Abstract
Patients with brief psychotic episodes (BPE) have variable and fluctuating clinical outcomes which challenge psychiatric care. Our meta-analysis aims at providing a comprehensive summary of several clinical outcomes in this patient group. A multistep systematic PRISMA/MOOSE-compliant literature search was performed for articles published from inception until 1st March 2021. Web of Science database was searched, complemented by manual search of original articles reporting relevant outcomes (psychotic recurrence, prospective diagnostic change or stability, remission, quality of life, functional status, mortality and their predictors) for patients diagnosed with acute and transient psychotic disorders (ATPD), brief psychotic disorders (BPD), brief intermittent psychotic symptoms (BIPS) and brief limited intermittent psychotic symptoms (BLIPS). Random-effects methods and Q-statistics were employed, quality assessment with Newcastle-Ottawa Scale, assessment of heterogeneity with I2 index, sensitivity analyses (acute polymorphic psychotic disorders, APPD) and multiple meta-regressions, assessment of publication bias with funnel plot, Egger's test and meta-regression (psychotic recurrence and sample size). A total of 91 independent articles (n = 94 samples) encompassed 37 ATPD, 24 BPD, 19 BLIPS and 14 BIPS samples, totalling 15 729 individuals (mean age: 30.89 ± 7.33 years, mean female ratio: 60%, 59% conducted in Europe). Meta-analytical risk of psychotic recurrence for all BPE increased from 15% (95% confidence interval (CI) 12-18) at 6 months, 25% (95% CI 22-30) at 12 months, 30% (95% CI 27-33) at 24 months and 33% (95% CI 30-37) at ⩾36 months follow-up, with no differences between ATPD, BPD, BLIPS and BIPS after 2 years of follow-up. Across all BPE, meta-analytical proportion of prospective diagnostic stability (average follow-up 47 months) was 49% (95% CI 42-56); meta-analytical proportion of diagnostic change (average follow-up 47 months) to schizophrenia spectrum psychoses was 19% (95% CI 16-23), affective spectrum psychoses 5% (95% CI 3-7), other psychotic disorders 7% (95% CI 5-9) and other (non-psychotic) mental disorders 14% (95% CI 11-17). Prospective diagnostic change within APPD without symptoms of schizophrenia was 34% (95% CI 24-46) at a mean follow-up of 51 months: 18% (95% CI 11-30) for schizophrenia spectrum psychoses and 17% (95% CI 10-26) for other (non-psychotic) mental disorders. Meta-analytical proportion of baseline employment was 48% (95% CI 38-58), whereas there were not enough data to explore the other outcomes. Heterogeneity was high; female ratio and study quality were negatively and positively associated with risk of psychotic recurrence, respectively. There were no consistent factor predicting clinical outcomes. Short-lived psychotic episodes are associated with a high risk of psychotic recurrences, in particular schizophrenia spectrum disorders. Other clinical outcomes remain relatively underinvestigated. There are no consistent prognostic/predictive factors.
Highlights
Since the 19th century, brief psychotic episodes (BPE) have been characterised as a divergent and shifting nosographic concept, providing a major challenge both for clinical practice and classification
We demonstrated meta-analytically that, at 4.5 years follow-up, about 56% of patients with BPE retained their index diagnosis whereas 44% shifted to other diagnoses, schizophrenia being the most frequent one (21%, 95% confidence interval (CI) 16–25) (Fusar-Poli et al, 2016c)
The inclusion criteria were: (a) original studies, published in English; (b) conducted in individuals meeting Brief intermittent psychotic symptoms (BIPS) or Brief limited intermittent psychotic symptoms (BLIPS) criteria according to Structured Interview for Psychosis-Risk Syndromes (SIPS any version) (McGlashan TH, 2010) or Comprehensive Assessment of At-Risk Mental States (CAARMS any version) (Yung et al, 2006); ATPD according to ICD criteria (World Health Organization, 1992); or brief psychotic disorder (BPD) according to DSM criteria (American Psychiatric Association, 2013) and (c) reporting on at least one of metaanalytic outcomes
Summary
Since the 19th century, brief psychotic episodes (BPE) have been characterised as a divergent and shifting nosographic concept, providing a major challenge both for clinical practice and classification. Their fleeting and dynamical nature constituted an early anomaly within the Kraepelinian dichotomous concept of psychoses World Health Organization includes the concept of acute and transient psychotic disorders (ATPD) in ICD-10 within the group of ‘schizophrenia, schizotypal and delusional disorders’ (World Health Organization, 1992), with six subtypes, including disorders defined by acute. Brief intermittent psychotic symptoms (BIPS) exclude individuals with seriously disorganising and dangerous features (Miller et al, 2003) and extend the duration of brief psychotic symptoms up to 3 months
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