Transient Psychotic Disorders Research Articles

Acute and transient psychotic disorders (ICD-10 F23): a review from a European perspective

The tenth revision of the International Classification of Mental and Behavioural Disorders (ICD-10) introduced the category F23 'Acute and transient psychotic disorders' (ATPD) to incorporate clinical concepts such as the French bouffée délirante, cycloid psychosis (Germany), and the Scandinavian reactive and schizophreniform psychoses. The aim of this paper is to review the literature on ATPD and to examine how it has been differentiated from the other categories of F2 group 'schizophrenia and related disorders'. Papers published between 1993 and 2007 were found through searches in Medline, PsychInfo and Google Scholar. Further references were identified from book chapters and comprehensive reviews of the topic. ATPD is reported as being prevalent in females and as having onset in early-middle adulthood. Although follow-up studies suggest that its outcome is more favourable than other disorders in the F2 group, ATPD tends to recur and half of cases convert mainly into either schizophrenia or affective disorders. No evidence supports the view that the traditional conditions subsumed under ATPD all refer to this diagnostic category. The lack of defining features and poor prognostic validity argue against the separation of ATPD from borderland categories.

P03-198 Sexual dysfunction in patients on antipsychotic therapy Vladica Sibinovic psychiatry clinic CC Nis

The aim of this study was to determine difference in sexual dysfunction between 137 stabilized male outpatients who met ICD-10 criteria for acute and transient psychotic disorders (F 23) and schizophrenia (F 20) under therapy atypical and typical antipsychotic.Arizona Sexual Experience Scale (ASEX) and the subscale on sexual function of the UKU Side Effects Rating Scale were applied at a single interview.Sexual dysfunction was observed in 55, 47% (76 patients). We find higher ASEX and UKU score in patient with schizophrenia under therapy atypical and typical antipsychotic (p=0, 01). in patients with schizophrenia under typical antipsychotic, orgastic dysfunction (p< 0, 05) is more common.Ejaculatory dysfunction and erectile dysfunction are also high in that group (p< 0, 05).Therapies with atypical and typical antipsychotic have the same effects on increased or diminished sexual desire in bout group of patients.In patients with schizophrenia under typical antipsychotic there is higher ASEX score then in patients under atypical antipsychotic (p< 0, 05). Patients with acute and transient psychotic disorders do not have difference on level of sexual dysfunction in correlation with treated by atypical and typical antipsychotic.Results show that sexual dysfunction is more common in patients with schizophrenia under therapy with typical antipsychotic. in group of patients with acute and transient psychotic disorders there is no difference betven therapy atypical or typical antipsychotic in sexual dysfunction.

P03-180 Diagnostic stability of psychotic disorders: A retrospective study

Background:An essential condition to validate a diagnosis is its stability over time. Since there are no biological markers for psychiatric disorders, the diagnosis relies on clinical expertise, with several consequences in treatment planning, disease burden and disability, affecting outcome and public health.Objectives:The aims of this study were:1.the assessment of long term stability of the diagnosis of psychotic disorders,2.its implications in patient treatment, and3.the evaluation of eventual predictors of diagnosis stability.Methods:This was a retrospective study carried out in the Department of Psychiatry of a large University Hospital (Hospital S. João, Porto, Portugal). Patients enrolled were admitted in the inpatient unit from 2000 to 2003 (n=190, 12.41% of 1531 patients admitted), experienced a first psychotic episode, and fulfilled criteria for one of the following diagnosis: schizophrenia, schizoaffective disorder, bipolar disorder, drug induced psychosis, acute and transient psychotic disorders, schizophreniform disorder and psychosis NOS (ICD-10 classification). the diagnoses were extracted from clinical records, and reassessed five years after the initial diagnosis. the analysis focuses on diagnostic agreement over time; clinical and demographic variables were also collected and putative associations with diagnostic shift considered.Results:The study is now under statistic evaluation.

CS09-02 Overlap between schizophrenia and bipolar disorders in terms of symptoms and course

At the end of the 19th century Emil Kraepelin dichotomized the so-called “endogenous psychoses” into dementia praecox (later schizophrenia) and manic-depressive insanity (later mood disorders). According to Kraepelin there are significant differences between the two groups regarding age at onset, phenomenology, and prognosis. But some years later Kraepelin himself recognized that there was a domain between the two groups showing a lot of overlaps and thus making a distinction impossible. Modern research confirmed this observation and opinion of Kraepelin: There are psychopathological syndromes showing characteristics of both mood and schizophrenic spectra. The overlap of the spectra gives rise to syndromes like schizoaffective disorders or acute and transient psychotic disorders having their own characteristics which differ from core schizophrenia or core mood disorders. Obviously there is a genetic determination of the overlap. The characteristics of syndromes created by the overlap of the spectra and the therapeutic consequences will be discussed.

Acute and transient psychotic disorders: Precursors, epidemiology, course and outcome

Background:ICD-10 delineates Acute and Transient Psychotic Disorders (ATPD, F 23) as distinct from schizophrenia and affective psychosis. We investigated the descriptive epidemiology of ATPD and predictive validity of the diagnosis, compared its three-year outcomes with affective psychosis and schizophrenia, and explored whether acute onset and early remission identify a distinct good outcome subgroup in non-affective psychoses.Method:Between 1992-1994, all first-episode psychosis patients in Nottingham were identified and assigned an intake ICD-10 diagnosis. Patients were assessed three years later using established outcome measures and longitudinal diagnosis assigned. Multivariate analyses were conducted to determine whether acute onset and early remission predicted favourable three-year outcome in non-affective psychotic disorders.Results:Of 168 cases of first-episode psychosis, 112 received an intake diagnosis of non-affective psychoses (F20-29) and 32 (19%) of ATPD (F23). ATPD diagnosis was stable in women over three years, but not in men. Outcomes of ATPD were better than schizophrenia and similar to affective psychosis. In non-affective psychoses, favourable outcomes were a function of gender and good premorbid functioning rather than acute onset and early remission.Conclusion:ICD-10 ATPD criteria identify a diagnostically unstable group of disorders consisting of ‘good outcome’ schizophrenia, affective psychosis and a very small group of ‘true’ non-affective, non-schizophrenic acute and transient psychoses. Although ATPD have a better outcome than schizophrenia, in non-affective psychoses, acute onset and early remission do not independently predict favourable outcome over three years.

Acute and transient psychotic disorders: Do ICD-10 criteria identify a distinct category?

Acute and transient psychotic disorders: Do ICD-10 criteria identify a distinct category?

Incidence and diagnostic stability of ICD-10 acute and transient psychotic disorders

Objective The 10th Revision of the International Classification of Diseases ( ICD-10) introduced a new diagnostic category, F23 acute and transient psychotic disorders (ATPD) to embrace clinical concepts such as the French bouffée délirante, Kleist and Leonhard's cycloid psychoses, and the Scandinavian reactive and schizophreniform psychoses. The relative rarity of these disorders and insufficient follow-up studies with adequate numbers of patients makes ATPD classification as uncertain as their validity. The aim of this study was to evaluate incidence and validity of ATPD in terms of diagnostic stability. Method A 6-year analysis of readmission patterns of all subjects listed in the Danish psychiatric central register as having been first-ever admitted to hospital or treated in outpatient services with a diagnosis of ATPD from January 1 to December 31, 1996, was conducted. Results The incidence of ATPD was 9.6 per 100 000 population, with a higher rate of females than males (9.8 vs 9.4). Incidence rates by age group were higher for males than for females, with a marked reversal of this pattern above 50 years. This contrasted with incidence of schizophrenia that was almost twice as high in males as in females, particularly in the 20-29 year age group. Of 416 cases with a first-admission diagnosis of ATPD, an increasing number tended to change on subsequent admissions, nearly half to another F2 category schizophrenia and related disorders. The overall stability rate reached only 39%. Conclusions Although demographic differences from schizophrenia are topics that deserve further research, poor diagnostic stability argues against attempts to separate ATPD from borderland disorders.

Differentialdiagnose und Behandlung akuter Verwirrtheit bei psychischen Störungen

In classical and contemporary German and Swiss psychiatry the term confusional (akuter Verwirrtheitszustand) describes an ill-defined complex of symptoms and signs of heterogeneous pathogenesis characterised by a lack of comprehensibility and incoherence of actions and verbal expressions. It is frequently associated with suddenly developing or severe episodes of psychotic or affective disorders. In this context we address the issue of the currently increasing disenchantment with the disease-entity assumption (Kendell and Jablensky, 2003) because there is still little evidence that most currently recognised mental disorders, which are in principle based on the psychopathologically defined signs and findings, are separated by natural boundaries. In the following article we intend to give a review of some pertinent issues in relation to the clinical features, assumed pathogenesis and differential diagnosis related and limited to confusional states during acute states of affective or psychotic disorders focused on the following particular group of psychiatric disorders: acute and transient psychotic disorders (especially the cycloid psychoses according to Leonhard), severe depressive episodes, manic and mixed episodes. Brief psychotic disorder is defined by the presence of delusions, hallucinations, disorganised speech or grossly disorganised or catatonic behaviour, a duration of at least one day but less than one month and eventual full return to the premorbid level of functioning. Practice guidelines for the psychopharmacological treatment of patients with brief psychotic disorder remain controversial. Delirious mania is a syndrome of acute onset, the patients are excited, grandiose, emotionally labile and suffer from delusions and insomnia characteristic of mania. An additional characteristic is the disorientation and altered consciousness typical of delirium. Catatonia frequently accompanies the clinical picture. The difficulty in distinguishing delirious mania from excited or malignant catatonia is emphasised. Moreover, until the concepts of these particular psychiatric syndromes are clarified, we lack valid criteria to accurately separate delirious mania, malignant catatonia, excited catatonia, rapid-cycling mania and mania with psychotic features (Fink, 1999). Finally, some unintended and sometimes unrecognised toxic side effects during otherwise correct psychopharmacologic treatments of these disorders with dopamine receptor antagonists or serotonergic antidepressant medications that require early diagnosis and therapeutic intervention are described: neuroleptic malignant syndrome, serotonin syndrome and drug-induced hyponatraemia. These particular drug-induced states are selected because they are often accompanied by an acute confusional state and they can resemble the original illness-related state.

Pathological Journeys or Help Seeking Behavior: The Case of Travelers to Geneva, An International City

Several international organizations have their headquarters in and are thus hypothesized to attract both people seeking help for human right abuses and also pathological travelers. The present study aimed at characterizing pathological travelers, a population seldom studied in psychiatry. Patients referred for pathological journeys to the only psychiatric hospital in were retrospectively identified on the basis of medical certificates. Their medical records were then analyzed. The study covered a 4-year period. Seventy-six patients were identified. They were in majority male, aged less than 50 and single; 62% came from European countries and 84% had some prior psychiatric history; 58% were diagnosed with a psychotic disorder, mainly schizophrenia, acute transient psychotic disorder and delusional disorder. Sixteen patients (21%) had been attracted to specifically because of its international organizations, while 60 came for other reasons. Prevalence of persecutory delusions was significantly higher among travelers attracted by the interna- tional Geneva (88% versus 43%, P<0.005). Pathological journeys represent an identifiable cause of psychiatric hospitali- zation in Geneva. Prospective studies should be conducted using a more precise and restrictive definition of this entity in order to avoid stigmatization of people crossing borders for other motives.

Behandlungsleitlinien für nichtschizophrene psychotische Störungen?

To provide an overview of diagnostics, outcome and treatment of "non-schizophrenic psychotic disorders" (ICD-10: delusional disorders, acute and transient psychotic disorders and schizoaffective disorders). Literature was identified by searches in "Medline" and "Cochrane Database of Systematic Reviews". The frequency of "non-schizophrenic psychotic disorders" within the whole diagnostic group "schizophrenia, schizotypal and delusional disorders" (ICD-10) ranges between 22% and 49%. Patients with these disorders show a more favourable long-term outcome than those with schizophrenia. With regard to therapy, as yet only a small empirical database exists. The comparability of those studies is limited by the use of different diagnostic criteria. There are only few evidence-based treatment guidelines for these disorders. There is a substantial need for controlled studies on the treatment of "non-psychotic schizophrenic disorders". Alternatively, clinical guidelines could be based on a dichotomy of affective and schizophrenic disorders or on a dimensional approach.

Akute vorübergehende psychotische Störungen - Eine Frauenkrankheit?

The ICD-10 category F23 Acute and Transient Psychotic Disorders” reflects an attempt to describe a group of psychosis neither identical with schizophrenia nor with schizoaffective disorders. Typically, the clinical picture is turbulent, sometimes dramatic. Primarily, women are affected. The onset is acute or even abrupt. A preceding severe psychosocial stressor is rare. Therapeutic response to antipsychotics is good. In some cases mood stabilizer such as lithium are indicated. Although relapse is frequent, long-term prognosis is mostly favourable, therefore the clinical distinction of this disorder from schizophrenia is important.

Longitudinal follow-up in acute and transient psychotic disorders and schizophrenia

Longitudinal follow-up in acute and transient psychotic disorders and schizophrenia

Acute and transient psychotic disorders in a rapidly developing country, State of Qatar

Little is known about acute and transient psychotic disorders, which is a diagnostic group, introduced with International Classification of Disease, 10th revision. It is an interesting area of research receiving a lot of attention. The aim of the study was to find the incidence of acute and transient psychotic disorders in the population and determine its sociodemographic features in the State of Qatar. Design. This is a retrospective descriptive study. Setting. The study was conducted in the Department of Psychiatry of the Rumaillah Hospital, Hamad Medical Corporation, Doha, Qatar. All Qatari, non-Qatari Arabs, and expatriate patients who were hospitalized with psychotic disorders in the inpatient wards or treated in the outpatient clinics of the Department of Psychiatry over a 7-year period were enrolled in the study. Data were collected from the medical records of patients. The study was conducted from August 1, 1996, to January 1, 2004, amongst the patients with acute and transient psychotic disorders. The diagnostic classification of definite psychotic disorders was made in accordance with criteria based on the International Classification of Disease, 10th revision (ICD-10). A total of 174 patients were treated during a 7-year period. Among them, 69% were males and 31% females. No cases were found in children aged less than 15 years. The highest frequency (43.7%) was found in the early adulthood (16-29 years of age). The incidence of acute and transient psychotic disorders was higher in the expatriates (66.7%). More than half (63.8%) of the patients were employed. Most of the cases (35.6%) had acute schizophrenia-like psychotic disorders (F23.2). There was no statistically significant difference in the frequency of acute and transient psychotic disorders between males and females, Qatari and non-Qatari Arabs, and single and married. The study found markedly lower incidence rate of acute and transient psychotic disorders in females than males. The highest frequency was found in the early adulthood (16-29 years). No cases were found in children aged less than 15 years. It is important to find ways to promote healthier lifestyles in this population in order to prevent the onset of psychotic disorders.

Beyond the Kraepelinian dichotomy: acute and transient psychotic disorders and the necessity for clinical differentiation

The concept of acute and transient psychoses is, together with that of schizoaffective disorders, a challenge by the Kraepelinian dichotomy. Although these conditions have some similarities to schizophrenia, they differ significantly from schizophrenia regarding onset, duration, prognosis, gender and premorbid adaptation. They show some similarities with bipolar disorders. They do not fit into the dichotomous concept.

Diagnostic stability and status of acute and transient psychotic disorders

We read with interest the article by Pillmann & Marneros ([2005][1]). Acute and transient psychosis is a common clinical presentation in the developing world. We retrieved medical records of all patients with psychotic disorders (F06.0–06.3, F20–29, F30.2, F31.2, F31.5, F32.3, F33.3) who

Revisiting cycloid psychosis: A case of an acute, transient and recurring psychotic disorder

We report a case of recurrent psychosis, spanning decades, with full inter-episode recovery and minimal functional impairment. While it is difficult to classify this disorder using DSM IV-TR criteria, Leonhard and others have described a ‘cycloid psychosis’ that correlates well with the phenomenology and course of this case. We believe this may represent a subset within the ICD-10 category of ‘acute and transient psychotic disorders’. While this disorder, of unknown incidence, is not well reported in the U.S., it is worthy of further investigation and clinical attention given its generally favorable prognosis and potentially distinct pathophysiology and treatment.

A preliminary open trial of olanzapine in paediatric acute and transient psychotic disorders

Background:Acute and transient psychotic disorders (ATPD) have been characterized by the development of florid psychotic symptoms within 2 weeks and complete remission of symptoms. Although there are no definite guidelines, these are usually treated by antipsychotic medication.Aim:This preliminary study examined the effectiveness of olanzapine in paediatric ATPD.Methods:In this 6-week open trial of olanzapine in paediatric ATPD, the patients were rated weekly on the Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI) Scale and Dosage Record Treatment Emergent Symptom Scale (DOTES).Results:Twenty-three patients (11 males, 12 females; mean age 14.0±1.3 years; range 11–16 years) were included in the study. The mean olanzapine dosage was 12.7±3.9 mg/day (range 5–20 mg/day). All the patients showed significant improvement in 6 weeks. The results showed a significant decrease (p< 0.0001) in scores of BPRS (mean at baseline 46.2±7.0 to 21.4±3.9 at week 6). Severity of illness (CGI) decreased from 4.7±0.8 to 1.6±0.9 in 6 weeks. Also, global improvement (CGI) showed marked improvement in 14 (60.9%), good improvement in 8 (34.8%) and minimal improvement in 1 (4.3%) patient. Some common side-effects were dryness of mouth (n=14, 60.9%), increase in appetite (n=12, 52%), weight gain (n=12, 52%) and drowsiness (n=8, 34.8%). No patient developed extrapyramidal symptoms.Conclusion:Olanzapine was safe and effective in paediatric ATPD.

Diagnostic Stability in Patients with First-Episode Psychosis

To examine the short-term stability of Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) and International Classification of Diseases (10th revision; ICD-10) diagnoses in a group of patients with first-episode psychosis. Sixty patients with first-episode psychosis admitted consecutively to Roozbeh Hospital, Tehran, were sampled; their illnesses could not be attributed to any medical or substance-induced conditions. Patients were assessed at the time of discharge from the hospital, and at 3, 6 and 12 month intervals following admission. At each visit, two psychiatrists made consensus DSM-IV and ICD-10 diagnoses, based on all available information. Stability was discerned as the consistency between diagnoses at the time of discharge and at 12 month follow up. Forty-eight patients completed follow up. Affective psychotic disorders and schizophrenia in both classification systems were highly stable. In addition, all patients with DSM-IV brief psychotic disorder and ICD-10 acute and transient psychotic disorders remained the same at follow up. Affective psychoses and schizophrenia, in line with previous findings, remained stable. Diagnoses of brief psychoses were highly stable as well; this could reflect a non-relapsing course of acute brief psychoses, especially in developing countries.

Is There Evidence in the EEG for Increased Epileptiform Activity in ICD-10 Acute and Transient Psychotic Disorder?

Background: The aim of this study was to examine whether there is electroencephalographic evidence for an increased epileptiform activity in the EEG of ICD-10 acute and transient psychotic disorders (ATPD; F23) as a hint for a closer relationship to epilepsy. Methods: We analyzed the EEGs of 39 inpatients with ATPD, comparing them with ‘positive’ schizophrenic and bipolar schizoaffective controls matched for age and gender. The evaluation was performed visually and qualitatively using a rating scale of demonstrated reliability. Results: We found no indication of an increased incidence of epileptiform discharges in ATPD compared with ‘positive’ schizophrenic and bipolar schizoaffective controls. Conclusion: The hypothesis of a relationship between ATPD and epilepsy could not be confirmed by EEG findings.

Longitudinal follow-up in acute and transient psychotic disorders and schizophrenia

We prospectively studied the long-term course of individuals with acute and transient psychotic disorders and a control group with positive schizophrenia matched for age and gender. Follow-up investigations using standardised instruments were performed at three time-points covering 7 years after the index episode or 12 years after the first episode. During follow-up, those with positive schizophrenia experienced a deterioration in their general functioning whereas those with acute and transient psychotic disorders retained their high level of functioning. At the end of the observation period, 12 out of 39 (31%) of those with acute and transient psychotic disorders were functioning well without medication compared with 0 out of 38 with positive schizophrenia.