Cyclical psychosis related to the menstrual cycle is an entity not included in the DSM-V and ICD-10 classifications, however there are data collected in the literature on cases that agree with this diagnosis. When reviewing cases, psychotic symptoms of sudden onset are described a few days before menstruation, with the symptoms resolving in a self-limited way when the bleeding ends. The end of psychotic symptoms is not directly related to the use of antipsychotics. The complete clinical picture is nonspecific and fluctuating. With acute onset, short duration, cyclical repetition, with psychotic symptoms (mutism, confusion, delusions, hallucinations) or a manic episode. We present the case of a 14-year-old adolescent with a history of epileptic seizures in childhood, without current treatment. She goes to the emergency department brought by her father and brother presenting psychomotor agitation, verbiage, flight of ideas, loss of the common thread in the speech, referring delusional ideas with experience of harm. His relatives report that he has not slept for a few days, with soliloquies, unmotivated laughter. They refer that the picture has been repeated in recent months during the days of menstruation.

Knowing a diagnosis not included in the current classifications.

Imaging tests and neurological evaluations rule out organic picture.

Given the periodicity of the condition, the symptoms are self-limiting at the end of menstruation, without a clear relationship with psychopharmacological treatment (although agitation improves).

Cyclical menstrual psychosis approximates affective disorders, especially bipolar disorder in adolescence. The role of psychotropic and hormonal treatment is debatable.

No significant relationships.

Acute psychotic states characterized by clinical lability and dream-like qualities are a staple of classic psychopatology. An excessive focus on diagnostic criteria for bipolar or schizophrenia-spectrum disorders risks missing this particular set of patients; defined through their dynamic presentation as much as by any cluster of symptoms or types of course.

To explore the concept and relevance of oneroid-like cyclic psychosis through a clinical case and review.

We report the case of a 37 year old woman with bipolar disorder (three previous instances of manic episodes with psychotic symptoms) and various gynecological issues that required hormone therapy. After a couple of days having difficulty sleeping, the patient developed a clinical picture consisting of wide and sudden oscillations between hyperactive and inhibited psychomotor activity, moods of dread and ecstasy, and states of disorganized thought and childlike activities with perplexity and mutism. Frequent behaviors as if experiencing visual alucinations and repeated allusions to feeling as if in a dream. These symptoms lasted for 2-3 weeks, after treatment with risperidone and lithium. A narrative review concerning the case was also performed.

Kleist’s ‘innate instability’ permeates much of the previous literature. Similar entities highlight different issues closely related to various biological rhythms: atypical psychosis and epilepsy, puerperal psychosis and estrogen dysregulation, cyclic psychosis and sleep disorders, delirious mania and effectiveness of electro-convulsive-therapy, etc.

Our findings point to the clinical relevance of oneiroid cyclic psychosis as innate instability. Further studies on the role of biological rhythms and its repercussions on daily practice are required.

No significant relationships.