F23.2

F23.2, classified under the ICD-10 system, refers to an acute psychotic disorder with symptoms closely resembling schizophrenia. It is marked by the sudden onset of delusions, hallucinations, and thought disturbances that fulfill diagnostic criteria for schizophrenia but occur for a short duration (less than one month).

The disorder presents as a time-limited condition, distinct from chronic schizophrenia or other psychotic disorders. Early recognition and treatment are crucial for a favorable outcome.

Key features

• Rapid Onset: Symptoms emerge within two weeks.
• Schizophrenia-Like Symptoms: Hallucinations, delusions, and disorganized thinking dominate the clinical picture.
• Short Duration: Symptoms persist for less than one month, with full recovery in most cases.
• Exclusion of Chronic Disorders: Symptoms do not meet the duration or progression criteria for schizophrenia or other chronic psychoses.

Symptoms

Core psychotic features

1. Hallucinations:

Often auditory (e.g., hearing voices), which may comment on actions or issue commands.

Visual or tactile hallucinations can also occur but are less common.

2. Delusions:

• Fixed false beliefs, often paranoid or persecutory.
• Delusions may include thought insertion, broadcasting, or control.

3. Disorganized thinking:

• Speech may be incoherent, tangential, or include loose associations.
• Patients may struggle to organize or express their thoughts clearly.

4. Catatonic behavior:

Episodes of immobility, mutism, or purposeless hyperactivity can occur but are not mandatory for diagnosis.

Emotional and behavioral symptoms

• Emotional Blunting: Reduced emotional expression similar to schizophrenia.
• Irritability or Aggression: May result from paranoia or delusional beliefs.
• Social Withdrawal: Avoidance of interpersonal contact due to mistrust or fear.

Cognitive symptoms

Poor concentration and impaired memory, particularly during acute episodes.

Diagnostic criteria (ICD-10)

To diagnose F23.2, the following must be present:

1. Acute onset: Symptoms develop quickly, typically within two weeks.

2. Schizophrenia-Like Symptoms:

At least one of the following from ICD-10 schizophrenia criteria:

• Persistent auditory hallucinations.
• Delusions of control, influence, or passivity.
• Thought echo, insertion, withdrawal, or broadcasting.
• These symptoms must dominate the clinical picture.

3. Duration: Symptoms last for less than one month.

4. Exclusion of other causes: Symptoms are not due to substance use, mood disorders, or underlying medical conditions.

Differential diagnosis

Accurate diagnosis of F23.2 requires differentiating it from similar psychiatric and medical conditions.

1. Schizophrenia (F20)

• Schizophrenia requires symptoms to persist for six months or more.
• Negative symptoms (e.g., social withdrawal, apathy) are more prominent in schizophrenia.
• F23.2 resolves within one month and lacks chronic progression.

2. Acute polymorphic psychotic disorder (F23.0, F23.1)

• F23.0 lacks specific schizophrenic symptoms like persistent auditory hallucinations or delusions of control.
• F23.1 includes polymorphic symptoms that fluctuate, whereas F23.2 closely mimics schizophrenia without variability.

3. Brief psychotic disorder (DSM-5)

Brief psychotic disorder typically lasts less than one month, similar to F23.2, but may lack the sustained schizophrenia-like symptoms seen in F23.2.

4. Bipolar disorder with psychotic features (F31.2)

• Psychotic symptoms are mood-congruent and occur during manic or depressive episodes in bipolar disorder.
• F23.2 is not associated with significant mood changes.

5. Schizoaffective disorder (F25)

Schizoaffective disorder involves simultaneous mood episodes and psychotic symptoms lasting longer than one month.

6. Substance-induced psychotic disorder (F1x.5)

• Linked to substance use (e.g., amphetamines, hallucinogens) or withdrawal.
• Symptoms resolve with cessation of the substance.

7. Delirium (F05)

Delirium involves altered consciousness, disorientation, and fluctuating cognitive impairment, often due to a medical condition.

Diagnosis

1. Comprehensive history

• Assess the rapid onset and progression of symptoms.
• Explore any history of schizophrenia-like symptoms.

2. Psychiatric evaluation

• Identify core psychotic features such as delusions, hallucinations, and disorganized thinking.
• Evaluate the absence of chronic or mood-related features.

3. Exclusion of other causes

Perform medical examinations and lab tests to rule out:

• Substance-induced psychosis (e.g., toxicology screening).
• Neurological conditions (e.g., brain imaging for tumors or lesions).
• Metabolic imbalances or infections.

4. Monitor duration

• Confirm that symptoms do not persist beyond one month.

Treatment

Pharmacological management

Antipsychotics:

Risperidone, Olanzapine, or Haloperidol to reduce psychotic symptoms.

Benzodiazepines:

Lorazepam or Diazepam to manage agitation or anxiety.

Psychosocial support

• Therapeutic intervention to assist the patient in their condition, developing effective coping strategies.
• Family education to provide a supportive environment for recovery.

Do I need a hospitalization?

May be necessary for severe symptoms or if there is a risk of harm to self or others.

Prognosis

• F23.2 typically has a favorable prognosis, with most individuals recovering fully within one month.
• Early treatment reduces the risk of recurrence or progression to chronic psychosis.
• Recurrences, if they occur, may warrant a reassessment for schizophrenia or related disorders.

Source:

1. World Health Organization. (2016) ICD-10 Version:2016. F23.2 Acute schizophrenia-like psychotic disorder. Available at: https://icd.who.int/browse10/2016/en .
2. Medentic. (2025) ICD-10 – F23.2: Acute schizophrenia-like psychotic disorder. Available at: https://www.medentic.app/en/resources/icd-codes/f23-2 .
3. PMC. (2018) Acute schizophrenia-like psychotic disorder. Indian Journal of Psychiatry, 60(Suppl 2), pp. S238–S243. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC6042983/ .
4. Gesund.bund.de. (2025) ICD-10 code: F23.2 Acute schizophrenia-like psychotic disorder. Available at: https://gesund.bund.de/en/icd-code-search/f23-2 .
5. Charles University, Department of Psychiatry. (n.d.) Acute psychiatric disorders. Available at: https://psychiatrie.lf1.cuni.cz/file/6237/13-acute-psychotic-disorders.pdf .
6. Medentic. (2025) ICD-10 – F23: Acute and transient psychotic disorders. Available at: https://www.medentic.app/en/resources/icd-codes/f23 .
7. BetterHelp. (2024) Acute Psychosis: ICD-10 Code, Symptoms, And Treatments. Available at: https://www.betterhelp.com/advice/psychosis/acute-psychosis-icd-10-code-symptoms-and-treatments/ .