is the Brief Psychotic Disorder a Distinct Nosologic Entity?: A Longitudinal Study of 80 Patients

Introduction:The DSM-IV-TR category “brief psychotic disorder” includes different concepts that have been defined before like bouffée délirante, cycloid psychosis and “acute and transient psychosis” in the last ICD-10. Limited prospective studies have been done, and they all show a marked diagnostic instability during follow-up. According to that, its independent nosologic entity is still uncertain.Aims:To determine the diagnostic stability of the brief psychotic disorders as well as their distinct clinical features.Method:Observational, retrospective, longitudinal study of 80 consecutive patients admitted at the acute psychiatric inpatient service of a general hospital between 2000 and 2006. at discharge, all of them fulfilled diagnostic criteria for “brief psychotic disorder” according to DSM-IV. Demographic and psychopathological data were analysed.Results:Mean age (SD) was 31.3 (9.5), most of them women (63%). the most frequent previous stressor was related to labour, while up to 45% didn't report any. 51% had no psychiatric family history. 15 (19%) patients previously had a brief psychotic episode. Psychopathological disturbances identified were: thought disorder 69%, anxiety 66.6%, insomnia 57.7%, suspiciousness 53.5%, rapidly changing delusions 53.3% (paranoid contents 75.3%), perplexity 46.5%, auditory hallucinations 45.1%, mood lability 36.6%, elation 23.9%, depressed mood 22.5% and irritability 12.7%. in the 24 month follow-up, 32.5% changed diagnosis to schizophrenia, 3"9% to schizoaffective, 10% to bipolar disorder and 16.9% achieved clinical remission. 28.5% were lost to follow-up.Conclusion:“Brief psychotic disorder” category is still uncertain and more data may be necessary to clarify if it should remain as a distinct nosologic entity.

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The concordance of ICD-10 acute and transient psychosis and DSM-IV brief psychotic disorder

Psychological Medicine ◽

10.1017/s0033291702005408 ◽

2002 ◽

Vol 32 (3) ◽

pp. 525-533 ◽

Cited By ~ 57

Author(s):

F. PILLMANN ◽

A. HARING ◽

S. BALZUWEIT ◽

R. BLÖINK ◽

A. MARNEROS

Keyword(s):

Psychotic Disorder ◽

Psychotic Disorders ◽

Good Prognosis ◽

Acute Onset ◽

Schizophreniform Disorder ◽

Not Otherwise Specified ◽

Brief Psychotic Disorder ◽

Icd 10 ◽

Dsm Iv

Background. ICD-10 acute and transient psychotic disorder (ATPD; F23) and DSM-IV brief psychotic disorder (BPD; 298.8) are related diagnostic concepts, but little is known regarding the concordance of the two definitions.Method. During a 5-year period all in-patients with ATPD were identified; DSM-IV diagnoses were also determined. We systematically evaluated demographic and clinical features and carried out follow-up investigations at an average of 2·2 years after the index episode using standardized instruments.Results. Forty-two (4·1%) of 1036 patients treated for psychotic disorders or major affective episode fulfilled the ICD-10 criteria of ATPD. Of these, 61·9% also fulfilled the DSM-IV criteria of brief psychotic disorder; 31·0%, of schizophreniform disorder; 2·4%, of delusional disorder; and 4·8%, of psychotic disorder not otherwise specified. BPD showed significant concordance with the polymorphic subtype of ATPD, and DSM-IV schizophreniform disorder showed significant concordance with the schizophreniform subtype of ATPD. BPD patients had a significantly shorter duration of episode and more acute onset compared with those ATPD patients who did not meet the criteria of BPD (non-BPD). However, the BPD group and the non-BPD group of ATPD were remarkably similar in terms of sociodemography (especially female preponderance), course and outcome, which was rather favourable for both groups.Conclusions. DSM-IV BPD is a psychotic disorder with broad concordance with ATPD as defined by ICD-10. However, the DSM-IV time criteria for BPD may be too narrow. The group of acute psychotic disorders with good prognosis extends beyond the borders of BPD and includes a subgroup of DSM-IV schizophreniform disorder.

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M97. PREDICTORS OF TRANSITION TO SCHIZOPHRENIA IN BRIEF PSYCHOTIC DISORDER: FINDINGS FROM A 3-YEAR LONGITUDINAL STUDY IN THE PAFIP COHORT

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa030.409 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S171-S172

Author(s):

Álvaro López-Díaz ◽

Rosa Ayesa-Arriola ◽

Victor Ortiz-García de la Foz ◽

Benedicto Crespo-Facorro ◽

Miguel Ruiz-Veguilla

Keyword(s):

Logistic Regression ◽

Mental Disorders ◽

Psychotic Disorder ◽

Psychotic Disorders ◽

Living Alone ◽

First Episode ◽

Multivariate Logistic Regression ◽

Brief Psychotic Disorder ◽

Dsm Iv

Abstract Background The category ‘brief psychotic disorder’ (BPD) is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a short-lived psychotic condition in which delusions, hallucinations, disorganised speech or grossly disorganised or catatonic behaviour are present for at least 1 day but less than 1 month. BPD is a relatively uncommon disease accounting for 2–7% of first-episode psychoses (FEP) and it has been poorly investigated in comparison with other psychotic disorders, probably due to its low prevalence and associated good prognosis. However, FEP patients with BPD have low diagnostic stability at follow-up and a high transition rate (around 55%) to long-lasting psychotic disorders, mainly to schizophrenia. This study explored the proportion of diagnostic transition to schizophrenia after 3 years in a cohort of FEP patients with BPD, to determine whether there were early predictive factors for such transition in this BPD population. Methods A 36-month prospective observational study of patients with first-episode BPD was conducted. The sample included subjects aged 18–60 from the intervention programme of first-episode psychosis non-affective psychosis (PAFIP) of the University Hospital Marques de Valdecilla (Spain). BPD diagnoses were confirmed using the Structured Clinical Interview for DSM-IV (SCID-I) at 6 months following admission into the PAFIP programme. Sociodemographic, premorbid and baseline clinical variables were collected and patients were followed over 3 years while they received treatment in the PAFIP programme. A DSM-IV diagnostic reassessment was performed on those patients who completed the follow-up and subjects were classified according to whether or not they had developed schizophrenia after 3 years. Univariate screening was performed to determine variables eligible for the predictive model, and factors that reached statistical or marginal significance (p ≤ 0.1) were selected for multivariate logistic regression analysis. Significant statistical level was set at 0.05. All statistical evaluation was performed using MedCalc Statistical Software (version 19.0.7). Results Of the 569 patients enrolled in the PAFIP programme between 2001 and 2018, 59 met the criteria for BPD. Of those, 40 (67.8%) completed the 36-month follow-up and 16 (40%) maintained their initial BPD diagnosis. Among the patients who developed other mental disorders by the end of the study period (60%; n = 24), the proportion of transition to schizophrenia was 62.5% (n = 15). Being younger at psychosis onset, living alone, a poor premorbid adjustment, acute onset of psychotic symptomatology, and higher severity of hallucinatory behaviour were variables that showed univariate associations with subsequent development of schizophrenia. A multivariate logistic regression model revealed that transition to schizophrenia was independently significantly associated with younger age at psychosis onset (OR = 0.83, 95% CI 0.69–0.99; p = 0.048), living alone (OR = 14.3, 95% CI 1.09–186.77; p = 0.042) and greater hallucinatory activity (OR = 1.81, 95% CI 1.07–3.07; p = 0.028). Discussion Our main findings were that 37.5% of patients who presented an initial BPD diagnosis developed schizophrenia in the following 36 months. Being younger at psychosis onset, living alone and experiencing greater hallucinatory activity at baseline were independent predictors of diagnostic transition to schizophrenia in this BPD population. Individuals with BPD presenting these risk factors should therefore be targeted for intensive interventions similar to those performed on patients with first-episode schizophrenia.

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Diagnostic validity of ICD-10 acute and transient psychotic disorders and DSM-5 brief psychotic disorder

European Psychiatry ◽

10.1016/j.eurpsy.2017.05.028 ◽

2017 ◽

Vol 45 ◽

pp. 104-113 ◽

Cited By ~ 18

Author(s):

A.C. Castagnini ◽

P. Fusar-Poli

Keyword(s):

Psychotic Disorder ◽

Psychotic Disorders ◽

Case Identification ◽

Migrant Populations ◽

Diagnostic Categories ◽

Dsm 5 ◽

Characteristic Family ◽

Brief Psychotic Disorder ◽

Icd 10

AbstractBackground:Short-lived psychotic disorders are currently classified under “acute and transient psychotic disorders” (ATPDs) in ICD-10, and “brief psychotic disorder” (BPD) in DSM-5. This study's aim is to review the literature and address the validity of ATPDs and BPD.Method:Papers published between January 1993 and December 2016 were identified through searches in Web of Science. Reference lists in the located papers provided further sources.Results:A total of 295 articles were found and 100 were included in the review. There were only a few studies about the epidemiology, vulnerability factors, neurobiological correlates and treatment of these disorders, particularly little interest seems to exist in BPD. The available evidence suggests that short-lived psychotic disorders are rare conditions and more often affect women in early to middle adulthood. They also are neither associated with premorbid dysfunctions nor characteristic family predisposition, while there seems to be greater evidence of environmental factors particularly in developing countries and migrant populations. Follow-up studies report a favourable clinical and functional outcome, but case identification has proved difficult owing to high rates of transition mainly either to schizophrenia and related disorders or, to a lesser extent, affective disorders over the short- and longer-terms.Conclusions:Although the lack of neurobiological findings and little predictive power argue against the validity of the above diagnostic categories, it is important that they are kept apart from longer-lasting psychotic disorders both for clinical practice and research. Close overlap between ATPDs and BPD could enhance the understanding of these conditions.

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Brief psychotic disorder associated with quarantine and mild COVID-19

BMJ Case Reports ◽

10.1136/bcr-2020-240088 ◽

2020 ◽

Vol 13 (12) ◽

pp. e240088

Author(s):

Peter M Haddad ◽

Majid Al Abdulla ◽

Javed Latoo ◽

Yousaf Iqbal

Keyword(s):

Psychotic Disorder ◽

Physical Symptoms ◽

Psychotic Symptoms ◽

First Episode ◽

Psychotic Episode ◽

Psychiatric Medication ◽

Diagnostic And Statistical Manual ◽

First Psychotic Episode ◽

Episode Psychosis ◽

Brief Psychotic Disorder

A 30-year-old man with no significant previous or family psychiatric history became severely anxious about his health after a positive COVID-19 test. Physical symptoms of COVID-19 were mild, with no evidence of hypoxia or pneumonia, throughout his illness. He was admitted to a quarantine facility. He remained highly anxious, and 1 week later, he developed paranoid delusions and auditory hallucinations (his first psychotic episode). He was treated with lorazepam 1 mg four times a day, mirtazapine 30 mg nocte and risperidone 1 mg two times a day. His psychotic symptoms lasted 1 week. He stopped psychiatric medication after 4 weeks and had remained well when reviewed 3 months later. A Diagnostic and Statistical Manual of Mental Disorders fifth edition diagnosis of brief psychotic disorder with marked stressor (brief reactive psychosis) was made. Anxiety about his health and social isolation appeared the main aetiological factors but an inflammatory component cannot be excluded. The case highlights that first episode psychosis can be associated with mild COVID-19.

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Overview of Schizophrenia and Other Psychotic Disorders

10.2310/psych.13011 ◽

2020 ◽

Author(s):

James A. Wilcox ◽

Donald W. Black

Keyword(s):

Psychotic Disorder ◽

Schizoaffective Disorder ◽

Psychotic Disorders ◽

Public Health Problem ◽

Premature Death ◽

Major Public Health Problem ◽

Schizophreniform Disorder ◽

Schizophrenia Spectrum ◽

Brief Psychotic Disorder ◽

The Individual

Psychotic disorders are among the most disabling conditions and constitute a major public health problem. Described throughout recorded time, they affect as many as 5% of the population and cause a disproportionate amount of suffering and loss to society. In the chapter on schizophrenia spectrum and other psychotic disorders, the DSM-5 lists delusional disorder, brief psychotic disorder, schizophreniform disorder, schizophrenia, and schizoaffective disorder, as well as categories for substance- or medically induced psychotic disorders. The term psychosis indicates that the individual has a severe inability to interpret the surrounding environment in a realistic way. Symptoms include hallucinations, delusions, and bizarre behavior. Psychotic disorders are associated with premature death, mostly attributable to suicide. The pathophysiology and etiology of psychotic disorders are only now beginning to be understood, and treatment for these conditions remains suboptimal. Researchers are currently refining the cause of these symptoms and developing more effective treatments. This review contains 3 tables, and 34 references. Key words: Brief psychotic disorder, delusions, hallucinations, psychosis, schizoaffective disorder, schizophrenia, schizophreniform disorder

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T195. PSYCHOTIC DISORDERS IN PATIENTS WHO USE SYNTHETIC CANNABINOIDS: CLINICAL CHARACTERISTICS AND PATIENT PROFILE

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa029.755 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S305-S306

Author(s):

Valentin Skriabin ◽

Maria Vinnikova

Keyword(s):

Clinical Characteristics ◽

Psychotic Disorders ◽

Clinical Presentation ◽

Violent Behavior ◽

Synthetic Cannabinoids ◽

Psychotic Episode ◽

Patient Profile ◽

Observational Cohort ◽

Male Patients

Abstract Background Cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC) are the two principal ingredients of natural cannabis with counteracting functions. Synthetic cannabinoids (SCs) are much more potent than natural cannabis, since they act as a more potent full agonist at the cannabinoid subtype 1 receptor than THC, and they also lack cannabinoids such as CBD that may otherwise counteract psychoactive properties of THC. Therefore, SCs may induce a more severe clinical presentation than natural cannabis does: the use of SCs may be associated with agitation, anxiety, tachycardia, hallucinations, irritability, memory and cognitive impairment, violent behavior, unresponsiveness, and psychosis. Clinical characteristics, specificity of the disease course and patient profile of the SC-induced psychoses are still poorly characterized in the scientific literature. The present study was therefore designed to evaluate the psychotic disorders in patients with synthetic cannabinoid use disorder in terms of patient profile and clinical characteristics with reference to their follow-up. Methods A total of 60 male patients (n=60; mean (standard deviation [SD]) age: 23.6 (3.5) years) diagnosed with psychotic disorder induced by the SC use who were hospitalized at the intensive care unit or emergency department of the Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare were included in this single-centre, longitudinal, observational cohort study. The catamnestic follow-up period was up to 2 years. Results We evaluated different clinical cases of SC-induced psychoses and identified four clinical types of them on the ground of leading psychopathological syndrome during the patient’s entire length of hospitalization: Then we performed a catamnestic follow-up of patients to reveal the possible schizophrenic process manifestation in patients who use SC. Catamnestic follow-up revealed that manifestation of the schizophrenic process was present in 8 patients (13% of cases). Discussion Our results revealed that SC-induced psychoses affect young adults primarily. Consistent with the statement that the majority of first-time SC users are experienced marijuana smokers, SC was used following other transitional substances rather than as the first substance in the majority of our patients, with cannabis being the most popular antecedent substance. SC was not the first substance used in the majority of our patients, and it had been preceded by use of other transitional substances, such as cannabis in most cases. Despite the exogenous nature, structurally such psychoses are often endoformic. For instance, even the delirium is atypical and includes the elements of Kandinsky-Clerambault’s syndrome. Psychopathologically hallucinations and delusions dominate in the clinical presentation of the psychoses (with predominant hallucinatory symptoms or affective paranoid symptoms). Development of substance-induced psychoses is often associated with the manifestation of the schizophrenic process (in our study it was revealed in 13% of cases). It is extremely difficult to create a differential diagnosis between such psychotic disorders and a primary endogenous psychotic episode. In such cases the appearance of deficit symptoms specific for schizophrenia becomes crucial.

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Acute and transient psychoses: clinical and nosological issues

BJPsych Advances ◽

10.1192/apt.bp.115.015198 ◽

2016 ◽

Vol 22 (5) ◽

pp. 292-300 ◽

Cited By ~ 9

Author(s):

Augusto Castagnini ◽

Gian Maria Galeazzi

Keyword(s):

Psychotic Disorder ◽

Psychotic Disorders ◽

Diagnosis And Treatment ◽

Cycloid Psychosis ◽

Dsm 5 ◽

Brief Psychotic Disorder ◽

Icd 10

SummaryThis article examines the clinical, epidemiological and nosological aspects of short-lived psychotic disorders as currently classified under ‘acute and transient psychotic disorders' in ICD-10 and ‘brief psychotic disorder’ in DSM-5. After describing earlier diagnostic concepts such as bouffée délirante, cycloid psychosis, reactive psychosis and schizophreniform psychosis, we present an overview of the literature and discuss implications for classification, diagnosis and treatment of these conditions, pointing out differences from longer-lasting psychotic disorders.

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Comorbidity in Schizophrenia

European Psychiatry ◽

10.1016/s0924-9338(09)71446-4 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

A. Chinchilla ◽

M. Vega ◽

A. Cebollada ◽

T. Alvarez ◽

M. Gómez ◽

...

Keyword(s):

Body Weight ◽

Treatment Adherence ◽

Psychotic Episode ◽

Secondary Effects ◽

Dual Pathology ◽

Medical Status ◽

Schizophrenic Patients ◽

Dsm Iv ◽

Worse Prognosis

Introduction:The coexistence of comorbidity in schizophrenia (somatic, dual pathology, personality…) can conditionate evolution and prognosis in this severe mental illness, those aspects should be taken in account to planify treatments and follow up issues.Objective:We are interested in this work in evaluate previous and developed comorbidity in schizophrenic patients; we also analyzed comorbidity consequences in clinical, therapeutical management, treatment adherence, relapses and hospitalizations.Material and method:In 50 Schizophrenic patients (DSM-IV TR Diagnostic criteria) with at least one previous psychotic episode we have studied longitudinal and transversally sociodemographic, clinical and therapeutical variables, related comorbidity (somatic, drugs related and dual pathology) and evolution, prognosis, clinical, treatment adherence and tolerance variables were also studied. We also evaluate psychopathologic and medical status (EEG, EKG, Chest RX, BMI, body weight, general analysis) secondary effects were registered. Uxue and CGI were the scales used.Results:Between 20% and 25% had other medical conditions, and 25-30% had some kind of drug abuse, those were who had worse prognosis, more secondary effects and usually were treated with classic antipsychotics.Conclusions:The results are discussed, and we propose integrative treatments for schizophrenia and the co morbidities, focusing on affectivity and tolerance.

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Stability of early-phase primary psychotic disorders with concurrent substance use and substance-induced psychosis

The British Journal of Psychiatry ◽

10.1192/bjp.bp.105.015784 ◽

2007 ◽

Vol 190 (2) ◽

pp. 105-111 ◽

Cited By ~ 61

Author(s):

Carol L. M. Caton ◽

Deborah S. Hasin ◽

Patrick E. Shrout ◽

Robert E. Drake ◽

Boanerges Domínguez ◽

...

Keyword(s):

Mental Illness ◽

Substance Use ◽

Early Phase ◽

Psychotic Disorders ◽

History Of ◽

Dsm Iv ◽

The Stability ◽

Primary Substance ◽

Diagnostic Changes

BackgroundThe stability of the diagnostic distinction between a substance-induced psychosis and a primary psychotic disorder co-occurring with substance use is not established.AimsTo describe DSM – IV diagnostic changes over 1 year and determine the predictive validity of baseline indicators of the substance-induced psychosis v. primary psychosis distinction.MethodWe conducted a 1-year follow-up study of 319 psychiatric emergency department admissions with diagnoses of early-phase psychosis and substance use comorbidity.ResultsOf those with a baseline DSM—IV diagnosis of substance-induced psychosis, 25% had a diagnosis of primary psychosis at follow-up. These patients had poorer premorbid functioning, less insight into psychosis and greater family mental illness than patients with a stable diagnosis of substance-induced psychosis. Reclassifying change cases to primary psychoses on follow-up, key baseline predictors of the primary/substance-induced distinction at 1 year also included greater family history of mental illness in the primary psychosis group.ConclusionsFurther study of substance-induced psychoses should employ neuroscientific and behavioural approaches. Study findings can guide more accurate diagnoses at first treatment.

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From Speech Illusions to Onset of Psychotic Disorder: Applying Network Analysis to an Experimental Measure of Aberrant Experiences

Schizophrenia Bulletin Open ◽

10.1093/schizbullopen/sgaa025 ◽

2020 ◽

Vol 1 (1) ◽

Author(s):

Lindy-Lou Boyette ◽

Adela-Maria Isvoranu ◽

Frederike Schirmbeck ◽

Eva Velthorst ◽

Claudia J P Simons ◽

...

Keyword(s):

Psychotic Disorder ◽

Psychotic Disorders ◽

Psychotic Symptoms ◽

Positive Symptoms ◽

Clinical High Risk ◽

Cross Sectional ◽

Affective Symptoms ◽

The Eu

Abstract Aberrant perceptional experiences are a potential early marker of psychosis development. Earlier studies have found experimentally assessed speech illusions to be associated with positive symptoms in patients with psychotic disorders, but findings for attenuated symptoms in individuals without psychotic disorders have been inconsistent. Also, the role of affect is unclear. The aim of this study was to use the network approach to investigate how speech illusions relate to individual symptoms and onset of a psychotic disorder. We estimated a network model based on data from 289 Clinical High-Risk (CHR) subjects, participating in the EU-GEI project. The network structure depicts statistical associations between (affective and all) speech illusions, cross-sectional individual attenuated positive and affective symptoms, and transition to psychotic disorder after conditioning on all other variables in the network. Speech illusions were assessed with the White Noise Task, symptoms with the BPRS and transition during 24-month follow-up with the CAARMS. Affective, not all, speech illusions were found to be directly, albeit weakly, associated with hallucinatory experiences. Hallucinatory experiences, in turn, were associated with delusional ideation. Bizarre behavior was the only symptom in the network steadily predictive of transition. Affective symptoms were highly interrelated, with depression showing the highest overall strength of connections to and predictability by other symptoms. Both speech illusions and transition showed low overall predictability by symptoms. Our findings suggest that experimentally assessed speech illusions are not a mere consequence of psychotic symptoms or disorder, but that their single assessment is likely not useful for assessing transition risk.

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