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

Abstract

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.

Epidemiology, Course and Outcome of Acute Polymorphic Psychotic Disorder: Implications for ICD-11

“…These findings enhance the understanding of ATPDs and support the view that they show variations not only in incidence rates and age of onset, but also in course and outcome. It would appear that APPD is more common in females and occurs later than the subtypes with schizophrenic symptoms, which are characterized by a male preponderance, an increased risk of schizophrenia in family members, and a tendency to convert into schizophrenia and related disorders [8,9,10,11,12,13,16]. Although the predictive validity is relatively low, APPD fared better than any specific ATPD subtype in terms of both temporal stability and cases with a single episode of psychosis.…”

“…It was also found that patients with APPD are more likely to experience transition to mood disorders than those with schizophrenic or predominantly delusional symptoms. Follow-up studies reported a more favorable course and outcome of ATPDs than schizophrenia and a closer kinship to bipolar disorder [8,9,10,13,17,18,19]. However, genetic epidemiological surveys have challenged a sharp demarcation between ATPDs and schizophrenia, while the relationship to affective disorders remains less clear [16].…”

“…These findings have implications not only for psychiatric nosology, but also for clinical practice, as ATPD patients are often included in studies of first-episode psychosis and prescribed antipsychotic drugs [9,10,13]. The long-term treatment with antipsychotics can induce both metabolic and cardiovascular events, and increase the risk of premature mortality [23,24].…”

“…Case identification may be difficult in ATPDs owing to the lack of clearly defining features and varying transition rates either to schizophrenia and related disorders or affective disorders [8,9,10,11,12,13]. The proposed revision for ICD-11 wound introduce a major change, restricting the ATPD category to acute polymorphic psychotic disorder, while the subtypes with schizophrenic and predominantly delusional symptoms would be reclassified into other categories of the newly renamed F2 section ‘schizophrenia spectrum and other primary psychotic disorders' [14].…”

Short-term course and outcome of acute and transient psychotic disorders: Differences from other types of psychosis with acute onset

“…Varying transition rates have been reported in ATPDs either to schizophrenia and related disorders or affective disorders (Aadamsoo, Saluveer, Küünarpuu, Vasar, & Maron, 2011;Castagnini et al, 2013b;Jørgensen, Bennedsen, Christensen, & Hyllested, 1997;Pillmann & Marneros, 2005;Queirazza, Semple, & Lawrie, 2014;Rusaka & Rancāns, 2014;Singh, Burns, Amin, Jones, & Harrison, 2004). While younger age at onset, male gender and longer hospital admission are features more likely to be associated with increased risk of subsequent diagnosis change to schizophrenia (Aadamsoo et al, 2011;Castagnini et al, 2013b;Queirazza et al, 2014;Rusaka & Rancāns, 2014), the effect of acute onset and early remission on diagnostic stability and/or favourable outcome remains unclear.…”