Schizophrenia-related Disorders Research Articles

Pilot randomised trial of a brief intervention for comorbid substance misuse in psychiatric in-patient settings.

ObjectiveThis proof of principle study evaluated the effectiveness and feasibility of a brief motivational intervention, delivered in mental health in‐patient settings, to improve engagement in treatment for drug and alcohol misuse.MethodA randomised controlled trial using concealed randomisation, blind, independent assessment of outcome at 3 months. Participants were 59 new adult admissions, to six acute mental health hospital units in one UK mental health service, with schizophrenia related or bipolar disorder diagnoses, users of community mental health services and also misusing alcohol and/or drugs. Participants were randomised to Brief Integrated Motivational Intervention (BIMI) with Treatment As Usual (TAU), or TAU alone. The BIMI took place over a 2‐week period and encouraged participants to explore substance use and its impact on mental health.ResultsFifty‐nine in‐patients (BIMI n = 30; TAU n = 29) were randomised, the BIMI was associated with a 63% relative odds increase in the primary outcome engagement in treatment [OR 1.63 (95% CI 1.01–2.65; P = 0.047)], at 3 months. Qualitative interviews with staff and participants indicated that the BIMI was both feasible and acceptable.ConclusionMental health hospital admissions present an opportunity for brief motivational interventions focussed on substance misuse and can lead to improvements in engagement.

English

CONTEXT: Family, Twin and Adoption studies show the inheritance patterns of schizophrenia. The findings from these studies provide support to the claim that familial clustering of schizophrenia is a combined expression of genetic and environmental factors. AIMS: Following the line of previous research, this study attempts to find out any difference in the psychiatric morbidity pattern among the first-degree relatives of familial and sporadic schizophrenics. SETTINGS AND DESIGN: We conducted a cross-sectional survey among a convenience sample of 100 first-degree relatives (age between 18 to 55 years) of familial (n=22) and sporadic (n=29) schizophrenics from psychiatric outpatient clinic, of a Government Hospital, India. The schizophrenics satisfied the DSM-IV criteria and all the first degree relatives interviewed never had any psychiatric consultation before or were abusing alcohol or other substances or having any organic pathology. METHODS AND MATERIAL: Informed consent from the patients and relatives was obtained. Survey questionnaires were administered and no personal identifying information was collected. Middle Sex Hospital Questionnaire (MHQ), Eysenck's Personality Questionnaire (EPQ), Multi-Phasic Personality Questionnaire (MPQ) and Screening Test for Co-Morbid Personality Disorders (STCPD) were administered to the participants. STATISTICAL ANALYSIS: The two groups of relatives were then compared on various scales with each other. The chi- square test was used as statistical test of significance p value of≤0.01 was taken as highly significant and≤ 0.05 considered significant observation for all the variables studied. RESULTS: MHQ illustrates that the two groups differ in anxiety, obsession traits, MPQ demonstrates that the two groups highly differ in schizophrenia, anxiety traits, EPQ depicts that the two groups highly differ in psychoticism, STCPD show that the two groups significantly differ in dependent, avoidant, and borderline personality disorders and The two groups highly differ in schizoid - schizotypal personality disorder, less significantly in paranoid personality disorder using diagnostic criteria for schizophrenia related personality disorder. CONCLUSIONS: Significant differences exist between the first-degree relatives of familial and sporadic schizophrenics. Familial clustering of some of the psychiatric disorder and personality factors lent support to the genetic inheritance of traits/ disorder in the first-degree relatives of familial schizophrenics.

English

Mental illnesses are multifactorial disorders caused by the interaction of genetic and environmental factors. Multiple lines of evidence suggest that the roles of genetic and environmental factors depend on each other. The aim of the report is to share the presentation of different psychiatric illnesses in generations of a family. A 31 year old male, unmarried, studied up to class eight, unemployed, muslim, non smoker, with average intelligence, hailing from the Dhaka with lower-middle economic background was diagnosed as a case of Schizophrenia. He has very strong family history of mental illness more prominent in male and persistent in generations. Males were affected by schizophrenia, personality disorder and substance related disorder, whereas only one female was affected by depression with suicide. In the patient’s generation, two males were affected with schizophrenia, two male with personality disorder and two with substance related disorder without any presentation in female. In previous generation one male was affected with personality disorder (Father) and one female was suicide committer due to depression (Aunt). There was also presence of male psychotic patients in the grandmother’s family of the patient. Family, twin and adoption studies have shown that, for schizophrenia, autism, manic depressive illness, major depression, attention deficit hyperactivity disorder, panic disorder and other mental illnesses, the transmission of risk was heredity. Our case strongly made us curious to search for any common genetic link between different mental illnesses running in the family. Key words: Genetic inheritance, gene-environment interaction, case report.

Voluntary and Involuntary Psychiatric Admissions in China.

This study examined admission patterns, including voluntary, involuntary, and partly voluntary admissions to Chinese psychiatric hospitals, in relation to sociodemographic and clinical factors, before a new mental health law was implemented in 2013. Previously admitted patients were interviewed within one week after discharge from 16 psychiatric hospitals across China. Patients' basic sociodemographic and clinical data, including results from the Modified Overt Aggression Scale (MOAS) and the Insight and Treatment Attitudes Questionnaire (ITAQ), were collected. Among 797 patients, 224 (28%) had voluntary admissions, 336 (42%) had involuntary admissions, and 237 (30%) had partly voluntary admissions. Male gender, history of hospitalization, diagnosis of schizophrenia and related disorders, and high MOAS score were the risk factors for involuntary admissions, whereas more years of education, higher ITAQ score, and outpatient treatment before the index admission were its protective factors. A diagnosis of schizophrenia-related disorder and high MOAS score were the risk factors for partly voluntary admission, whereas more education and high ITAQ score were its protective factors. Perception of dangerousness and poor insight about mental illness were significant factors in involuntary psychiatric admissions in China. Factors contributing to the changes in patterns of psychiatric admissions after China's implementation of the mental health law are important topics for further research.

Emergency department use and hospitalizations among homeless adults with substance dependence and mental disorders.

BackgroundHomelessness, substance use, and mental disorders each have been associated with higher rates of emergency department (ED) use and hospitalization. We sought to understand the correlation between ED use, hospital admission, and substance dependence among homeless individuals with concurrent mental illness who participated in a ‘Housing First’ (HF) intervention trial.MethodsThe Vancouver At Home study consisted of two randomized controlled trials addressing homeless individuals with mental disorders who have “high” or “moderate” levels of need. Substance dependence was determined at baseline prior to randomization, using the Mini International Neuropsychiatric Interview diagnostic tool, version 6.0. To assess health service use, we reviewed the number of ED visits and the number of hospital admissions based on administrative data for six urban hospitals. Negative binomial regression modeling was used to test the independent association between substance dependence and health service use (ED use and hospitalization), adjusting for HF intervention, age, gender, ethnicity, education, duration of lifetime homelessness, mental disorders, chronic health conditions, and other variables that were selected a priori to be potentially associated with use of ED services and hospital admission.ResultsOf the 497 homeless adults with mental disorders who were recruited, we included 381 participants in our analyses who had at least 1 year of follow-up and had a personal health number that could be linked to administrative health data. Of this group, 59% (n = 223) met criteria for substance dependence. We found no independent association between substance dependence and ED visits or hospital admissions [rate ratio (RR) = 0.85; 95% CI 0.62–1.17 and RR = 1.21; 95% CI 0.83–1.77, respectively]. The most responsible diagnoses (defined as the diagnosis that accounts for the length of stay) for hospital admissions were schizo-affective disorder, schizophrenia-related disorder, or bipolar affective disorder; collectively reported in 48% (n = 263) of admissions. Fifteen percent (n = 84) of hospital admissions listed substance dependence as the most responsible diagnosis.ConclusionsSubstance dependence was not independently associated with ED use or hospital admission among homeless adults with mental disorders participating in an HF trial. Hospital admissions among this cohort were primarily associated with severe mental disorders.Trial registration: ISRCTN57595077 and ISRCTN66721740

ECOLOGY OF MENTAL EPIDEMICS

Mental epidemics is a new phenomenon of integrative mentality medicine and singular progression. Mental epidemics are contagious polymodal and multiform mental disorders and conditions. The ground of mentality epidemiology is constituted by normative and permanent anomia and permissiveness of singular and crisis reality. There have been separated mechanisms of mental epidemics: deformation of conscience and identity, resonance and induction, anonymity and uncontrollability, generalization and expanded reproduction. There has been proposed a working classification of mental epidemics: dependent and induced, somatoform and psychosomatic, schizophrenia-related and schizoaffective disorders. There have been grounded the principles of a new paradigm of public health and public conscience adaptive protection from mental epidemics based on the synergetic biopsychosociospiritual methodology of mentality medicine as a new psychiatric paradigm of integrative medicine.

Anabolic-androgenic steroid use and psychopathology in athletes. A systematic review.

The use of anabolic-androgenic steroids (AASs) by professional and recreational athletes is increasing worldwide. The underlying motivations are mainly performance enhancement and body image improvement. AAS abuse and dependence, which are specifically classified and coded by the DSM-5, are not uncommon. AAS-using athletes are frequently present with psychiatric symptoms and disorders, mainly somatoform and eating, but also mood, and schizophrenia-related disorders. Some psychiatric disorders are typical of athletes, like muscle dysmorphia. This raises the issue of whether AAS use causes these disorders in athletes, by determining neuroadaptive changes in the reward neural circuit or by exacerbating stress vulnerability, or rather these are athletes with premorbid abnormal personalities or a history of psychiatric disorders who are attracted to AAS use, prompted by the desire to improve their appearance and control their weights. This may predispose to eating disorders, but AASs also show mood destabilizing effects, with longterm use inducing depression and short-term hypomania; withdrawal/discontinuation may be accompanied by depression. The effects of AASs on anxiety behavior are unclear and studies are inconsistent. AASs are also linked to psychotic behavior. The psychological characteristics that could prompt athletes to use AASs have not been elucidated.

Sustained antipsychotic effect of metacognitive training in psychosis: A randomized-controlled study

Persistent psychotic symptoms represent a major challenge for psychiatric care. Basic research has shown that psychotic symptoms are associated with cognitive biases. Metacognitive training (MCT) aims at helping patients to become aware of these biases and to improve problem-solving. Fifty-two participants fulfilling diagnostic criteria of schizophrenia or schizoaffective disorders and persistent delusions and stabilized antipsychotic medication were enrolled in this study. Following baseline assessment patients were randomized either to treatment as usual (TAU) conditions or TAU+MCT. The intervention consisted of eight weekly 1-hour sessions (maximum: 8 hours). Participants were assessed at 8 weeks and 6-months later by blind assessors. Participants were assessed with the Psychotic Symptoms Rating Scales (PSYRATS) and the positive subscale of the PANSS. Between-group differences in post- and pre-test values were significant at a medium effect size in favor of the MCT for the PSYRATS delusion scale and the positive scale of the PANSS both at post and follow-up. The results of this study indicate that MCT training has a surplus antipsychotic effect for patients suffering from schizophrenia-related disorders who demonstrate only a partial response to antipsychotic treatment and that the effect of the intervention persists for at least 6 months after the intervention.

Patterns of psychiatric emergency at tertiary referral psychiatric hospital

Background Psychiatric emergency has been extensively studied over years with different transcultural presentations. Objective The aim of the study was to assess sociodemographic aspects and clinical diagnoses of psychiatric emergency cases attending emergency room (ER) at tertiary referral mental hospital and to study some of the clinical contributions of admitted patients through ER. Patients and methods During 3-month period, 3666 attendants to psychiatric ER were submitted for this cohort study. Patients were submitted to medical assessment and psychiatric evaluation by semistructured clinical interview. Of them, 283 were admitted and further submitted to Mini–Mental State Examination, Brief Psychiatric Rating Scale, and Crisis Triage Rating Scale at ward. Results A total of 3666 patients (2352 male and 1314 female) who were aged 33.44±11.5 years, age range of 8–70 years, with psychiatric emergency attended Al Taif Psychiatric Hospital ER, KSA. The most prevalent psychiatric diagnoses were schizophrenia-related disorders in 30.4%, mood disorders in 28.8%, substance-related disorders in 21.4%, anxiety in 9.6%, developmental disorders (MR) in 3.2%, personality disorders in 0.6%, somatoform disorders in 0.14%, and neurological disorders in 2.2%, whereas 3.3% of ER attendants had no formal psychiatric disorder. The main cause for attending ER was refill of medicine in 31%, followed by natural exacerbation of illness in 26%, then familial conflict in 16%, and finally social problem in 15% of patients. The hospitalization rate was found to be 7.7%; most admitted patients were alert. Hospitalized male patients were found to be more severe and had less social support with little cooperativeness from their families than female patients. Conclusion Psychiatric emergency constitutes a significant route for providing service for mentally ill patients. Family education and early detection of psychiatric disorders minimize the burden of psychiatric illness.

The effect of ziprasidone on metabolic syndrome risk factors in subjects with schizophrenia: a 1 year, open-label, prospective study

Objective:Metabolic syndrome (MetS) is prevalent in subjects with schizophrenia-related psychotic disorders and contributes to increased rates of premature death due to cardiovascular disease. This study examined the impact of switching from another antipsychotic to ziprasidone on the distribution of the number of risk factors for MetS in subjects with schizophrenia or related psychotic disorders.Research design and methods:In this 1 year, open-label, prospective study, all subjects received ziprasidone 40–160 mg/day. Standard exclusion criteria included treatment resistance, physical health disorders, and substance abuse. The primary end point was the percentage of subjects achieving a reduction from baseline of at least one risk factor for MetS at end point (week 52 or premature discontinuation) in the per-protocol population (treated for at least 16 weeks). Secondary end points included the mean change from baseline in number of MetS risk factors, the prevalence of MetS, individual MetS risk factors (waist circumference, blood pressure, fasting triglycerides, high-density lipoprotein cholesterol, and glucose), and 10 year coronary heart disease (Framingham score) risk.Clinical trial registration:www.clinicaltrials.gov: NCT00748566.Main outcome measures:Of 114 evaluable subjects, 58.77% demonstrated one less MetS risk factor at week 52 (last observation carried forward) compared with baseline. Secondary end points also improved, with reductions in other metabolic parameters (fasting low-density lipoprotein cholesterol, total cholesterol and serum insulin, weight, body mass index and glycosylated hemoglobin [HbA1c]). The 10 year coronary heart disease risk decreased continually over time. The open-label and uncontrolled design is a limitation of the study.Conclusions:Ziprasidone treatment reduced both the rate of MetS and its individual risk factors in subjects with schizophrenia and related psychotic disorders. The results have implications for the selection of first-line treatments in schizophrenia and related psychotic disorders, and provide treatment options for subjects who have developed MetS as a result of other antipsychotics.

Porous Diagnostic Boundaries: A New Emphasis for the Bulletin

Porous Diagnostic Boundaries: A New Emphasis for the Bulletin

Improving patient adherence in schizophrenia and schizophrenia-related disorders.

Improving patient adherence in schizophrenia and schizophrenia-related disorders.

NMDA receptor antagonists interventions in schizophrenia: Meta-analysis of randomized, placebo-controlled trials

BackgroundWe examined whether N-methyl d-aspartate (NMDA) receptor antagonists as adjunctive therapy have therapeutic potential for schizophrenia treatment. MethodSystematic review of PubMed, Cochrane Library, PsycINFO and Google Scholar up until October 2012 and meta-analysis of randomized placebo-controlled trials were performed. Risk ratio (RR), 95% confidence intervals (CI), numbers-needed-to-harm (NNH), and standardized mean difference (SMD) were calculated. ResultsResults were across 8 studies and 406 patients (85.5% schizophrenia related disorder and 14.5% bipolar disorder) were included (amantadine: 5 trials and 220 patients, memantine: 3 trials and 186 patients). NMDA receptor antagonists (NMDAR-ANTs) as adjunctive therapy were not superior to placebo in overall (SMD = −0.25, CI = −0.72, 0.23, p = 0.31, N = 6, n = 347), positive symptoms (SMD = −0.20, CI = −0.70, 0.31, p = 0.44, N = 4, n = 205), and negative symptoms (SMD = −0.69, CI = −1.65, 0.27, p = 0.16, N = 4, n = 205), and Clinical Global Impression Severity scale (SMD = −0.27, CI = −1.20, 0.65, p = 0.56, N = 3, n = 177). There was also no significant difference in discontinuation rate between NMDAR-ANTs and placebo treatments (all cause: RR = 1.23, CI = 0.89–1.70, p = 0.20, N = 8, n = 396, side effects: RR = 1.86, CI = 0.84–4.13, p = 0.13, N = 6, n = 359, inefficacy/worsening psychosis: RR = 0.70, CI = 0.20–2.38, p = 0.56, N = 7, n = 380). However, memantine was favorable compared with placebo in Mini-Mental State Examination in schizophrenia (SMD = −0.77, CI = −1.27, −0.28, p = 0.002, N = 3, n = 71). While NMDAR-ANTs caused weight loss compared with placebo (SMD = −0.42, CI = −0.73, −0.11, p = 0.008, N = 3, n = 165), amantadine caused more frequent insomnia than placebo (RR = 3.83, CI = 1.41–10.38, p = 0.008, NNH = 9, p = 0.002, N = 2, n = 147). ConclusionOur results indicate that NMDAR-ANTs as adjunctive therapy may improve cognitive function in patients with schizophrenia. Because the included studies were small, a replication study using larger samples is needed.

Is T‐helper type 2 shift schizophrenia‐specific? Primary results from a comparison of related psychiatric disorders and healthy controls

An imbalance between T-helper type 1 (Th1) and type 2 (Th2) cytokines has been implicated in schizophrenia, although empirical evidence is rare. The aim of this study was to examine if a Th1/Th2 imbalance occurs in schizophrenia and schizophrenia-related disorder. Twenty-six subjects with schizophrenia, 26 subjects with schizophrenia-related disorders, and 26 healthy controls were recruited. The Human Th1/Th2 Cytokine Cytometric Bead Array Kit-II was utilized to assess serum Th1/Th2 cytokines and ratios simultaneously. MANOVA was used to detect differences among the three diagnostic groups in distinct Th1/Th2 cytokines/ratios. Pearson/Spearman correlations were used to examine the relationships between distinct Th1/Th2 cytokines/ratios and clinical/psychopathological data in schizophrenia. Interferon (IFN)-γ/interleukin (IL)-4, IFN-γ/IL-10, IL-2/IL-4, and tumor necrosis factor (TNF)-α/IL-4 ratios were significantly decreased in schizophrenia, but not in schizophrenia-related disorders compared to healthy controls. IFN-γ/IL-4 and IFN-γ/IL-10 in schizophrenia subjects positively correlated with age, but not in schizophrenia-related disorder subjects or in healthy controls. A clear Th2 shift was observed in schizophrenia, but not in schizophrenia-related disorders. The Th2 shift in schizophrenia appeared to be an aberrant developmental phenomenon.

Delusional Misidentification Syndromes in Obsessive–Compulsive Disorder

Delusional misidentification syndromes (DMS) have been rarely reported in patients with conditions other than schizophrenia-related disorders, diffuse brain disease (dementia) and focal neurological illness. In this report, we describe DMS (i.e. Capgras and Fregoli syndromes) in two patients with severe and treatment resistant obsessive-compulsive disorder (OCD), one with paranoid personality disorder (PPD) and the other with a pervasive developmental disorder (PDD) not otherwise specified. While our findings highlight an interesting phenomenon (the occurrence of DMS in OCD), it is presently unclear whether this association is rare or underreported. Misidentification syndromes might be the ultimate result of a combination of obsessive fears and preexisting cognitive bias/deficits, such as mistrustfulness (in PPD) or poor theory of mind (in PDD).

Measurement of waist circumference at different sites affects the detection of abdominal obesity and metabolic syndrome among psychiatric patients

There is a lack of understanding about the impact of different waist circumference (WC) measurements on the detection of abdominal obesity and metabolic syndrome in psychiatric patients. This cross-sectional study included a total of 382 inpatients with schizophrenia-related disorders to assess each component of metabolic syndrome. WC was measured at the lowest rib, midpoint between the iliac crest and lowest rib, iliac crest, minimal waist, and umbilicus. Logistic regression analysis was performed to examine the ability of WC at each site to predict the presence of metabolic risk clustering. The mean WC values for all sites were significantly different from each other. The measurement site had an influence on the prevalence of abdominal obesity (30–38.2% in men and 53.9–86.3% in women). The influence on the prevalence of metabolic syndrome was greater with the International Diabetes Federation (IDF) criteria (19.3–23.9% in men and 29.4–43.1% in women) than with the Adult Treatment Panel III (ATP III) criteria (26.1–28.6% in men and 37.3–44.1% in women). The areas under the receiver operating characteristic curve for metabolic risk clustering were highest at the umbilicus and midpoint. Given that the WC measurement protocol has substantial influence on the prevalence of abdominal obesity and metabolic syndrome, a predefined measurement site is required for all psychiatric studies.

SCHIZOPHRENIA SPECTRUM PERSONALITY DISORDERS

One of the most important consequences of the genetic studies of schizophrenia is that the schizophrenic disorder cannot be restricted to the diagnostic criteria of schizophrenia but also consists of the spectrum of disorders somewhat similar to schizophrenia itself. Defining the individuals susceptible to schizophrenia became an important research topic in assessing the borders of the spectrum of disorders somewhat similar to schizophrenia and in explaining the ethiopathogenesis of schizophrenia. As a result of these researches, the term “schizophrenia spectrum” was suggested to represent schizophrenia related disorders, including individuals susceptible to schizophrenia. While certain personality disorders were the non-psychotic part, schizophrenia represented the most severe and psychotic part of the spectrum. In fact a few years before the term “schizophrenia spectrum”, a condition called “schizotaxia” was described as an ambiguous and mild brain dysfunction syndrome, which was not viewed as psychotic, but contained negative symptoms and neuropsychologic disorders on genetic liability basis. And with the term schizotaxia, delineation of schizophrenia spectrum personality disorders has been initiated. The aim of this overview is to give information about schizophrenia spectrum personality disorders including the non-psychotic individuals who are susceptible to schizophrenia.

The relation between objective and subjective domains of recovery among persons with schizophrenia-related disorders

In recent years, growing emphasis has been placed on the vision of recovery, which is broadly organized into two types: clinical objective versus personal subjective. The purpose of the present study was to investigate the relation between objective clinical recovery as defined by symptom severity and level of functioning, and subjective personal recovery as defined by quality of life, domains of personal confidence and hope, willingness to ask for help, reliance on others and no domination by symptoms. One hundred and fifty-nine persons diagnosed with schizophrenia or schizoaffective disorder completed measures of recovery, quality of life, perceived social support and emotional loneliness. Clinicians used the Modified Brief Psychiatric Rating Scale and the Global Assessment Functioning Scale to assess the severity of symptoms and level of functioning. Results revealed no direct correlation between total score of observer ratings of symptoms and total score of subjective self-report of being in recovery. The relationship between total score of symptoms and total score of subjective self-report of recovery was moderated by the age of onset. Magnitude of the self-report of subjective recovery was related to higher levels of reported social support and lower levels of reported loneliness. Finally, analyses suggested that the impact of social support and loneliness upon self-reported recovery was mediated by quality of life. Taken together, results are consistent with literature suggesting that clinical objective recovery is not synonymous with personal subjective recovery yet can be conceptualized as complementary.

Characterization of spontaneous Parkinsonism in drug-naive patients with nonaffective psychotic disorders

Spontaneous Parkinsonism (SP) in schizophrenia-related disorders is poorly characterized. The objective of this study was to examine the concordance and clinical validity of alternative definitions of SP in patients with nonaffective psychotic disorders. Two-hundred drug-naive patients with nonaffective psychotic disorders were examined for core parkinsonian signs, including bradykinesia, rigidity, and tremor, and diagnosed of SP according to the Simpson-Angus Scale (SAS) cutoff criterion, the UK Parkinson's disease brain bank (UKPDBB) criteria, the National Institute of Neurological Disorders and Stroke (NINDS) criteria, and criteria requiring the presence of all three core features (full syndrome criteria). Parkinsonian signs and criteria were examined in relation to a number of relevant clinical variables. The most frequent sign was rigidity (33.5%) followed by bradykinesia (16%) and tremor (12%). The prevalence rate of SP according to the SAS cutoff criterion, the UKPDBB criteria, the NINDS criteria for possible and probable SP, and the full syndrome criteria were 20.5, 13, 25.5, 18.5, and 4%, respectively. Bradykinesia was specifically related to negative symptoms, rigidity to neurological soft signs, and tremor to dyskinetic movements. The set of criteria showing more associations with clinical variables were the NINDS criteria for probable SP. Patients fulfilling these criteria had higher ratings for poor premorbid adjustment, negative symptoms, dyskinesia, neurological soft signs, and poor global treatment response than those without that diagnosis. The NINDS criteria for probable SP, i.e., presence of any two of the three core parkinsonian signs, seem to be the most suitable for clinical and research purposes.

Diagnostic stability over 2 years in patients with acute and transient psychotic disorders

Objective: The nosological entity of acute and transient psychotic disorders (ATPD) as an independent diagnostic category has become a subject of controversial opinions. The present study aimed to follow-up the diagnostic stability of index episode of ATPD and to examine the influence of clinical and socio-demographic factors on the ATPD prognosis. Method: A sample of 153 (60.1% females; mean age 27.8 ± 8.2) first-admitted patients with ATPD was followed over 2 years. The clinical manifestations, global functioning and quality of life were regularly evaluated during follow-up period. Results: At the end of follow-up, the overall stability rate of ATPD, excluding the cases not readmitted until last assessment, reached 34%. The diagnostic transition was observed in 35.9% of the patients, mostly to schizophrenia and schizoaffective disorders. There was a significant deterioration in several clinical and social indicators among the patients who developed schizophrenia, compared with those with stable ATPD, whereas no reliable predictors were found for diagnostic transition to schizophrenia, except younger age, unmarried status and period of the first hospitalization. Conclusion: A sizeable proportion of the patients with initial diagnosis of ATPD is likely to represent early manifestations of schizophrenia-related disorders. In agreement with some previous observations, our study indicates a lack of strong rationale for separating ATPD from other psychotic disorders within the ICD-10 F2 category.