Recurrent brief episodes with psychotic features in adolescence: Periodic psychosis of puberty revisited

There are many reports of adolescents with periodic episodes, each followed by complete remission within 2 weeks; however, the nosology and long-term prognosis of such cases have not been elucidated. A prospective follow-up study on 11 cases (nine girls and two boys) who met predetermined criteria is reported. The first several episodes were found to meet ICD-10 symptomatic criteria for recurrent depressive disorder in all cases and, with the exception of two cases, showed psychotic features. The episodes were linked to one phase of the menstrual cycle in only two of six girls with regular menses. There were no recurrences while on lithium in eight of nine cases. Of nine patients followed up 5–14 years after the first onset, three had been well, three had become bipolar and three were still suffering from brief depressive episodes. Recurrent brief episodes in adolescence tend to show a near-monthly rhythm and psychotic features. Most appear to be manifestations of affective illness and may be treated and prevented as such.