Acute And Transient Psychotic Disorders Research Articles

Longitudinal course of core cognitive domains in first-episode acute and transient psychotic disorders compared with schizophrenia

Acute and transient psychotic disorder (ATPD) is characterized by acute onset of psychotic symptoms and early recovery. Contrastingly, schizophrenia (SZ) is a chronic mental disorder characterized by impaired functioning including a deficit in cognition. In SZ, the cognitive deficit is among the core symptoms, but in ATPDs, the existing evidence brings mixed results. Our primary aim was to compare three core cognitive domains (executive functioning/abstraction, speed of processing and working memory) of patients diagnosed with ATPD and SZ over a 12-month period. Moreover, we explored how these diagnostic subgroups differed in their clinical characteristics. We recruited 39 patients with a diagnosis of SZ and 31 with ATPD with schizophrenic symptoms. All patients completed clinical and neuropsychological assessments. At baseline, we used a one-way ANCOVA model with a group as the between-subjects factor. Mixed-model repeated-measures ANOVAs with time as the within-subjects factor and group as the between-subjects factor were run to test the overtime differences. At baseline, we did not find any differences in cognition - with sex, education and age as covariates - between ATPDs and SZ. After one year, all patients showed an improvement in all three domains, however, there were no significant overtime changes between ATPDs and SZ. Regarding clinical profiles, ATPDs demonstrated less severe psychopathology and better functioning compared to SZ both at baseline and after 12 months. The medication dosage differed at retest, but not at baseline between the groups. Our findings suggest clinical differences and a similar trajectory of cognitive performance between these diagnostic subgroups.

Predictors of transition to schizophrenia and other long-lasting non-affective psychoses in first-episode patients with acute and transient psychotic disorders: A validation study

Background and objectivesAlmost half of the individuals with a first-episode of psychosis who initially meet criteria for acute and transient psychotic disorder (ATPD) will have had a diagnostic revision during their follow-up, mostly toward schizophrenia. This study aimed to determine the proportion of diagnostic transitions to schizophrenia and other long-lasting non-affective psychoses in patients with first-episode ATPD, and to examine the validity of the existing predictors for diagnostic shift in this population. MethodsWe designed a prospective two-year follow-up study for subjects with first-episode ATPD. A multivariate logistic regression analysis was performed to identify independent variables associated with diagnostic transition to persistent non-affective psychoses. This prediction model was built by selecting variables on the basis of clinical knowledge. ResultsSixty-eight patients with a first-episode ATPD completed the study and a diagnostic revision was necessary in 30 subjects at the end of follow-up, of whom 46.7% transited to long-lasting non-affective psychotic disorders. Poor premorbid adjustment and the presence of schizophreniform symptoms at onset of psychosis were the only variables independently significantly associated with diagnostic transition to persistent non-affective psychoses. ConclusionOur findings would enable early identification of those inidividuals with ATPD at most risk for developing long-lasting non-affective psychotic disorders, and who therefore should be targeted for intensive preventive interventions.

A case report of COVID-19-associated severe psychotic symptoms and suicidal behavior: a late psychiatric intervention

A 25-year-old previously healthy female patient experienced new-onset psychosis and showed suicidal behavior after contracting COVID-19. Based on the International Statistical Classification of Diseases and Related Health Problems (ICD-10), the diagnosis of an acute and transient psychotic disorder (ATPD) was appropriate. Due to poor insight into illness, the patient received an oral solution containing 2 mg/mL haloperidol and fully recovered after the first month of treatment. This is the first case of a COVID-19-associated psychotic episode showing full recovery with late intervention, which occurred nearly 45 days after exhibiting the first psychotic symptoms. Additionally, the patient would require long-term follow-up owing to an ultra-high risk of relapse.

Acute and transient psychotic disorders: A review of Indian research.

Acute and transient psychotic disorder (ATPD) was recognized as separate from other psychotic disorders and described in the International Classification of Diseases (ICD) tenth revision for the first time. A lot of research on ATPD has been conducted in India over the last six decades, but a review focusing exclusively on Indian research on ATPD is not available. This paper aims to review the literature on ATPD emerging from India. A combination of search terms "Acute and Transient Psychosis," "acute psychosis," "non-affective psychosis," "non-affective psychotic disorder," "reactive psychosis," "first-episode psychosis," and "India" were searched on various search engines like PUBMED, Medknow, Hinari, and Google Scholar. We also did a hand search for additional relevant articles, including published abstracts of the Indian Journal of Psychiatry from 2007 to 2023. Relevant papers were selected. The prevalence of ATPD varies across different study settings, and it tends to have an abrupt to acute onset, and is primarily associated with stress. Few studies have assessed the subtypes of ATPD, and symptom profile has been inconsistently reported. There is a lack of trials on the effectiveness or efficacy of antipsychotics in ATPD patients. In a large proportion of patients initially diagnosed with ATPD, the diagnosis remains stable, with recurrence varying from 10% to 46.6% based on the duration of follow-up. There is a need for more multicentric studies, studies with larger sample sizes, and consistency in data about risk factors. There is a need to evaluate symptom profile, course, outcome, and treatment outcomes in patients with ATPD using validated instruments to improve our understanding. Further, there is a need for comparative studies to evaluate the risk factors for ATPD.

Стресові реакції у хворих з розладами спектру шизофренії та комплексний підхід в їх лікуванні

Abstract The psychotraumatic factors that occurred during the war of 2022-2023 significantly affect on the onset and dynamics of schizophrenia spectrum disorders (SSD). Objective. To study the relationship between the influence of stress factors in patients with SSD with the dynamics of exacerbation of psychopathological symptoms and to create complex of treatment and rehabilitation (CTR) for these patients. Methods and materials. There was psychopathological examination of 68 patients with different types of SSD who experienced severe stress during the war and assessed the clinical features of theire psychotic state, and the content of stress factors. Results. In the research the largest number were patients with schizophrenia (Sch, 42.6% of cases), most often with paranoid form with progressive paroxysmal course, as well as patients with acute and transient psychotic disorders (APD), schizoaffective disorder (SchAD) and schizotypal disorder (StD). There were diagnosed affective and delusional symptoms (54.4% of cases) most often as the leading psychopathological reaction to the psychotraumatic stress effects in patients with SSD. Only patients with Sch had the highest incidence of hallucinatory-paranoid syndrome (71.4% of cases). The onset or relapse of a psychotic episode among patients with SSD developed as a result of a significant impact of stress factors with different content, but related to the war in all cases. The most frequent of these were difficulties during evacuation, which caused increasing in family conflicts, especially in patients with Sch and StD. It was found the stressful media impact caused an exacerbation of psychotic symptoms in one third of patients with Sch and StD. There was essential psychotraumatic impact to patients with SSD as of the repeated bombing; the death of relatives; fears experienced during the occupation; inability to continue treatment; and psychotraumatic circumstances associated with the loss of work or no money to live. The CTR for patients with SSD who have been significantly affected by stress based on the analysis of the relationship between nosology, clinical symptoms and stress factors. The aim of the CTR is effective treatment of a psychotic episode or reactive psychotic state, should be steady and consist of the following stages: diagnostic; emergency, outpatient and/or inpatient care; psycho-rehabilitation, as well as support and psychoprophylaxis. Its structure should combine the use of psychopharmacotherapy with psychotherapy (psychocorrection) and psychoeducation, followed support of the patient at the stage of remission.

Urbanicity and Psychosis: Is there a Connection? A Comparative Study between an Urban and Rural Area in Portugal

Introduction: Studies about urbanicity and psychosis show contradictory results. In northern European countries and China there is a positive relationship; in southern European and underdeveloped countries, a significant difference between rural and urban rates of psychosis has not been found. Methods: We carried out a 5‐year retrospective observational study, with patients admitted to two inpatient units for first‐episode psychosis (FEP), in a rural area (Évora) and an urban area (Lisbon). We excluded affective or organic psychosis. Socio‐demographic and clinical data were extracted and analyzed.Results: The prevalence of FEP was the same for both areas (42/100 000 inhabitants), with a predominance of unemployed (63%) and lonesome individuals (81% in Évora versus 72% in Lisbon). The mean age was similar (Évora 43.4 years old; Lisbon 41.4 years old). Lisbon had a greater diversity of nationalities (16.3% vs 4.6%) and a higher rate of psychotic disturbance due to substance use (26.5% vs 21.6%). The most prevalent diagnosis in the Lisbon was unspecified psychotic disorder (UPD) (34.7%), while in Évora it was delusional disorder (DD) (21.5%) and acute andtransient psychotic disorder (21.5%). DD was a prevalent diagnosis in both areas, affecting mainly women and those with a higher median age. Duration of untreated psychosis (DUP) of less than 1 month was higher in Lisbon (24.5% vs 4.5%), but there was a high prevalence of DUP of more than 2 years in both samples (20.4% vs 23.1%). Discussion: The mean age of FEP was higher than in other studies, which may translate a significant prevalence of DD or reflect a higher DUP. A reduced DUP of less than 1 month in the rural area can be explained by greater isolation of the population, lower health literacy or better integration of patients in the community. The prevalence of UPD was higher in the urban area, possibly due to different forms of registration or a lower DUP. Conclusion: Our results are in line with studies reported in southern European countries, where no association was found between psychosis and urbanicity, and further studies are needed to elucidate this issue.

Clinical features and outcomes in acute psychosis: A retrospective hospital-based study in rural patients of central India.

Acute and transient psychotic disorder (ATPD) is a distinct diagnostic category (F23) in ICD-10 which includes non-schizophrenic and non-affective psychoses following a transient course. The clinical features, diagnostic stability, and epidemiology of ATPD have not been adequately explored in the developing countries. The aim was to explore the socio-demographic and clinical characteristics of ATPD as well as examine the diagnostic stability and longitudinal revisions in the diagnosis of ATPD. An observational retrospective study based on 10-year OPD records of ATPD patients was conducted in a tertiary health care center after ethics committee approval. A total of 120 patient records were analyzed for socio-demographic data, clinical symptoms, mental status examination findings, diagnosis on the first visit, and subsequent revisions in the diagnosis. The mean age of ATPD patients was 31.8 (±11.73) years. Delusion was the most common psychiatric symptom in ATPD patients followed by abnormal speech, hallucinations, and disorganized behavior. Antecedent psychosocial stressors were found in 44.2% cases. More than half of ATPD patients (51%) followed up after initial symptom remission and were diagnosed with chronic mental illnesses (schizophrenia or bipolar affective disorder). The ATPD patients experiencing a stressor at the onset of illness were less likely to develop chronic mental illness compared to the ones who did not have antecedent stressors. Irrespective of the genetic and phenomenological distinctiveness of ATPD, which has led to its inclusion as a separate diagnostic category in ICD-10, ATPD is an unstable diagnosis.

A case report of COVID-19-associated severe psychotic symptoms and suicidal behavior: a late psychiatric intervention

A 25-year-old previously healthy female patient experienced new-onset psychosis and showed suicidal behavior after contracting COVID-19. Based on the International Statistical Classification of Diseases and Related Health Problems (ICD-10), the diagnosis of an acute and transient psychotic disorder (ATPD) was appropriate. Due to poor insight into illness, the patient received an oral solution containing 2 mg/mL haloperidol and fully recovered after the first month of treatment. This is the first case of a COVID-19-associated psychotic episode showing full recovery with late intervention, which occurred nearly 45 days after exhibiting the first psychotic symptoms. Additionally, the patient would require long-term follow-up owing to an ultra-high risk of relapse.

Immune-mediated inflammatory markers in acute and transient psychotic disorders-comparison with schizophrenia: An exploratory comparative study.

Considering Acute and Transient psychotic disorders (ATPDs) to be a close entity to Schizophrenia (SZ) with a completely different course and outcome, studies evaluating the immunological abnormalities are scarce in ATPDs. We analysed immune-mediated inflammatory marker levels [Interleukin-2 (IL-2), Interleukin-4 (IL-4), Interleukin-6 (IL-6), Interleukin-8 (IL-8), Interleukin-17 (IL-17) and Tumour necrosis factor-alpha (TNF-α)] in patients with ATPDs (in the acute phase and after remission), and compared these with patients with SZ in remission and with healthy controls. Ninteen subjects with ATPDs in acute phase of illness were age-/gender-matched with healthy controls and patients with schizophrenia in remission; recruited through purposive sampling. Clinical assessment and immune-marker levels were carried out in all the three groups. Follow -up repeat immune-marker levels assessment in the ATPD group was conducted after remission status was ensured. Immune-marker levels were compared across the three groups. Patients with ATPDs had elevated levels of the pro-inflammatory cytokines IL-6 and IL-17 and low levels of IL-8 in the acute phase and low levels of IL-6 and elevated levels of IL-8 during the remission phase. Compared to patients with SZ in remission, patients with ATPD in remission had low levels of all the three pro-inflammatory cytokines (with significantly low IL-6 levels and non-significant, yet low levels of IL-8 and IL-17) and had significantly low and high levels of IL-6 and IL-8 respectively than healthy controls. These findings suggest that there existed immunological abnormalities in the acute and remission phase of illness in patients with ATPDs compared to both patients with SZ in remission and healthy controls.

A Study on Clinical Characteristics and Diagnostic Stability in Acute and Transient Psychotic Disorders

Background and Aim: The acute and transient psychotic disorders (ATPDs) as an independent diagnostic entity have become a subject of nosological debate. Numerous studies considered these psychosis as schizophrenia variants or mood disorders leading to diagnostic instability. The present study aimed to investigate the clinical characteristics and diagnostic stability in acute and transient psychotic disorders. Methodology: A total of 45 acute and transient psychotic disorders diagnosed patients were investigated at Psychiatry and Behavioral Sciences LGH Lahore and Psychiatry unit, Khyber Teaching Hospital Peshawar Pakistan for six months duration from 1st June 2021 to 30th November 2021. All the patients with ages ranging from 17 to 65 years fulfilling ATPDs criteria as per ICD-10 were enrolled. The written informed consent form was taken from the patients’ relatives. Patients with drug intoxication, psychotic illness history, brain disorders, mental retardation, and those taking regular antipsychotic treatment were excluded. Patients were followed up for one month and three months and diagnosis was reevaluated after each follow-up. During the follow-up period, global functioning, clinical manifestations, and quality of life were all evaluated on a regular basis. Results: Of the total 45 ATPD diagnosed patients, male and female patients were 18 (40%) and 27 (60%) respectively. Overall mean age was 29.7±7.9 years. After one month follow-up, the prevalence of ATPD, mood disorder, and schizophrenia was 39 (86.7%), 4 (8.9%), and 2 (4.4%) respectively. After 3 months follow-up, the incidence of diagnosed ATPDs, schizophrenia, and mood disorder were 36 (80%), 5 (11.1%), and 4 (8.9%) respectively. About 36 (80%) patients retained ATPDs whereas diagnosis of psychotic disorders changed in 9 (20%) patients. Conclusion: The acute and transient psychotic disorder was diagnostically stable entity. Patient’s sizable proportion of ATPDs initial diagnosis changed to Schizophrenia-related disorders representing early manifestations. Keywords: Acute and Transient Psychotic Disorders, Schizophrenia, Diagnostic Stability

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Background:Acute and transient psychotic disorder (ATPD) is characterized by an acute onset (within 2 weeks) of delusions and hallucinations causing behavioral disorganization. Neutrophil to lymphocyte ratio (NLR) alteration is an inexpensive subclinical marker to understand the inflammatory pathogenesis of ATPD.Methodology:We investigated the NLR to explore the causative etiology of ATPD using data from psychiatric OPD and ward of Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh. NLR of patients diagnosed with ATPD (F23, ICD-10) was correlated with disease severity assessed using the Brief psychiatric rating scale (BPRS) and Clinician-rated dimensions of psychosis symptom severity scale (CRDPSS) respectively.Result:High NLR was seen in most ATPD patients which corroborated with disease severity and late return to premorbid functioning. Statistical significance of particular(s) will be discussed at the time of presentation.

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Background and Aims:Acute and transient psychotic disorder (ATPD) is a distinct diagnostic category in ICD-10 which includes non schizophrenic and non affective psychoses following a transient course. The clinical features, diagnostic stability and epidemiology of ATPD have not been adequately explored in the developing countries. The objective of this study was to examine the outcome, symptom profile and sociodemographic correlates in the diagnosis of ATPD.Methodology:An observational retrospective study based on 10-year OPD records of ATPD patients was conducted in tertiary health care center. A total of 120 patient records were analysed for sociodemographic data, clinical symptoms, mental status examination findings, diagnosis on the first visit and subsequent revisions in the diagnosis.Result:The mean age of patients was 31.8 (±11.73) years. Delusion was the most common psychiatric symptom in the patients followed by abnormal speech, hallucinations and disorganized behavior. Antecedent psychosocial stressors were found in 44.2% cases. More than half the patients (51%) returned after initial symptom remission and were diagnosed with chronic mental illnesses (schizophrenia or bipolar affective disorder). The patients experiencing a stressor at the onset of illness were less likely to develop chronic mental illness compared to the ones who did not have antecedent stressor.Conclusion:The outcomes of ATPD range from a complete remission following first episode to the development of severe chronic mental illnesses. Hence, irrespective of its genetic and phenomenological distinctiveness, which has led to its inclusion as a separate diagnostic category in ICD-10, ATPD is an unstable diagnosis.

A Case Report on Acute Transient’s Psychotic Disorders

Background: Little is known about acute and transient psychotic disorders (ATPD), a diagnostic category introduced with ICD-10.
 Case Presentation: Acute transient psychotic disorder is a heterogeneous group of disorders characterised by the acute onset of psychotic symptoms such as delusion, hallucination and perceptual disturbances, and by the severe disruption of ordinary behaviour. Patient history: The Male patient 48 year old who was apparently admitted in AVBRH on date 08/05/2021 with chief complaint was Abnormal behaviour( taking clothes off in public ), irritability, aggressive, muttering and smiling to self from 10 days back. His parents once locked him in a room as they fear he might hurt him. He was taken to a faith healer in Pandarkawda twice by his parents. The Baba gave him some mysterious beats like bracelet to wear which eventually decreased his symptoms for 3 days but the symptoms persisted from the fourth day. This time, the Baba mixed a lemon juice, turmeric powder & kumkuma (a powder made from dried turmeric with a bit of slaked lime) and applied all over him eyes which severely inflamed & burnt his eyes. His eye injury elevated his psychotic symptoms which is why his parents took him to psychiatric OPD in AVBRH.
 Past History: Patient was apparently asymptomatic 2 yrs back. He was married to a woman of his parent’s choice. His marriage life was stressful and unhealthy. He was underestimated by his wife due to his low qualification and health problem.
 Clinical Finding: The patient has been undergone with various investigations like culture, blood tests, Physical examination and mental status examination symptomatically with antipsychotic agent and anticonvulsant such as Tab Olanzapine 10mg- HS, Tab Clonazepam 0.5mg – SOS.
 Medical Management: Antibiotic eye drop homatropine and eye ointment ciprofloxacin.
 Nursing Management: Administered fluid replacement i.e DNS and RL, eye care was done with betadine and Normal Saline solutions, eye care by administering eye drops and monitored all vital signs hourly.
 Conclusion: Patient was admitted to hospital with the chief complaint of muttering to self, irritability and eye injury, blisters, pus discharge from eyes and his condition was very critical and patient was admitted in AVBR Hospital ,immediate treatment was started by health team member and all possible treatment were given and now the patient condition is satisfactory.

Case Report on Acute Transient Psychotic Disorder

Introduction: Acute and Transient Psychotic disorder (ATPD) is defined by the ICD-10 as hallucinations, delusions, and/or senseless or nonsensical speech having an acute [1]. The distinguishing characteristic of ATPD is its abrupt onset. Second, there are characteristic symptoms present, and third, there is related acute stress [2].
 Clinical Findings: Sleep disturbance, aggressiveness, muttering to self, irritability, irrelevant talks and loss of appétit, hearing of voices not heard by others, suspiciousness, increased talkativeness, increased energy and fearfulness.
 Mental Status Examination: Conscious, dressed appropriately, well groomed, standing, eye to eye contact initiated, non cooperative, activity normal, and the mood is exhausted, frustrated, the affect is irritable, guarded, and the flow of speech rate is rapid with moderate volume and responsive quality, Thought-flight of thoughts is evident, as are perceptual abnormalities- auditory hallucination, impaired social judgment, and full denial of sickness.
 Outcome: After treatment, the patient shows improvement. Irritability has reduced, sleeping pattern is improved, self muttering has stopped, irrelevant talks are less, and aggressiveness is reduced.
 Conclusion: Patient was admitted to Psychiatric Ward with a known case of Bipolar Affective Disorder and after Mental Status Examination he is diagnosed as Acute Transient Psychotic Disorder with complain of Sleep disturbance, aggressiveness, muttering to self, irritability, irrelevant talks. He improved after receiving adequate treatment, and the treatment was continuously ongoing until my last date of care.

Developing and Validating an Individualized Clinical Prediction Model to Forecast Psychotic Recurrence in Acute and Transient Psychotic Disorders: Electronic Health Record Cohort Study.

Acute and transient psychotic disorders (ATPDs) include short-lived psychotic episodes with a high probability of developing psychotic recurrences. Clinical care for ATPD is currently limited by the inability to predict outcomes. Real-world electronic health record (EHR)-based retrospective cohort study STROBE/RECORD compliant included all individuals accessing the South London and Maudsley NHS Trust between 2006 and 2017 and receiving a first diagnosis of ATPD (F23, ICD-10). After imputing missing data, stepwise and LASSO Cox regression methods employing a priori predictors (n = 23) were compared to develop and internally validate an individualized risk prediction model to forecast the risk of psychotic recurrences following TRIPOD guidelines. The primary outcome was prognostic accuracy (area under the curve [AUC]). 3018 ATPD individuals were included (average age = 33.75 years, 52.7% females). Over follow-up (average 1042 ± 1011 days, up to 8 years) there were 1160 psychotic recurrences (events). Stepwise (n = 12 predictors) and LASSO (n = 17 predictors) regression methods yielded comparable prognostic accuracy, with an events per variable ratio >100 for both models. Both models showed an internally validated adequate prognostic accuracy from 4 years follow-up (AUC 0.70 for both models) and good calibration. A refined model was adapted in view of the new ICD-11 criteria on 307 subjects with polymorphic ATPD, showing fair prognostic accuracy at 4 years (AUC: stepwise 0.68; LASSO 0.70). This study presents the first clinically based prediction model internally validated to adequately predict long-term psychotic recurrence in individuals with ATPD. The model can be automatable in EHRs, supporting further external validations and refinements to improve its prognostic accuracy.

Prognostic significance of psychotic relapse in patients with first-episode acute and transient psychosis: New empirical support for ICD-11

This study examined the impact of psychotic relapse on the diagnostic stability of acute and transient psychotic disorders (ATPD), and how this potential risk factor could differentiate ‘acute polymorphic psychotic disorder without symptoms of schizophrenia’ (APPD; ICD-10 code F23.0) from the remaining non-APPD subtypes (F23.1–9). A two-year cohort study was performed on 68 patients with first-episode ATPD. At the end of follow-up, the diagnostic stability of ATPD was 55.9% and the overall rate of psychotic relapse was 61.8%. Statistical analysis showed that recurrence was an independent risk factor for diagnostic shift in ATPDs (relative risk [RR] = 1.67, 95% confidence interval [CI] = 1.17–2.39; p = 0.005) and that this risk differed among their subtypes insofar as its appearance significantly increased the likelihood of diagnostic change in patients with non-APPD subtypes (RR = 2.52, 95% CI = 1.56–4.07; p < 0.001), but not in those with APPD (RR = 0.95, 95% CI = 0.57–1.57; p = 0.844). Our findings confirm the negative implications of recurrence in patients with ATPD, encourage long-term intervention targeting relapse prevention in this population, and provide new empirical evidence in support of narrowing the ATPD category to APPD in the upcoming ICD-11.

Clinical outcomes in brief psychotic episodes: a systematic review and meta-analysis.

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.

Acute and Transient Psychotic Disorders: Newer Understanding.

We review the ongoing research in the area of acute and transient psychotic disorders (ATPDs) with regard to their nosology, epidemiology, clinical description, genetics, and neurobiology, examining evidence for distinctiveness or otherwise of ATPDs. We further highlight the lacuna in research in ATPDs. Studies on ATPDs as defined in the ICD 10 have been reported from different parts of the world, more so from the developing countries. There is consistent evidence that there exist a group of ATPDs that occur more commonly among females, are often precipitated by stressful life events or exposure to physiological stresses like fever, child birth, are associated with well-adjusted premorbid personality, and show complete recovery in a short period. Although in some cases of ATPDs, there is symptomatic overlap with schizophrenic symptoms in the acute phase, they follow a completely different course and outcome, exhibit genetic distinctiveness, and do not share genetic relationship with schizophrenias or bipolar affective disorder (BPAD). Comparative studies on neurophysiology and neuroimaging in ATPDs and schizophrenias have demonstrated evidence of hyper arousal and hyper metabolism in ATPDs vs hypo arousal and hypo metabolism as noted in the P300 response and on FDG PET studies, respectively. Immune markers such as IL-6, TNF-alpha, and TGF-beta show higher levels in ATPDs as compared to healthy controls. Findings on the neurobiological mechanisms underlying ATPDs, so far, point towards significant differences from those in schizophrenia or BPAD. Although the studies are few and far between, nevertheless, these point towards the possibility of ATPDs as a distinct entity and underscore the need for pursuing alternate hypothesis such as neuro inflammatory or metabolic. Research on ATPDs is limited due to many reasons including lack of harmony between the ICD and DSM diagnostic systems and clinician biases. Available research data supports the validity of ATPDs as a distinct clinical entity. There is also evidence that ATPDs are different from schizophrenias or BPAD on genetic, neuroimaging, neurophysiological, and immunological markers and require further studies.

The prognostic role of catatonia, hallucinations, and symptoms of schizophrenia in acute and transient psychosis

To examine the prospective temporal stability of acute and transient psychotic disorders (ATPDs) and analyze whether there are clinical, psychopathological, or sociodemographic characteristics that predict ATPD diagnostic stability. We conducted a prospective, 2-year, observational study of patients presenting a first-episode ATPD. A multivariate logistic regression model was developed to identify independent variables associated with ATPD diagnostic stability. Well-established predictive factors of diagnostic stability, as well as all the psychopathological features included in the ICD-10 Diagnostic Criteria for Research (DCR) descriptions of ATPD, were analyzed. Sixty-eight patients with a first episode of ATPD completed the study with a diagnostic stability rate as high as 55.9% (n=38) at the end of the follow-up period. Multivariate analysis revealed that diagnostic stability was independently significantly associated with the baseline presence of motility disturbances (OR=6.86, 95% CI=1.10-42.62; P=0.039), the absence of hallucinations (OR=5.75, 95% CI=1.51-21.98; P=0.010), and the absence of schizophrenic features (OR=7.13, 95% CI=1.38-36.90; P=0.019). A symptom checklist assessing these psychopathological features would enable early identification of those subjects whose initial ATPD diagnosis will remain stable over time.

Predictors of diagnostic stability in acute and transient psychotic disorders: validation of previous findings and implications for ICD-11.

Acute and transient psychotic disorders (ATPD) have moderate prospective diagnostic stability. Female gender, older age at onset, good premorbid adjustment, abrupt onset, shifting polymorphic symptomatology and absence of schizophrenic features have been found to be predictive factors of diagnostic stability in ATPDs. Nevertheless, most of these findings need to be replicated. The purpose of this study was to evaluate the diagnostic stability of patients with ATPD, and to determine whether previously accepted predictors of diagnostic stability for ATPD could be externally validated in our cohort. To that end, a prospective 2-year observational study was conducted on patients with first-episode ATPD. Multivariate analysis was performed to determine factors associated with ATPD diagnostic stability at the end of the follow-up period. The following prior knowledge variables were analyzed: female gender, older age at onset, good premorbid adjustment, abrupt onset, shifting polymorphic symptomatology and absence of schizophrenic features. Sixty-eight patients with first-episode ATPD completed the follow-up, of whom 55.9% (n = 38) retained their diagnosis of ATPD at the end of the study. Multivariate analysis revealed that diagnostic stability was independently significantly associated with the presence of shifting polymorphic symptomatology (OR = 7.42, 95% CI 1.65-33.30; p = 0.009) and the absence of schizophrenic features (OR = 6.37, 95% CI 1.47-27.54; p = 0.013) at the onset of the psychotic disorder. Our findings provide empirical support for the ICD-11 proposal restricting the new ATPD category to the acute polymorphic disorder without schizophrenia symptoms.