classification systems, namely the 10th edition of the International Classification of Diseases and the revised fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (Jablensky, 2001; Nugent et al., 2011). Further research is required to elucidate the validity of prognostically distinct acute remitting psychoses, particularly with respect to their boundaries and relationship with schizophrenia spectrum disorders, posing challenges for contemporary classification systems.