Short-term outcome in acute and transient psychotic disorder and its correlate to various sociobiological factors

Abstract

Background: There is a higher incidence of acute and transient psychotic disorder, however there are not much data on the course of disease and its association with sociobiological factors. We assessed the outcome in patients who met the ICD 10 DCR criteria for acute and transient psychotic disorder, at a follow up period of 6 months. Methods: We conducted a prospective observational study conducted at out-patient department of the Institute of Psychiatry and Human Behaviour, Bambolim, Goa. Fifty-seven patients were enrolled and were followed up for a period of 6 months from the day of enrollment. The outcome was 'review of diagnosis and 'no review of diagnosis at the end of 6 months. Results:The mean age of the study sample was 32.25 years. In three-fourth of the patients, there was no change in the diagnosis. Nearly 65% of the patients were women and 35% of them were men. No review in diagnosis was made in significant proportion of the population. Average duration of education was 7.35 years. Most of them were unskilled laborers and homemakers. A significant number of the study population was migrants. Two-third of the population did not have any family history of psychiatric disorder. The onset was acute in majority of the patients. Suicidal thoughts were present at the time of diagnosis in certain patients. The treatment adherence was lower in those whose diagnoses did not change at the end of 6 months. Sleep disturbances, ideas of persecution, and concentration difficulties were the frequently reported symptoms.No repeat episodes were noted in our study.

Acute and transient psychotic disorders: A review of Indian research

“…Most of the studies that have evaluated patients with ATPD have provided information on some or other clinical aspects of ATPD[ 49 62 63 66 67 70 72 73 74 75 76 78 79 84 88 89 90 91 92 97 98 99 100 101 102 103 104 105 ] exclusively. At the same time, some studies that have provided information about the clinical profile of ATPD also included patients with other acute psychotic states[ 32 34 35 36 39 40 51 52 53 56 61 65 69 80 82 83 85 93 94 95 96 106 ] like first episode psychosis,[ 42 43 44 45 58 64 71 86 107 108 ] postpartum psychosis,[ 46 47 54 55 109 ] etc.…”

“…Varied assessment tools have been utilized to either diagnose, rate the severity of the psychosis, or evaluate the symptom profile. The commonly used scales include Brief Psychiatric Rating Scale (BPRS),[ 39 42 43 56 63 70 72 74 75 76 79 88 98 99 102 105 ] Present State Examination (PSE),[ 32 34 35 36 85 93 95 96 ] Positive and Negative Syndrome Scale (PANSS),[ 39 43 44 45 64 66 71 78 86 ] and Comprehensive Psychopathological Rating Scale (CPRS). [ 40 46 62 69 78 80 92 ]…”

“…Later, other studies have also reported the nature of the onset of the ATPD. [ 39 46 51 53 54 62 66 67 70 78 79 85 91 101 ] Among these studies, episodes were of abrupt onset in 13%[ 78 ] to 75%[ 53 ] of the study samples, acute in 25%[ 53 ] to 87.5% of the samples,[ 78 ] subacute in 6.7%[ 79 ] to 16.2% of the samples,[ 85 ] and insidious in 15.4%[ 54 ] to 61.7%. [ 39 ] A study that compared the onset of patients with ATPD and mania reported a significant majority of patients with ATPD had an abrupt onset of illness when compared to patients with mania.…”

“…Studies that have assessed risk factors for ATPD have identified risk factors like life events or stressors,[ 53 61 66 67 73 74 78 79 82 83 84 85 88 89 101 ] immune markers,[ 75 88 ] cortisol,[ 88 ] and anti-NMDA antibodies to be associated with ATPD[ 56 ] [ Table 3 ].…”

“…Stressors have been assessed using the Presumptive Stressful life event scale (PSLES)[ 66 67 69 74 78 79 80 84 89 98 195 196 ] in most studies or as a part of routine history taking. While some studies[ 73 78 79 ] found no association between the onset of psychosis with stressors, other studies found a significant association between the two. [ 61 66 67 74 80 82 195 196 ] However, it is important to note that many of these studies have not included a control group.…”