Diagnostic Stability of Acute and Transient Psychotic Disorders in Developing Country Settings: An Overview.

Shubham Mehta

doi:10.4081/mi.2015.5640

Abstract

Acute and transient psychotic disorders (ATPD), introduced in the International Classification of Diseases (ICD-10) diagnostic system in 1992, are not receiving much attention in developing countries. Therefore, the main objective of this article is to review the literature related to the diagnostic stability of ATPD in developing countries. A PubMed search was conducted to review the studies concerned with this issue in the context of developing countries, as diagnostic stability is more of a direct test of validity of psychiatric diagnoses. Four publications were found. According to the literature search, the stability percentage of the ICD-10 ATPD diagnosis is 63-100%. The diagnostic shift is more commonly either towards bipolar disorder or schizophrenia, if any. Shorter duration of illness (<1 month) and abrupt onset (<48 hours) predict a stable diagnosis of ATPD. Based on available evidence, the diagnosis of ATPD appears to be relatively stable in developing countries. However, it is difficult to make a definitive conclusion, as there is a substantial lack of literature in developing country settings.

Highlights

Acute and transient psychotic disorder (ATPD) as a descriptive entity was recognized for the first time in 1992 in the International Classification of Diseases (ICD-10), which included it under psychotic disorders (F23) as a three digit code.[1]
The duration of psychotic disorders with schizophrenic symptoms is limited to 1 month because F20 schizophrenia requires a period longer than 1 month, whereas if acute psychotic disorders have polymorphic features or nonbizarre delusions, the diagnosis should be changed to F22 persistent delusional disorder after 3 months.[1]
Only four studies have evaluated the diagnostic stability of ATPD in the context of developing country settings with followup period ranging from 12-36 months. 63-100% of patients retained their diagnosis of ATPD at follow-up, suggesting a high diagnostic stability of this diagnosis

Summary

Introduction

Acute and transient psychotic disorder (ATPD) as a descriptive entity was recognized for the first time in 1992 in the International Classification of Diseases (ICD-10), which included it under psychotic disorders (F23) as a three digit code.[1]. The duration of psychotic disorders with schizophrenic symptoms is limited to 1 month because F20 schizophrenia requires a period longer than 1 month, whereas if acute psychotic disorders have polymorphic features or nonbizarre delusions, the diagnosis should be changed to F22 persistent delusional disorder after 3 months.[1]. Acute and transient psychotic disorder is consistently reported to occur in females between early and middle adulthood.[2,3,4] Patients affected with ATPD do not have significant pre-morbid dysfunctions.[5] They are more likely to experience shifting polymorphic features, e.g., hallucinations or delusions of different type, which usually change in either content or intensity from day to day or within the same day.[6] As a group, ATPD has different pattern of illness risk compared to schizophrenia, and different subtypes of ATPD may be genetically heterogeneous.[7]

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