INTRODUCTION:

Acute and Transient Psychotic Disorder (ATPD) is a brief psychotic illness characterized by sudden onset of delusions, hallucinations, and disorganized behavior, typically resolving within weeks to three months¹. It often affects individuals with no prior psychiatric history and presents with a polymorphic clinical picture. Psychosocial stressors such as interpersonal conflicts, postpartum changes, or major life events are frequently identified as triggers in ATPD, especially in collectivist cultures where family and social expectations are high^2,3. In India, such stressors have been reported in over 60% of ATPD cases².

Unlike schizophrenia, ATPD features emotional variability, abrupt onset, rapid resolution, and a good prognosis with minimal residual impairment⁴.

Early diagnosis and intervention are critical to prevent complications and ensure full recovery.

This case study highlights a young male who developed ATPD following postpartum family stress. It emphasizes the role of psychosocial factors in triggering acute psychosis and the need for culturally sensitive clinical evaluation.

HISTORY:

The patient was reportedly functioning well up to ten days before admission. He maintained adequate sleep and appetite, had cordial relationships with his family and friends, helped with household chores, and regularly visited their farm for work. His routine life was stable and uneventful.

The changes began after the return of his wife from her maternal home, around fifteen days post-delivery. Within 2–3 days of her return, the patient started showing noticeable behavioural changes. He became increasingly irritable, especially when asked to perform routine tasks or when interrupted by someone. This irritability, which was initially mild, escalated significantly over the following days and led to instances of physical aggression. He became hostile toward his family members and, in one incident, attempted to hit his wife when she requested him to eat food—a situation witnessed and interrupted by his mother. Despite several such episodes, he showed no remorse or guilt and did not apologize for his behavior, instead appearing emotionally indifferent.

During this period, the patient began withdrawing socially. He isolated himself in his room, avoided conversations, and spent most of the day lying in bed and using his phone. Any attempt by family members to interact with him would be met with irritation and demands to be left alone. He consistently avoided eye contact and responded minimally to questions, further indicating emotional detachment.

Over the next 5–6 days, his behavior became increasingly erratic. He started leaving home without informing anyone and was often found wandering alone in the market. When contacted by phone, he would say he was with friends, although he was frequently seen alone. This was in stark contrast to his usual behavior, as he had always informed his family before leaving home. Even repeated phone calls would not ensure his return. Around three days before admission, a family friend noticed him behaving abnormally in the market, talking to himself and expressing a strong desire to go to Delhi. This prompted his brother to forcibly bring him back home.

In the following days, his condition worsened. He began muttering to himself, initially during the daytime, which later progressed to night-time as well. His speech was marked by repetition of certain phrases and responding to unseen stimuli. He often talked about unrelated or incoherent things, and his speech included lines like, “I am not who you think I am.” He would frequently repeat the same sentence over and over and would become irritated when questioned.

Alongside these symptoms, he also exhibited disturbed biological functions. He complained of severe headaches and a sense of tightness in his head. He started lying on the floor, crying continuously, and refusing to eat food. Although he occasionally took food when offered by friends, he would soon stop or get agitated. His overall self-care was poor, and he had stopped engaging in household work, social visits, or farming duties.

His mood throughout this period remained irritable. He avoided any meaningful interaction with family or friends, and his suspiciousness increased to the extent that he even stopped visiting the farm, suspecting people of poisoning his food. Considering the severity of his symptoms, deteriorating functioning, and potential risk to self and others, he was admitted under Section 89 of the Mental Health Care Act (MHCA).

Differential Diagnosis and Investigation:

The client, a thin-built male, was admitted with acute behavioural disturbances, altered mental status, and emotional withdrawal following a significant psychosocial stressor. On the Brief Psychiatric Rating Scale (BPRS), elevated scores in hostility and uncooperativeness indicated marked behavioural and interpersonal dysfunction, with other domains largely unremarkable.

The Mental Status Examination (MSE) revealed drowsiness, reduced psychomotor activity, minimal and repetitive speech, and low responsiveness. He appeared emotionally blunted, showed signs of distress when engaged, and exhibited poor attention, concentration, and memory. Although no overt hallucinations or delusions were noted, his judgment and insight were severely impaired.

Based on the abrupt onset, fluctuating symptoms, lack of psychiatric or substance use history, and prominent emotional and behavioural disturbances, the clinical presentation is most consistent with Acute Transient Psychotic Disorder (ATPD) as per ICD-10/ICD-11. A concurrent consideration is Brief Psychotic Disorder, the DSM-5 counterpart, sharing similar features of acute onset, brief duration, and expected full recovery. Diagnostic categorization depends on the classification system applied.

Treatment:

Following the diagnosis of Acute Transient Psychotic Disorder (ATPD), the patient was started on pharmacological management with Risperidone 2mg at bedtime, Trifluoperazine (THP) 2mg once daily, and Clonazepam 0.5mg at bedtime to manage psychotic symptoms and associated anxiety. In view of persistently elevated blood pressure readings recorded during the first five days of admission, the Medicine department was consulted, and Amlodipine 5mg once daily was prescribed to manage hypertension.

In addition to medical management, the patient also participated in Yoga therapy sessions as part of the hospital’s integrated psychosocial rehabilitation approach. The therapeutic sessions aimed to reduce psychological distress and enhance emotional regulation and body awareness.

The patient repeatedly reported headaches, which were addressed symptomatically and monitored in relation to blood pressure and possible metabolic causes (noting bilateral basal ganglia calcification on CT imaging). Daily clinical observation and supportive nursing care ensured medication adherence and gradual symptom improvement.

Outcome:

Over the course of 23 days of inpatient care, the patient showed steady clinical improvement. Emotional withdrawal, disorganized behavior, and uncooperativeness significantly reduced, and the patient became increasingly cooperative and communicative. Participation in Yoga therapy contributed to emotional stabilization and stress management. Blood pressure was effectively controlled with antihypertensive therapy.

By the end of the second week, the patient had regained orientation, insight into his condition had begun to return, and no further acute behavioural disturbances were noted. With a favourable clinical response, the patient was discharged in stable condition, with advice for regular follow-up, continuation of medications, and further evaluation of chronic headache if needed.

DISCUSSION:

Acute and Transient Psychotic Disorder (ATPD) is characterized by the sudden onset of psychotic symptoms, including hallucinations, delusions, and perceptual disturbances, usually following a significant psychosocial stressor. In our case, the patient developed psychotic symptoms within days of experiencing major familial conflict and academic pressure. Such psychosocial stressors are commonly reported antecedents in ATPD, distinguishing it from schizophrenia and other primary psychotic disorders.⁵

The clinical presentation in ATPD is often polymorphic, with rapidly shifting psychotic features. Our patient demonstrated a fluctuating course, with visual hallucinations, persecutory delusions, and emotional lability all resolving within two weeks of treatment initiation. This temporal and symptomatic pattern is consistent with ICD-10 diagnostic criteria for ATPD, particularly the polymorphic subtype ⁶. These features help differentiate ATPD from affective psychosis and brief psychotic disorder as described in DSM-5, where the stressor or emotional background may not be as prominent or may follow a different temporal course ⁷.

The role of acute psychosocial stress as a precipitant for psychosis is well documented. Individuals with low stress tolerance, limited coping strategies, or those experiencing chronic adversity are at higher risk of developing transient psychotic episodes. In our case, the stressor (academic failure and family conflict) was temporally linked to the psychotic break, supporting the stress–vulnerability understanding of ATPD.

In conclusion, this case underscores the importance of recognizing ATPD as a distinct diagnostic entity, particularly in regions with high psychosocial stress and limited mental health support. Timely identification, stress management, and short-term pharmacotherapy can result in excellent outcomes, as demonstrated in this case.

AUTHOR CONTRIBUTIONS:

Ishfaq Ahmad Rather: I contributed to the conception, patient assessment, literature review, drafting, and finalization of this case report. I take full responsibility for the content and integrity of this work.

CONSENT:

Consent was obtained from parents to publish this case report in accordance with the journal's patient consent policy.

ACKNOWLEDGEMENT:

I sincerely thank the patient and his family for their cooperation and consent to publish this case. I also extend my gratitude to the faculty and clinical supervisors for their guidance and support during the preparation of this case report.

FUNDING:

The authors received no financial support for the research, authorship, and/or publication of this article.

CONFLICT OF INTERESTS:

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

REFERENCES:

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3. Murthy RS, Janaki Ramaiah N. Acute and transient psychosis: A paradigmatic approach. Indian J Psychiatry. 1996; 38:3–9.

4. Susser E, Wanderling J. Epidemiology of nonaffective, nonorganic psychosis in developing countries. Arch Gen Psychiatry. 1994; 51: 905–12.

5. Sartorius N, Jablensky A, Korten A, Ernberg G, Anker M, Cooper JE, et al. Early manifestations and first-contact incidence of schizophrenia in different cultures. Psychol Med. 1986; 16: 909–28.

6. Beards S, Gayer-Anderson C, Borges S, Dewey ME, Fisher HL, Morgan C. A preliminary report on the initial evaluation phase of the WHO Collaborative Study on determinants of outcome of severe mental disorders. Psychol Med. 2013; 43(4): 236

7. Zubin J, Spring B. Vulnerability: A new view of schizophrenia. J Abnorm Psychol. 1977; 86: 103–26.

Received on 24.10.2025 Revised on 29.11.2025

Accepted on 30.12.2025 Published on 30.04.2026

Available online from May 02, 2026

Asian J. Nursing Education and Research. 2026;16(2):134-136.

DOI: 10.52711/2349-2996.2026.00027

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