A case of acute and transient psychosis–What to expect?

IntroductionThe Tenth Revision of the International Classification of Diseases (ICD-10) introduced the category of Acute and transient psychotic disorders (ATPD), that assimilate clinical concepts such as the French Bouffée Délirante, Kleist and Leonhard's cycloid psychosis, and the scandinavian reactive psychosis.Methods and aimsThe authors present a clinical case of ATPD and a literature review based on PubMed/MEDLINE, using the keywords: “acute and transient psychotic disorder”, “prognosis” and “diagnostic stability”, aiming to discuss the main challenges regarding the diagnosis, treatment and prognosis.ResultsThe patient is a male with 37 years old with two previous psychotic episodes (with 2.5 years of interval), both with an acute onset (of 7 and 3 days respectively), and a fast response to antipsychotic treatment, with periods of complete symptom's remission. He maintains treatment with 6 mg of paliperidone. In the literature, we found scarce information on ATPD. Though several variables have been described as having influence on the prognosis (gender, pre-morbid functioning, acute onset and presence of affective symptoms), this topic remains controversial. Another difficult aspect about ATPD seems to be its low diagnostic stability, with diagnosis changing mostly to Schizophrenia, Schizoaffective disorder and Bipolar disorder. Duration of treatment after complete remission of symptoms is another controversial aspect of this disease.ConclusionsATPD seems to have low diagnostic stability and poor research investment, and so it represents a challenge for psychiatrists on managing these patients in terms of treatment and follow-up plan. Further studies should be held regarding prognosis and treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Clinical manifestations in patients with acute and transient psychosis

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1303 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S363-S364

Author(s):

Á. López Díaz ◽

A. Soler Iborte ◽

S. Galiano Rus ◽

J.L. Fernández González ◽

J.I. Aznarte López

Keyword(s):

Psychotic Disorder ◽

Psychotic Disorders ◽

Clinical Manifestations ◽

Retrospective Chart Review ◽

International Classification Of Diseases ◽

Exact Test ◽

Chi Squared ◽

Classification Of Diseases ◽

Icd 10 ◽

Competing Interest

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.

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Diagnostic Stability of Acute and Transient Psychotic Disorders in Patients Attending Tertiary Care Hospital

Journal of Universal College of Medical Sciences ◽

10.3126/jucms.v2i4.12035 ◽

2015 ◽

Vol 2 (4) ◽

pp. 7-10 ◽

Cited By ~ 1

Author(s):

Sanjeev Ranjan ◽

R Shakya ◽

P M Shyangwa

Keyword(s):

Mood Disorders ◽

Psychotic Disorders ◽

Tertiary Care ◽

International Classification Of Diseases ◽

Health Science ◽

Care Hospital ◽

Medical Sciences ◽

Diagnostic Stability ◽

Classification Of Diseases ◽

Icd 10

INTRODUCTION: Acute and Transient Psychotic Disorders (ATPDs) have been the subject of nosological debate. Some authors argue that these conditions should be considered as an independent group of disorders. Others view these psychoses as variants of schizophrenia or mood disorders, pointing to their diagnostic instability. There have been few studies of the diagnostic stability based on the International Classification of Diseases-tenth edition (ICD-10) category of ATPDs, and these studies have mixed results. This study was done to examine the diagnostic stability of ATPDs according to ICD-10. MATERIAL AND METHODS: Thirty patients diagnosed as ATPDs at psychiatry department of B.P. Koirala Institute of Health Science (BPKIHS) were followed up at one month and after three months of their onset of illness. Their diagnosis was reassessed at every follow-up using standard instrument. RESULTS: The diagnosis of ATPDs was unchanged in twenty four (80%) out of thirty patients. Diagnostic change was to schizophrenia in three cases and to mood disorders in three other cases. CONCLUSION: Overall, ATPDs is a diagnostically stable entity.DOI: http://dx.doi.org/10.3126/jucms.v2i4.12035Journal of Universal College of Medical Sciences (2014) Vol.02 No.04 Issue 08,Page: 7-10

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Diagnostic stability of acute and transient psychotic disorders in developing country settings: an overview

Mental Illness ◽

10.1108/mi.2015.5640 ◽

2015 ◽

Vol 7 (1) ◽

pp. 13-15

Author(s):

Shubham Mehta

Keyword(s):

Developing Countries ◽

Developing Country ◽

Psychotic Disorders ◽

Diagnostic System ◽

International Classification Of Diseases ◽

Abrupt Onset ◽

Diagnostic Stability ◽

Classification Of Diseases ◽

Icd 10 ◽

Pubmed Search

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.

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Diagnostic stability of acute and transient psychotic disorders in developing country settings: an overview

Mental Illness ◽

10.4081/mi.2015.5640 ◽

2015 ◽

Vol 7 (1) ◽

Author(s):

Shubham Mehta

Keyword(s):

Developing Countries ◽

Developing Country ◽

Psychotic Disorders ◽

Diagnostic System ◽

International Classification Of Diseases ◽

Abrupt Onset ◽

Diagnostic Stability ◽

Classification Of Diseases ◽

Icd 10 ◽

Pubmed Search

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Increased prevalence of psychosis in patients who get admitted with atrial fibrillation with worse outcomes

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.856 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S575-S576

Author(s):

Z. Mansuri ◽

S. Patel ◽

P. Patel ◽

O. Jayeola ◽

A. Das ◽

...

Keyword(s):

Atrial Fibrillation ◽

Hospital Admissions ◽

Temporal Trends ◽

International Classification Of Diseases ◽

Trend Test ◽

Classification Of Diseases ◽

Competing Interest ◽

Armitage Trend Test ◽

The Impact

ObjectiveTo determine trends and impact on outcomes of atrial fibrillation (AF) in patients with pre-existing psychosis.BackgroundWhile post-AF psychosis has been extensively studied, contemporary studies including temporal trends on the impact of pre-AF psychosis on AF and post-AF outcomes are largely lacking.MethodsWe used Nationwide Inpatient Sample (NIS) from the healthcare cost and utilization project (HCUP) from year's 2002–2012. We identified AF and psychosis as primary and secondary diagnosis respectively using validated international classification of diseases, 9th revision, and Clinical Modification (ICD-9-CM) codes, and used Cochrane–Armitage trend test and multivariate regression to generate adjusted odds ratios (aOR).ResultsWe analyzed total of 3.887.827AF hospital admissions from 2002–2012 of which 1.76% had psychosis. Proportion of hospitalizations with psychosis increased from 5.23% to 14.28% (P trend < 0.001). Utilization of atrial-cardioversion was lower in patients with psychosis (0.76%v vs. 5.79%, P < 0.001). In-hospital mortality was higher in patients with Psychosis (aOR 1.206; 95%CI 1.003–1.449; P < 0.001) and discharge to specialty care was significantly higher (aOR 4.173; 95%CI 3.934–4.427; P < 0.001). The median length of hospitalization (3.13 vs. 2.14 days; P < 0.001) and median cost of hospitalization (16.457 vs. 13.172; P < 0.001) was also higher in hospitalizations with psychosis.ConclusionsOur study displayed an increasing proportion of patients with Psychosis admitted due to AF with higher mortality and extremely higher morbidity post-AF, and significantly less utilization of atrial-cardioversion. There is a need to explore reasons behind this disparity to improve post-AF outcomes in this vulnerable population.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Study of psychiatric disorders among nepalese patients working abroad and their family members

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v6i4.6718 ◽

2012 ◽

Vol 6 (4) ◽

pp. 1-6

Author(s):

B Yengkokpam ◽

SK Shah ◽

GR Bhantana

Keyword(s):

Psychiatric Disorders ◽

Psychotic Disorders ◽

Somatoform Disorders ◽

Bipolar Affective Disorder ◽

Family Members ◽

International Classification Of Diseases ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Classification Of Diseases ◽

Icd 10

This study was carried out among the patients working abroad and their family members, having various psychiatric disorders. 80 patients attending psychiatry OPD between the age of 15 to 65 years both male and female in the period of July 2009 to July 2010 were included. The results were tabulated as per the diagnostic criteria of International Classification of Diseases (ICD-10). Out of total 80 patients, 41 were males and 39 were females, whose husbands were working abroad. 30 cases were of depression,out of which 16 were males and 14 were females.18 cases were having anxiety disorders out of which 5 were males and 13 were females. 12 cases were suffering from psychotic disorders out of which 10 were males and 2 were females.7 cases were having dissociative disorders with 1 male and 6 females.4 cases were having somatoform disorders with 2 males and 2 females.1 male and 1 female were suffering from mania.1 male and 1 female were suffering from bipolar affective disorder. 2 males were alcohol dependent and 2 males were having obsessive compulsive disorder. 1 male was having organic psychosis. Journal of College of Medical Sciences-Nepal,2011,Vol-6,No-4, 1-6 DOI: http://dx.doi.org/10.3126/jcmsn.v6i4.6718

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Obsessive-Compulsive Spectrum Phenomena and the DSM-V Developmental Process

CNS Spectrums ◽

10.1017/s1092852900016229 ◽

2008 ◽

Vol 13 (2) ◽

pp. 107-108 ◽

Cited By ~ 6

Author(s):

Eric Hollander

Keyword(s):

Psychotic Disorders ◽

Developmental Process ◽

International Classification Of Diseases ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Diagnostic And Statistical Manual ◽

Dsm V ◽

Classification Of Diseases ◽

Psychotic Features

Several of this month's articles and interviews touch on themes that relate to spectrum phenomena as well as the Diagnostic and Statistical Manual of Mental Disorders developmental process.First, Darrel A. Regier, MD, MPH, director of the Division of Research at American Psychiatric Association, discusses, in an interview with CNS Spectrums, the developmental process for DSM-V. He emphasizes the use of dimensional measures to determine both thresholds for disorders, and to assess response to treatments. He also highlights a focus on spectra of disorders that cut across traditional diagnostic boundaries as one way to deal with issues of comorbidity. Finally, he discusses new approaches to the five DSM axes, and the need to link together the DSM and International Classification of Diseases processes. Three other articles in this issue also clearly relate to these obsessive-compulsive spectra issues.For example, Leonardo F. Fontenelle, MD, PhD, describes how, although much attention has been paid to patients who lack insight into their obsessional beliefs, less importance has been given to individuals with obsessive-compulsive disorder (OCD) who display perceptual disturbances typically found in psychotic disorders, including schizophrenia, schizoaffective disorders, or mood disorders with psychotic features. The authors call attention to a phenomenon that has been neglected in the psychiatric literature (ie, the occurrence of hallucinations and related phenomena in patients with OCD). They describe five patients with OCD with hallucinations in several different sensory modalities, including the auditory, the visual, the tactile, the olfactory, and the cenesthetic modalities, and suggest that further psychopathological research should clarify the clinical significance of hallucinations among patients with OCD.

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Symptom rating scales for schizophrenia and other primary psychotic disorders in ICD-11

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796017000270 ◽

2017 ◽

Vol 27 (3) ◽

pp. 219-224 ◽

Cited By ~ 8

Author(s):

J. W. Keeley ◽

W. Gaebel

Keyword(s):

Negative Symptoms ◽

Rating Scales ◽

Psychotic Disorders ◽

Rating Scale ◽

Field Testing ◽

International Classification Of Diseases ◽

Severity Rating ◽

Classification Of Diseases ◽

The Cost ◽

Symptom Rating

The subtype system for categorising presentations of schizophrenia will be removed from International Classification of Diseases 11th Revision. In its place will be a system for rating six domains of psychotic disorder pathology: positive symptoms, negative symptoms, depressive symptoms, manic symptoms, psychomotor symptoms and cognitive symptoms. This paper outlines the rationale and description of the proposed symptom rating scale, including current controversies. In particular, the scale could adopt either a 4-point severity rating or a 2-point presence/absence rating. The 4-point scale has the advantage of gathering more information, but potentially at the cost of reliability. The paper concludes by describing the field testing process for evaluating the proposed scale.

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Risk of dementia associated with psychotic disorders in later life: the health in men study (HIMS)

Psychological Medicine ◽

10.1017/s003329171800065x ◽

2018 ◽

Vol 49 (2) ◽

pp. 232-242 ◽

Cited By ~ 5

Author(s):

Osvaldo P. Almeida ◽

Andrew H. Ford ◽

Graeme J. Hankey ◽

Bu B. Yeap ◽

Jonathan Golledge ◽

...

Keyword(s):

Psychotic Disorder ◽

Psychotic Disorders ◽

Age Of Onset ◽

Bipolar Disorders ◽

Later Life ◽

International Classification Of Diseases ◽

Renal Diseases ◽

Increased Risk ◽

Clinical Diagnoses ◽

Classification Of Diseases

AbstractBackgroundRecent research has identified several potentially modifiable risk factors for dementia, including mental disorders. Psychotic disorders, such as schizophrenia and delusional disorder, have also been associated with increased risk of cognitive impairment and dementia, but currently available data difficult to generalise because of bias and confounding. We designed the present study to investigate if the presence of a psychotic disorder increased the risk of incident dementia in later life.MethodsProspective cohort study of a community-representative sample of 37 770 men aged 65–85 years who were free of dementia at study entry. They were followed for up to 17.7 years using electronic health records. Clinical diagnoses followed the International Classification of Diseases guidelines. As psychotic disorders increase mortality, we considered death a competing risk.ResultsA total of 8068 (21.4%) men developed dementia and 23 999 (63.5%) died during follow up. The sub-hazard ratio of dementia associated with a psychotic disorder was 2.67 (95% CI 2.30–3.09), after statistical adjustments for age and prevalent cardiovascular, respiratory, gastrointestinal and renal diseases, cancer, as well as hearing loss, depressive and bipolar disorders, and alcohol use disorder. The association between psychotic disorder and dementia risk varied slightly according to the duration of the psychotic disorder (highest for those with the shortest illness duration), but not the age of onset. No information about the use of antipsychotics was available.ConclusionOlder men with a psychotic disorder have nearly three times greater risk of developing dementia than those without psychosis. The pathways linking psychotic disorders to dementia remain unclear but may involve mechanisms other than those associated with Alzheimer's disease and other common dementia syndromes.

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Antipsychotic polypharmacy in the treatment of schizophrenia in China and Japan

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867418805559 ◽

2018 ◽

Vol 52 (12) ◽

pp. 1202-1212 ◽

Cited By ~ 4

Author(s):

Hong Qiu ◽

Yong He ◽

Yongjing Zhang ◽

Minfu He ◽

Jin Liu ◽

...

Keyword(s):

Second Generation ◽

International Classification Of Diseases ◽

Medical Data ◽

Antipsychotic Treatment ◽

Study Cohort ◽

Younger Patients ◽

Data Centre ◽

Second Generation Antipsychotics ◽

Classification Of Diseases ◽

China And Japan

Background: Although antipsychotic monotherapy is recommended as the main treatment for schizophrenia, antipsychotic polypharmacy is not rare in practice. However, longitudinal data on antipsychotic polypharmacy in schizophrenia treatment are limited. Methods: This longitudinal database study described antipsychotic polypharmacy in the treatment of schizophrenia in real-world settings in China and Japan. We retrieved information about antipsychotic treatment for schizophrenia from January 2010 to December 2014 from two hospital Electronic Medical Records databases in China and one claims database, Japan Medical Data Centre in Japan. Eligible patients had a diagnosis of schizophrenia (International Classification of Diseases, Tenth Revision F20.x) and at least one prescription for first or second generation antipsychotics. Antipsychotic polypharmacy was defined as having more than one antipsychotic medication overlapping for ⩾60 days. The Japan Medical Data Centre study cohort was further stratified by employees (insurance beneficiaries) and their dependents. Results: The study cohorts comprised 11,961 patients from China and 25,034 (10,661 employee sub-cohort and 14,373 dependent sub-cohort) from 14 days Japan Medical Data Centre in Japan. Most patients were prescribed monotherapy (87.3% in China and 80.1% in Japan), of which oral second-generation antipsychotics were the majority (78.9% in China and 65.8% in Japan). The prevalence rate of antipsychotic polypharmacy was 12.7% in China and 19.9% in Japan (13.7% in employees vs 24.5% in dependents). The most common combinations were two oral antipsychotics. Combinations of more than two drugs were uncommon in China (0.3%) but were prescribed for 5.3% of patients in Japan. Among patients treated with monotherapy, 12.6/100 person-years (11.8%) in China and 9.6/100 person-years (11.0%) in Japan switched to antipsychotic polypharmacy during follow-up. Younger patients were more likely to switch to antipsychotic polypharmacy than older patents in all study cohorts. Conclusion: The observed rates of antipsychotic polypharmacy ranged from 12.7% in China to 19.9% in Japan. Switching from monotherapy to antipsychotic polypharmacy was most likely to occur in younger patients with schizophrenia.

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