Transient Psychotic Disorders Research Articles

Psychotic disorders in DSM-5 and ICD-11.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) was published by the American Psychiatric Association (APA) in 2013, and the Work Group on the Classification of Psychotic disorders (WGPD), installed by the World Health Organization (WHO), is expected to publish the new chapter about schizophrenia and other primary psychotic disorders in 2017. We reviewed the available literature to summarize the major changes, innovations, and developments of both manuals. If available and possible, we outline the theoretical background behind these changes. Due to the fact that the development of ICD-11 has not yet been completed, the details about ICD-11 are still proposals under ongoing revision. In this ongoing process, they may be revised and therefore have to be seen as proposals. DSM-5 has eliminated schizophrenia subtypes and replaced them with a dimensional approach based on symptom assessments. ICD-11 will most likely go in a similar direction, as both manuals are planned to be more harmonized, although some differences will remain in details and the conceptual orientation. Next to these modifications, ICD-11 will provide a transsectional diagnostic criterion for schizoaffective disorders and a reorganization of acute and transient psychotic and delusional disorders. In this manuscript, we will compare the 2 classification systems.

The incidence of schizophrenia and schizophrenia spectrum disorders in Denmark in the period 2000–2012. A register-based study

IntroductionWe aimed to examine changes over time in the incidence of broad and narrow schizophrenia spectrum disorders in Denmark from 2000 to 2012. MethodsPatients were classified as incident schizophrenia if registered with a first time in- or outpatient contact with relevant diagnostic codes in the Danish Psychiatric Central Register between 2000 and 2012. Their history of contacts was traced back to 1969. Broad schizophrenia included schizophrenia, schizotypal disorder, persistent delusional disorder, acute and transient psychotic disorders, schizoaffective disorders, and other nonorganic and unspecified psychotic disorders, (ICD 10 codes F20–F29). Narrow schizophrenia was defined with the ICD 10 codes F20.0–F20.9. Incidence rates (IR) and incidence rate ratios (IRR) were calculated using Poisson regression. ResultsThe IRR for broad schizophrenia increased by 1.43 (CI 95% 1.34–1.52) for females and 1.26 (CI 95% 1.20–1.33) for males. IRR for narrow schizophrenia increased by 1.36 (CI 95% 1.24–1.48) for females and 1.20 (CI 95% 1.11–1.29) for males. There was a significantly increased incidence in patients up to 32years of age. This was mainly explained by a significant 2–3 fold increase in outpatient incidence. We found a significant decrease in IRR for patients with broad and narrow schizophrenia aged 33 or older for both in- and outpatients. ConclusionThe increased incidence of schizophrenia could partly be explained by better implementation of the diagnostic criteria for schizophrenia in child and adolescent psychiatry and improved access to early intervention services, but a true increase in incidence of schizophrenia cannot be excluded. The decrease of incidence in the older age group could indicate that the national Danish early intervention strategy was successful.

Serum lipid profile in patients of acute & transient psychotic disorders

Forty subjects, aged 15-45 years were randomly selected. Subjects were separated age wise into 1st group (15-30 years) and 2nd group (31-45 years). They were divided into groups A & C. Group A included twenty patients of acute & transient psychiatric disorder while group C includes 20 age & sex matched normal controls. Serum total cholesterol (TC), Serum triglyceride (TG), Serum HDL-c & Serum phospholipid were done by using colorimetric methods. Serum LDL-c was calculated by Friedwald equation. Results obtained were analyzed by using students `t` test & level of significance was done. Altered lipid metabolism was found in patients of acute & transient psychotic disorders with decreased Serum TC, LDL-c and phospholipids.

The prognostic factors of unfavorable outcome of acute transient psychotic disorders

The study was carried out to investigate prognostic factors of outcomes of transient psychotic disorders/ The sampling included 168 patients with psychotic states meeting diagnostic criteria of ICD-10 for the given group of diseases (F 23.0; F 23.1; F 23.2; F 23.3; F 23.8; F 23.9). The clinical psychopathologic, clinical catamnesis, psychometric and statistical methods were applied. The data concerning characteristics of course of various clinical alternatives of acute transient psychotic disorders is presented. A number of characteristics associated with subsequent development of secondary psychotic attack was established. The characteristics indicating lingering course of the first psychotic episode had the most prognostic significance as regards development of relapse of disease.

Atypical psychosis – historical and current perspective

IntroductionClinical concepts regarding atypical psychosis such as the French bouffeé délirante, the German cycloid psychosis, and the Scandinavian reactive and schizophreniform psychoses are now under the category of F23 ‘Acute and transient psychotic disorders’ (ATPD) of the tenth revision of the International Classification of Mental and Behavioural Disorders (ICD-10).AimsThe authors’ aim is to highlight the clinical and scientific relevance of atypical psychosis from the historical concepts to the current perspective.MethodsA Pubmed database search using as keywords “atypical psychosis”, “acute and transient psychotic disorders”, and “brief psychotic disorder” and retrieved papers were selected according to their relevance.ResultsDifferent psychiatric schools, often of a regional or national character, have provided concepts for transient psychotic states. The acute and transient psychotic disorders of ICD-10 and the brief psychotic disorder of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) reflect the diversity of the history of such concepts. The available evidence suggests that case identification and follow-up is difficult in ATPD due to the heterogeneous and infrequent nature of this clinical phenomenon. Furthermore ATPD has a low diagnostic stability and there are few studies focused on brief psychotic disorders.ConclusionsThe present definition of acute and transient psychotic disorders and brief psychotic disorder, while taking into account the history of the concepts involved, leave many questions open to further studies.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Diagnostic stability of acute and transient psychotic disorder: A systematic review and meta-analysis

IntroductionThe validity and diagnostic stability of acute and transient psychotic disorder (ATPD) has been questioned by several authors, since its introduction in the International Statistical Classification of Diseases (ICD-10).ObjectiveTo determine the overall diagnostic stability of ATPD in scientific literature.MethodA systematic review and meta-analysis of prospective studies and retrospective chart reviews. Computerized search was performed in MEDLINE/PubMed, EMBASE, and Google Scholar, using the terms: “acute and transient psychotic disorder”, or “acute psychosis”, and “stability”, or “outcome”, or “long-term”, or “follow-up”, or “course”. Search was restricted to works in English published between 1993 and 2015, according to ICD-10 criteria. Opinion articles, individual case reports, researches with less than ten subjects, and overlapping studies were excluded. Data analysis was conducted using MedCalc software, version 15.8. Statistical procedure was calculated for meta-analysis of proportions.ResultsTwenty-six studies met the inclusion criteria (n = 10852). For methodological purposes, a distinction was made between short-term (less than 2 years), medium-term (between 2–7 years), and long-term stability (more than 7 years). For short-term group (k = 5), the overall stability was 60.69% (fixed effects model); Cochran's heterogeneity statistic Q = 14.9, I2 = 73.15%, P = 0.0049. For medium-term group (k = 15), it was 49.99%; Q = 181.6, I2 = 92.29%, P < 0.0001. For long-term group (k = 6), it was 61.86%; Q = 35.12, I2 = 92.29%, P < 0.0001.ConclusionThe global stability of ATPD indicates at the validity of the construct, but should be redefined in future revisions of ICD, to clarify better diagnostic criteria, and more predictive power.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Gender differences in acute and transient psychotic disorder

IntroductionIn the recent decades, there is a growing interest in gender differences in psychotic disorders. Also, in the field of acute and transient psychosis, according to various studies, women seem to have higher prevalence and long-term diagnostic stability.ObjectivesTo determine whether there are gender differences in clinical features of acute and transient psychotic disorders (ATPD).MethodsDescriptive cross-sectional study in the adult patients with ATPD were admitted between 2011 and 2015 in our acute psychiatric ward. Diagnostic criteria was according to the International Classification of Diseases (ICD-10). Descriptive and inferential statistic procedures for clinical symptoms and diagnostic subcategories were performed, using the MedCalc software, version 15.8.ResultsThirty-nine patients met the inclusion criteria. Males were (MG) 41%, females (FG) 59%. There were some statistically significant differences between gender in the polymorphic features group (>FG, P = 0.048), and in the presence of acute stress (>FG, P = 0.0277). Length of stay was also different, but without statistical significance (>MG, P = 0.0607). In contrast, symptomatic sets, family history of psychosis, and type of onset (sudden or acute) were similar for both groups.ConclusionsThe gender differences seem to be in favour of a higher prevalence of polymorphic psychotic symptoms, in relation to stressful events in women. Somehow, these factors could be a condition, which would determine a greater diagnostic stability in female patients, even in cases of recurrences.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Clinical manifestations in patients with acute and transient psychosis

IntroductionThe term, acute and transient psychosis, is comprehended as a heterogeneous group of disorders, which share, as a common feature, the abrupt and brief deployment of typical psychotic behaviour, either polymorph, delusional, or schizophreniform. This diversity of symptoms may also be present in other psychotic disorders, for which, some authors question its reliability.ObjetiveTo analyse the clinical manifestations present in acute and transient psychotic disorders (ATPD), and determine the differences between its different subcategories.MethodRetrospective chart review study of adult patients admitted in our psychiatric unit between 2011 and 2015, with a mean diagnosis of ATPD at hospital discharge. Diagnostic criteria was according to the International Classification of Diseases (ICD-10). Symptoms were divided under operative procedures, as set out in psychopatologic descriptions. For methodological reasons, statistical analysis was conducted between polymorphic features group (PM) and nonpolymorphic group (NPM). Chi-squared test and Fisher's exact test (as appropriate) were performed, using MedCalc software.ResultsThirty-nine patients met the inclusion criteria. Acute polymorphic psychotic disorder with and without symptoms of schizophrenia (39%), acute schizophrenia-like psychotic disorder (20%), acute predominantly delusional psychotic disorder (23%), other and NOS (18%). There were statistically significant differences between PM and NPM groups in emotional turmoil (>PM, P = 0.0006), grossly disorganized or abnormal motor behaviour (>PM, P = 0.0038), and type of onset (sudden >PM, P = 0.0145).ConclusionCurrently, the same concept encompasses two categories (PM and NPM) to be differentiated. The ATPD construct is under review, due its long-term instability.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Prognosis of Brief Psychotic Episodes: A Meta-analysis.

The prognostic significance of competing constructs and operationalizations for brief psychotic episodes (acute and transient psychotic disorder [ATPD], brief psychotic disorder [BPD], brief intermittent psychotic symptoms [BIPS], and brief limited intermittent psychotic symptoms [BLIPS]) is unknown. To provide a meta-analytical prognosis of the risk of psychotic recurrence in patients with remitted first-episode ATPD, BPD, BIPS, and BLIPS and in a benchmark group of patients with remitted first-episode schizophrenia (FES). We hypothesized a differential risk: FES > ATPD > BPD > BIPS > BLIPS. The Web of Knowledge and Scopus databases were searched up to May 18, 2015; the articles identified were reviewed as well as citations of previous publications and results of a manual search of the reference lists of retrieved articles. We included original articles that reported the risk of psychotic recurrence at follow-up for patients in remission from first-episode ATPD, BPD, BLIPS, BIPS, and FES. Independent extraction by multiple observers. Random-effects meta-analysis was performed, and moderators were tested with meta-regression analyses, Bonferroni corrected. Heterogeneity was assessed with the I2 index. Sensitivity analyses tested the robustness of the results. Publication bias was assessed with funnel plots and the Egger test. Proportion of patients with baseline ATPD, BPD, BLIPS, and BIPS who had any psychotic recurrence at 6, 12, 24, and 36 or more months of follow-up. Eighty-two independent studies comprising up to 11,133 patients were included. There was no prognostic difference in risk of psychotic recurrence between ATPD, BPD, BLIPS, and BIPS at any follow-up (P > .03). In the long-term analysis, risk of psychotic recurrence (reported as mean [95% CI]) was significantly higher in the FES group (0.78 [0.58-0.93] at 24 months and 0.84 [0.70-0.94] at ≥ 36 months; P < .02 and P < .001, respectively) compared with the other 4 groups (0.39 [0.32-0.47] at 24 months and 0.51 [0.41-0.61] at ≥ 36 months). There were no publication biases. Sex and exposure to antipsychotic medication modulated the meta-analytical estimates (.002 < P < .03). There are no prognostic differences in risk of psychotic recurrence between ATPD, BPD, BLIPS, and BIPS constructs of brief psychotic episodes. Conversely, there is consistent meta-analytical evidence for better long-term prognosis of brief psychotic episodes compared with remitted first-episode schizophrenia. These findings should influence the diagnostic practice and clinical services in the management of early psychosis.

Pharmacotherapy of acute psychotic states: The reason for benzodiazepines and valproic acid augmentation

Acute psychotic states (APS) usually are diagnosed as schizophrenia spectrum and affective disorders and make up about 45% of cases. The goal of the study was to elucidate the effect of benzodiazepines (BDZ) and valproic acid augmentation in the APS pharmacotherapy. The study was carried out on 102 inpatients diagnosed up to ICD-10 as schizophrenia (n = 24), acute and transient psychotic disorders (n = 40), other mental disorders due to brain damage and dysfunction and to physical disease (n = 17), schizoaffective disorder (n = 12), bipolar affective disorder (n = 9). Patients were randomized into four therapeutic groups:– benzodiazepines (BDZ);– one neuroleptic or combination of one neuroleptic and one BDZ (NBDZ);– combination of valproic acid with BDZ or neuroleptic (VBDZN);– polypragmasy (PP): from two drugs of one group up to four and more drugs at the same time.The mental state of the patients was evaluated daily and estimated before, weekly and after APS termination by BPRS and CGI scale. The APS in all groups lasted from 1 to 50 days (mean 11.4). The shortest duration of APS was In BDZ group – 4.7 days; in VBDZN and NBDZ, the duration was 7.0 and 7.4 days (P &lt; 0.05); in PP group, the treatment lasted 24.5 days (P &lt; 0.001). Before therapy, average BPRS rate was 43.5 ± 8.1, CGI – 6.2 ± 0.8; after APS, BPRS was 18.9 ± 2.1, CGI – 1.1 ± 0.3. All rates did not differ among subgroups. APS therapy by BDZ and its combination with neuroleptics and valproic acid was effective compared to the polypragmasy.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Medical repatriation from Razi Hospital in Tunisia

Introduction Travel might represent a stressful adventure that can influence mental state to a considerable extent. Some of the travellers experience psychiatric emergencies that require medical attention, during the course of their travel, leading to admission to psychiatric hospital and then repatriation. Aims Identify the number and clinical characteristics of foreign patients needing medical repatriation due to psychiatric disorders. Methods This is a retrospective and descriptive study on patients with nationalities other than Tunisian that were admitted to Razi Psychiatric Hospital in Tunis/Tunisia for a psychiatric condition from January 2000 to January 2015. Medical records were analyzed and patients requiring medical repatriation were identified. Results A total number of 157 hospitalizations of patients with foreign nationalities were recorded during the last fifteen years. Among those hospital admissions, 100 patient files were examined. Twenty-nine percent of patients were repatriated to their home countries, most of them to Europe (72.4%, n =21). The majority of patients were female and single. Fifteen out of these 29 patients (51.7%) were diagnosed with bipolar disorder, 34.4% with chronic psychotic disorders, and 6.8% with acute transient psychotic disorders. The majority of patients were visiting Tunisia as part of a pathological journey (55.1%, n =16), 24.1% of patients ( n =7) were tourists and 13.7% ( n =4) were resident in Tunisia. Conclusion The majority of repatriated patients was diagnosed with bipolar disorder and was visiting Tunisia in the context of a pathological journey. Other patients could have been repatriated without being hospitalized. Further studies must be conducted to refine results.

The particular issues of therapy of acute transient psychotic disorders without symptoms of schizophrenia

The study of clinical dynamical and therapeutic aspects of acute transient psychotic disorders without symptoms of schizophrenia was carried out on sampling of 77 examined patients with psychotic conditions corresponding to diagnostic criteria of ICD-10 for the given group of disorders (F 23.0, F 23.3, F 23.8, F 23.9). The clinical psycho-pathological, clinical catamnesis, psychometric and statistical techniques were applied. The data is presented concerning characteristics of development of acute transient psychotic disorders without symptoms of schizophrenia and also dynamics of psycho-pathologic symptomatic in process of anti-psychotic therapy. It is established that acute transient psychotic disorders revealed tendency to be recurrent in the form of productive psychotic disorders that shows the cause to prescribe supporting therapy after clinical reduction of first psychotic episode.

PATTERN OF PSYCHIATRIC REFERRAL FROM EMERGENCY DEPARTMENT OF A TERTIARY LEVEL HOSPITAL IN NEPAL

INTRODUCTION: Emergency department serves as one of the gateway through which patients with psychiatric disorders come for treatment. The referral to the psychiatry department enables a psychiatrist to provide services to these patients in need. So, the study of this pathway of care becomes important. MATERIAL AND METHODS: A total of 100 consecutive patients referred from emergency to the department of psychiatry were enrolled in this study. Their socio-demographic variables, reason and purpose for referral was assessed. The psychiatric diagnosis was made according to the International Classification of Diseases -10 (ICD-10) system. RESULTS: The psychiatric referral rate from the emergency was found to be 8.46%. Out of one hundred patients more referred patients were female (64%), from rural background (90%). Family members were the source of referral for emergency visit in most of the patients (74%). Dissociative disorder was the most common diagnosis (26%) followed by acute &amp; transient psychotic disorders at 12%. CONCLUSIONS: Fewer patients are referred to psychiatry department even in a tertiary level hospital of Nepal. Journal of Universal College of Medical Sciences (2015) Vol.03 No.02 Issue 10 Page : 5-9

Diagnostic Stability in the Follow-up of Acute and Transient Psychotic Disorder: A Preliminary Study

Introduction: Acute and transient psychotic disorder differentiates from other psychotic disorders with acute onset, occurrence after stressful life events and ending with full remission. It is suggested to have good prognosis and response to treatment. In some of the patients, the diagnosis is switched to schizophrenia or mood disorders in the follow-up. This study aimed to determine sociodemographic and clinical features of patients diagnosed with acute and transient psychotic disorder, as well as changes in the diagnosis in a 5 year the follow-up.

Successful Management of Recurrent Acute and Transient Psychotic Disorder with Catatonic Features with Fluphenazine Depot Injection

Successful Management of Recurrent Acute and Transient Psychotic Disorder with Catatonic Features with Fluphenazine Depot Injection

Olfactory hallucinations in schizophrenia: Does it carry any meaning?

Olfactory dysfunctions are reported in multiple psychiatric disorders, including schizophrenia. The patterns of olfactory distortion in schizophrenia include impairments in olfactory perception, olfactory discrimination, olfactory memory, and olfactory perception threshold sensitivity. Olfactory dysfunction is believed to be an early warning sign of schizophrenia and is an important endophenotypic marker. We highlight a case of late onset acute and transient psychotic disorder with olfactory hallucination. Different implications of olfactory hallucinations in a psychotic patient are discussed with a review of the literature.

Use of ECT in Nepal: A One Year Study From the Country's Largest Psychiatric Facility.

Electro-Convulsive Therapy (ECT) refers to the electrical stimulation of the brain to produce seizures for therapeutic purpose. Since the development of ECT, it's use has been consistent. Inspite of the common use, data pertaining to the use of ECT in Nepal is lacking. This study was undertaken with the aim of exploring the clinico-demographic profile of patients treated with ECT in the largest psychiatry facility in the country. It is a retrospective descriptive study of patients who were treated with ECT after admission in the inpatient psychiatry unit of Universal College of Medical Sciences Teaching Hospital, Bhairahawa, Nepal during a period of one year (August 2012 to July 2013). Out of 1095 patients admitted during the specified period, 81 (7.39%) patients received ECT. About 44.44% of the patients belonged to 20-29 years age group. Female patients constituted more than half of the subjects (55.56%). Review of diagnostic profile showed that majority of patients receiving ECT were suffering from Schizophrenia (44.4%), followed by Bipolar Affective Disorder/Mania (29.6%), Depressive disorder (11.1%), Acute and Transient Psychotic Disorder (6.2%), Post-partum Psychosis (3.7%) and substance induced mood/psychotic disorders (3.7%). A significant majority of subjects (75.3%) received about 5-7 ECT treatments. The mean seizure duration after ECT treatment was 31.13±5.79 seconds. No any major complications were noted during ECT treatment. This study suggests that ECT, use, as a treatment modality is common in young adults and females with Schizophrenia being the most common indication. Direct ECT is safe when used judiciously.

Correlates of Suicide-Related Ideations and Attempts in Patients with Acute and Transient Psychotic Disorder.

Acute and transient psychotic disorder (ATPD) is a brief, self-limiting psychiatric disorder commonly seen in developing countries. This condition is associated with an elevated risk of suicide, but data on this association are lacking in developing countries. Consecutive outpatients with a diagnosis ATPD as per ICD-10 criteria (n=29) were recruited over a period of six months (February-July 2014) and retrospectively assessed for suicide-related ideations and attempts and their correlates both during and in between episodes of their illness. A total of 16 patients (55.17%) experienced suicide-related ideations, which occurred during a psychotic episode in 14 patients. Six patients (20.69%) made suicide attempts. A later age of onset was significantly associated with suicidality (p=0.04), as was a family history of depression or related ("spectrum") conditions (p<0.01). A relationship with higher educational status, reported in an earlier study, was not replicated in our sample. Suicide-related ideation and suicide attempts are common in ATPD, and may be linked to a later onset and a genetic loading for depression-related conditions.

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

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

A case of cycloid psychotic disorder

Based on a case of an acute and transient psychotic disorder with full recovery between recurrences, the authors remind the concept of cycloid psychoses. This diagnosis has been neglected in modern psychiatry and in the current nosological systems. However, the cycloid psychoses concept may offer an alternative diagnosis for some psychotic disorders in spite of the need of more studies to improve the understanding of its etiology and treatment.