Acute

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Let’s examine the many potential applications of this word of the day: “acute.” From linguistics to geometry, this word can have many applications—such as in the case of an acute accent mark, acute angle, acute sense, and acute pain. Within the field of psychology, however, acute is an adjective used to describe a condition or symptoms an individual is experiencing. The definition of acute in the context of mental health conditions is an illness that occurs quickly, lasts for a short period, and is accompanied by significantly intense symptoms. The symptoms may be so distressing that the individual seeks or requires immediate treatment, also referred to as acute care. 

The opposite of an acute condition is a chronic one. Like a chronic physical ailment, a chronic mental illness is recurrent or lasts for an extended period or indefinitely. That said, a chronic mental health condition can also have acute episodes when symptoms come on quickly and severely. For example, someone with chronic depression may experience an acute episode during which their symptoms become severe and possibly debilitating, even though they were previously able to function alongside their symptoms. 

In addition, some mental illnesses may have alternating chronic and acute phases. For example, schizophrenia is a chronic condition that continues throughout a person’s life. However, a person with schizophrenia may not always display symptoms characteristic of the illness. They may go through periods where symptoms are minimal and have less impact on their functioning. Then, during acute episodes, they may display severe symptoms like hallucinations and delusions.

An acute mental illness comes on quickly and manifests as severe symptoms. While almost any condition can be acute, a few acute mental illnesses are more likely to be, including the following.  

Obsessive-compulsive disorder (OCD) 

While Obsessive-compulsive disorder (OCD)¹ is often regarded as a chronic illness, it can actually follow an acute, episodic, or chronic course. Acute OCD is more likely to occur in children. This is typically referred to as pediatric acute-onset neuropsychiatric syndrome (PANS) or pediatric autoimmune neuropsychiatric disorder associated with streptococcus (PANDAS), depending on its cause. 

A child or teen who develops the condition may have symptoms like acute-onset OCD, panic attacks,² irritability, unrecognizable handwriting, severe separation anxiety, and bedwetting. Obsessive or compulsive behaviors may seem to develop overnight and may be accompanied by an eating disorder or food restrictions. 

Acute stress disorder (ASD)

Acute stress disorder³ is a mental health condition that happens between three days to four weeks after someone experiences a traumatic event, including but not limited to sexual assault, physical assault, a serious car accident, or a natural disaster. Between 6% and 33% of people who experience trauma develop ASD. It is more likely to occur among those who experience a violent event, such as a robbery or mass shooting.

To be diagnosed with the condition, a person must exhibit at least eight of the symptoms outlined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which can fall under five categories: intrusion symptoms, negative mood, dissociative symptoms, avoidance symptoms, and arousal symptoms. Some common symptoms in these categories may include recurring nightmares, intense psychological or physical distress when thinking about the event, memory loss regarding the event, angry outbursts, and hypervigilance. If symptoms manifest for longer than four weeks, a person may be diagnosed with post-traumatic stress disorder (PTSD).⁴ 

Acute depression

According to the American Psychological Association (APA), acute depression is characterized by the sudden onset of depression or a severe episode that is accompanied by more symptoms than are necessary to qualify for a major depressive episode. Acute depression differs from chronic depression in that symptoms come on much more quickly and are more severe. 

Acute schizophrenia

Acute schizophrenia occurs when an individual displays apparent symptoms of schizophrenia⁵—such as hallucinations, disordered behavior, and delusions—rapidly and more severely than normal. Symptoms of acute schizophrenia may fall into one of three categories:

1. Disorganized symptoms: disorganized speech or behaviors that are unusual for the individual 
2. Positive symptoms: thoughts and behaviors the individual doesn’t usually display, such as hallucinations and delusions
3. Negative symptoms: thoughts and behaviors that the individual once displayed but no longer engages in, such as expressing emotions openly and engaging socially

Acute schizophrenia is often just one phase of the condition, along with the prodromal phase and the recovery phase. The acute phase occurs when symptoms come on quickly and are obvious and distressing.

When an individual develops an acute condition, the sudden and severe onset of symptoms may sometimes necessitate acute treatment. The hospital emergency room is often the default option for people experiencing an acute episode, and the most common symptoms or conditions that bring a person to the hospital for this reason include self-harm, suicidal ideation, suicide attempts, depression, and schizophrenia. Acute treatment may also be provided for:

• Manic episodes in bipolar I disorder 
• Delirium
• Psychosis
• Escalating impulsive behavior

Acute treatment may also be recommended for those experiencing symptoms unrelated to a mental health condition like depression or schizophrenia. Acute mental health episodes are sometimes linked to head trauma, extreme physical stress or exhaustion, medication reactions, substance use, or medical complications. 

When an individual seeks care for an acute episode, clinicians can work with them to determine whether they are safe independently or would benefit from acute treatment in a residential facility. Acute residential services offer accommodation and support for individuals who are having an acute mental health episode. They are often staffed 24 hours a day by mental health professionals. These facilities are designed to keep individuals physically safe, and they also offer services including:

• Therapy
• Psychoeducation
• Family education and therapy
• Discharge planning and a crisis safety plan

Although acute treatment can sometimes be necessary to protect individuals experiencing an acute episode, the care is often unpopular and may be traumatic or coercive, especially if provided on an involuntary basis. For example, someone who is at risk of harming themselves or others may be admitted for acute psychiatric inpatient treatment even if they don’t want to go. This admittance allows symptoms to be evaluated, diagnosed, and stabilized while the individual remains physically safe.

For those struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

For the acute mental illnesses listed above, a specific treatment(s) may relieve symptoms and improve quality of life. Below are a few of these treatment options, listed by disorder type. 

Acute OCD

Because PAN and PANDAS are most often caused by strep bacteria, intravenous immunoglobulin (IVIG) is often considered the first line of treatment. IVIG has been suggested to reduce OCD symptoms in 82% of children with PANDAS. However, this treatment is often only recommended for children with severe or persistent cases. 

Currently, the International OCD Foundation suggests that a combination of medical intervention and traditional exposure and response prevention (ERP) may be the most effective treatment for PANDAS. In ERP, children are taught strategies they can apply to ignore their irrational fears and overcome OCD thoughts. 

During ERP, a therapist can teach a child about their condition and learn about their specific symptoms. From there, the therapist can work with them to confront their feared scenarios while refraining from compulsive behavior. ERP often utilizes both imaginal and in vivo exposure. 

Acute stress disorder

Over 80% of people who develop acute dress disorder have PTSD six months later. However, when ASD is diagnosed in time, trauma-focused CBT can reduce an individual’s risk of developing post-traumatic stress disorder—a chronic and potentially debilitating condition. 

Using cognitive behavioral therapy (CBT), people can learn to change their thought patterns and strengthen their coping skills. CBT may also include exposure to the trauma narrative, where the individual tells the story of the traumatic event and identifies the thoughts and feelings they experienced, potentially gaining a sense of control over the event. Trauma-informed modalities like eye movement desensitization and reprocessing therapy (EMDR) and internal family systems (IFS) may also be helpful. 

Acute depression

When a person has depression, the first six to eight weeks of treatment are often considered acute treatment. Acute treatment aims to relieve symptoms to improve the individual’s quality of life. Therapy may also seek to reduce or eliminate symptoms sooner to prevent the depression from having a further impact on the individual’s life. 

During an acute depressive episode, a doctor or therapist may suggest short-term psychological support. Cognitive behavioral therapy is often used. This modality can help the client break negative thought patterns to change distressing beliefs and improve self-esteem. Additional treatments for acute depression may include psychoanalytic approaches or systemic therapy. 

Acute schizophrenia

Medication is often beneficial during the acute phase of schizophrenia, but therapy might help clients better cope with symptoms like hallucinations or delusions. In addition, therapy can help clients adhere to their medication regimens. Standard therapies include CBT, family therapy, and art therapy. 

It is important to consult with a doctor or medical professional before beginning or changing any medication plan. The information provided in this article is not intended as medical advice; please consult a qualified healthcare professional for personalized guidance.