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boufèe delirante Boufèe Delirante is a French term meaning "delirous outburst". This culture-bound syndrome is found predominately in West Africa and in Haiti. This syndrome may appear to be an episode of Brief Psychotic Disorder. It is characterized by sudden outbursts of agitated and hostile behavior, followed by marked confusion and psychomotor (movements or muscular activity associated with mental processes) excitment. Sometimes visual and auditory hallucinations and/or paranoid ideation can appear with these episodes.

History In the 1880’s, Valentin Magnan (1835-1916) and his student Maurice Legrain (1860-1939) described for the first time a psychopathological disorder named ‘bouffeè dèlirante des dègènèrès’. Magnan described the disorder of hereditary degenerates. He stressed the occurrence of specific psychotic illnesses of the degenerate. At the end of Magnan’s life, and with the influence of his theory of degeneration diminishing in the early 20th century, the concept of bouffeè dèlirante as largely abandoned. It was Henri Ey (1900-1977) who renewed the interest in the concept of bouffeè dèlirante.

Controversy Bouffeè Dèlirante is a unique syndrome occurring in patients without a history of psychiatric or neurological disorders among people under 30 years of age generally. It can require hospitalization to quickly begin care while the patient is vulnerable. The duration is short. There is a controversy in diagnosing this and ATPD (Acute and Transit Psychotic Disorder).

Being around for more than 100 years, bouffeè dèlirante is the oldest and most influential source for ATPD in the ICD-10 (International classification of mental and behavioral disorders, tenth edition). Bouffeè dèlirante can be best described as a subgroup of ATPD, but less voluminous. It is defined as a psychotic disorder of acute onset (within 2 weeks) and has a short duration (not longer than 3 months). For ATPD to be diagnosed, many major affective disorders, organic disorders and schizophrenia have to be excluded. Seeing how bouffeè dèlirante and ATPD can be so closely related, Pull (1983) set a more definite criterion. This new criteria included:

--the age of onset (between 20 to 40 years of age)

--acute onset without any prior psychiatric history

--no chronicity

--character symptoms of: delusion and/or hallucinations of any type, depersonalization and/or confusion, depression or elation, symptoms varying daily, and no organic mental disorder, alcoholism or drug abuse involved.

However, the criteria purposed by Pull may have been too narrow. So a study was conducted of 1,036 patients. Of these patients treated for psychotic disorders, 42 fulfilled the criteria of ATPD and of those, only 28.6% also fulfilled the criteria of Bouffeè Dèlirante. Therefore, there are indication that a diagnosis of Bouffeè Dèlirante carries a somewhat better prognosis than ATPD, however, the low frequency suggests that the criteria was too narrow for Bouffeè Dèlirante

Prognosis The occurrence of such an episode may require hospitalization in a psychiatric ward while the patient is vulnerable for the patients own protection. The duration is usually very short and if the appropriate treatment and monitoring have been established, the patient may never have a relapse of another episode. The medication used should be administered early to prevent an early relapse, however, it is difficult to prescribe because of the short duration and if it is given to early or to strongly, there may be a move towards depression.