Acute and transient psychotic disorders

2012 ◽  
pp. 602-608
Author(s):  
J. Garrabé ◽  
F.-R. Cousin
Keyword(s):  
Psychotic Disorders ◽  
Acute Stress ◽  
Abrupt Onset ◽  
Acute Onset ◽  
Stressful Events ◽  
Psychotic Symptoms ◽  
Time Interval ◽  
Psychotic State ◽  
Icd 10 ◽  
The Individual

The heterogeneous group of acute and transient psychotic disorders are characterized by three typical features, listed below in descending order of priority: ♦ suddenness of onset (within 2 weeks or less); ♦ presence of typical syndromes with polymorphic (changing and variable) or schizophrenic symptoms; ♦ presence of associated acute stress (stressful events such as bereavement, job loss, psychological trauma, etc.). The onset of the disorder is manifested by an obvious change to an abnormal psychotic state. This is considered to be abrupt when it occurs within 48 h or less. Abrupt onset often indicates a better outcome. Full recovery occurs within 3 months and often in a shorter time (a few days or weeks). However, a small number of patients develop persistent and disabling states. The general (G) criteria for these acute disorders in DCR-10 (Diagnostic Criteria Research of ICD) are as follows. G1 There is acute onset of delusions, hallucinations, incomprehensible or incoherent speech, or any combination of these. The time interval between the first appearance of any psychotic symptoms and the presentation of the fully developed disorder should not exceed 2 weeks. G2 If transient states of perplexity, misidentification, or impairment of attention and concentration are present, they do not fulfil the criteria for organically caused clouding of consciousness as specified for F05, criterion A. G3 The disorder does not satisfy the symptomatic criteria for manic episode (F30), depressive episode (F32), or recurrent depressive disorder (F33). G4 There is insufficient evidence of recent psychoactive substance use to satisfy the criteria for intoxication (F1x.0), harmful use (F1x.1), dependence (F1x.2), or withdrawal states (F1x.3 and F1x.4). The continued moderate and largely unchanged use of alcohol or drugs in the amounts or with the frequency to which the individual is accustomed does not necessarily exclude the use of F23; this must be decided by clinical judgement and the requirements of the research project in question. G5 There must be no organic mental disorder (F00–F09) or serious metabolic disturbances affecting the central nervous system (this does not include childbirth). (This is the most commonly used exclusion clause.) A fifth character should be used to specify whether the acute onset of the disorder is associated with acute stress (occurring 2 weeks or less before evidence of first psychotic symptoms): ♦ F23.x0 without associated acute stress and ♦ F23.x1 with associated acute stress. For research purposes it is recommended that change of the disorder from a non-psychotic to a clearly psychotic state is further specified as either abrupt (onset within 48 h) or acute (onset in more than 48 h but less than 2 weeks). Six categories of acute psychoses are presented in ICD-10, and we shall discuss them in order.

Gender differences in acute and transient psychotic disorder

2016 ◽  
Vol 33 (S1) ◽  
pp. S364-S364
Author(s):  
Á. López Díaz ◽  
S. Galiano Rus ◽  
A. Soler Iborte ◽  
J.L. Fernández González ◽  
J.I. Aznarte López
Keyword(s):  
Gender Differences ◽  
Psychotic Disorders ◽  
Acute Stress ◽  
Clinical Symptoms ◽  
Statistical Significance ◽  
Stressful Events ◽  
Psychotic Symptoms ◽  
Psychiatric Ward ◽  
Cross Sectional ◽  
Diagnostic Stability

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.

scholarly journals Long term outcomes of acute and transient psychotic disorders: The missed opportunity of preventive interventions

2018 ◽  
Vol 52 ◽  
pp. 126-133 ◽  
Author(s):  
Grazia Rutigliano ◽  
Sergio Merlino ◽  
Amedeo Minichino ◽  
Rashmi Patel ◽  
Cathy Davies ◽  
...  
Keyword(s):  
High Risk ◽  
Psychotic Disorders ◽  
Cumulative Risk ◽  
Acute Onset ◽  
Kaplan Meier ◽  
Schizophrenia Spectrum ◽  
National Health Service Trust ◽  
Icd 10

AbstractBackground:Acute and transient psychotic disorders (ATPD) are characterized by an acute onset and a remitting course, and overlap with subgroups of the clinical high-risk state for psychosis. The long-term course and outcomes of ATPD are not completely clear.Methods:Electronic health record-based retrospective cohort study, including all patients who received a first index diagnosis of ATPD (F23, ICD-10) within the South London and Maudsley (SLaM) National Health Service Trust, between 1 st April 2006 and 15th June 2017. The primary outcome was risk of developing persistent psychotic disorders, defined as the development of any ICD-10 diagnoses of non-organic psychotic disorders. Cumulative risk of psychosis onset was estimated through Kaplan-Meier failure functions (non-competing risks) and Greenwood confidence intervals.Results:A total of 3074 patients receiving a first index diagnosis of ATPD (F23, ICD-10) within SLaM were included. The mean follow-up was 1495 days. After 8-year, 1883 cases (61.26%) retained the index diagnosis of ATPD; the remaining developed psychosis. The cumulative incidence (Kaplan-Meier failure function) of risk of developing any ICD-10 non-organic psychotic disorder was 16.10% at 1-year (95%CI 14.83–17.47%), 28.41% at 2-year (95%CI 26.80–30.09%), 33.96% at 3-year (95% CI 32.25–35.75%), 36.85% at 4-year (95%CI 35.07–38.69%), 40.99% at 5-year (95% CI 39.12–42.92%), 42.58% at 6-year (95%CI 40.67–44.55%), 44.65% at 7-year (95% CI 42.66–46.69%), and 46.25% at 8-year (95% CI 44.17–48.37%). The cumulative risk of schizophrenia-spectrum disorder at 8-year was 36.14% (95% CI 34.09–38.27%).Conclusions:Individuals with ATPD have a very high risk of developing persistent psychotic disorders and may benefit from early detection and preventive treatments to improve their outcomes.

Postpartum psychosis—important clues to the aetiology of mood disorders

2014 ◽  
Author(s):  
Ian Jones
Keyword(s):  
Mood Disorder ◽  
Psychotic Disorders ◽  
Perinatal Period ◽  
Acute Onset ◽  
Psychotic Symptoms ◽  
Postpartum Psychosis ◽  
Research Strategies ◽  
Pregnancy And Childbirth ◽  
Unipolar Disorder ◽  
Disturbance Of Consciousness

It is of great regret that although corresponding with him at the start of my research career, I never met Channi Kumar face to face. His work, however, as evidenced by this book, remains an important influence on our field. I share his belief in the ‘maternal brain as a model for investigating mental illness’ (Kumar 2001), and this conviction has underlined much of my research. In this chapter I will discuss the concept of postpartum psychosis (PP), explore what we know about the relationship of these episodes to other mood and psychotic disorders, and consider research strategies aimed at understanding the nature of the postpartum trigger. I will argue that the nosological confusion surrounding this condition has been unhelpful and that it is time, perhaps, to consider whether we should revive postpartum psychosis as a diagnostic concept. Episodes of mood disorder in relation to pregnancy and childbirth are very common. In our group we have recently examined the history of perinatal episodes in over 1,500 women with mood disorder who have participated in our genetic studies and find that approximately two thirds of parous women, with both bipolar and unipolar disorder, have experienced a significant mood episode in the perinatal period (Di Florio et al. 2013). PP refers to some of the most severe forms of postpartum psychiatric disorder. Although the boundaries of this condition are not easy to define, the core concept is the acute onset of a manic or affective psychosis in the immediate postpartum period. Depending on the definition employed, the incidence is approximately 1 in 1,000 deliveries (Jones et al. 2010). Women may go from being very well to severely ill within hours. Affective (mood) symptoms, both elation and depression, are prominent, as is a disturbance of consciousness marked by an apparent confusion, bewilderment, or perplexity. As the name suggests, psychotic phenomena occur, with delusions and hallucinations prominent. Some women with severe manic episodes, but who do not show psychotic symptoms, may receive the diagnosis, although it is also possible to reserve the label for those women with frank psychotic presentations.

Psychotic Manifestations in a Patient with Mental Retardation and a 6.2 Megabase Deletion at the Distal Short Arm of Chromosome 12

CNS Spectrums ◽  
2008 ◽  
Vol 13 (6) ◽  
pp. 515-519 ◽  
Author(s):  
Milen Velinov ◽  
Gail Beldia ◽  
Hong Gu ◽  
John A. Tsiouris ◽  
Edmund C. Jenkins ◽  
...  
Keyword(s):  
Mental Retardation ◽  
Psychotic Disorders ◽  
Chromosome 12 ◽  
Psychotic Symptoms ◽  
Comparative Genomic ◽  
Comparative Genomic Hybridization Analysis ◽  
The Family ◽  
The Individual ◽  
Microarray Comparative Genomic Hybridization

ABSTRACTGenetic factors are known to contribute to the development of schizophrenia and related psychoses. Cytogenetic abnormalities have been occasionally found in patients with psychotic disorders and, thus, have helped identify candidate gene contributors for these conditions. The individual described here first presented with mental retardation and anxiety disorder in his mid-childhood. In his early 20s, the patient started exhibiting various psychotic manifestations, including delusions and hallucinations. His psychotic symptoms were difficult to control with psychotropic medications. The family history was negative for psychiatric disorders. This patient was found to have a 6.2 megabase deletion of the terminal portion of the short arm of chromosome 12 that was characterized using fluorescence in situ hybridization and microarray comparative genomic hybridization analysis. The maternal chromosomes were normal, but the paternal chromosomes could not be tested. To date such a chromosomal abnormality has not been described in association with schizophrenia/psychosis. This case suggests that psychosis-associated gene(s) may be located in the terminal region of the short arm of chromosome 12.

scholarly journals Acute and transient psychotic disorders: precursors, epidemiology, course and outcome

2004 ◽  
Vol 185 (6) ◽  
pp. 452-459 ◽  
Author(s):  
Swaran P. Singh ◽  
Tom Burns ◽  
Shazad Amin ◽  
Peter B. Jones ◽  
Glynn Harrison
Keyword(s):  
Psychotic Disorders ◽  
First Episode Psychosis ◽  
Acute Onset ◽  
Favourable Outcome ◽  
First Episode ◽  
Affective Psychosis ◽  
Episode Psychosis ◽  
Icd 10 ◽  
Premorbid Functioning ◽  
Better Than

BackgroundICD–10 has introduced the diagnostic group acute and transient psychotic disorders (ATPDs; F23). Aims To validate the nosological distinctiveness of ICD–10 ATPDs by following up an inception cohort with first-episode psychosis. Method All patients with first-episode psychosis identified in Nottingham between 1992 and 1994 and diagnosed using ICD–10 criteria were reassessed 3 years later. ATPD outcomes were compared with schizophrenia and affective psychosis. Multivariate analyses were conducted to determine whether acute onset and early remission predicted favourable 3-year outcome in first-episode psychosis. Results Of 168 cases of first-episode psychosis, 32 (19%) received an intake diagnosis of ATPD. The diagnosis of ATPD was stable in women over 3 years, but not in men. Outcomes in ATPD were better than in schizophrenia and similar to affective psychosis. In non-affective psychoses, favourable outcomes were a function of gender and premorbid functioning rather than acute onset and early remission. Conclusions The ICD–10 criteria for ATPDs identify a diagnostically unstable group of disorders. Acute onset and early remission do not independently predict favourable outcome over 3 years in first-episode psychosis.

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

2002 ◽  
Vol 32 (3) ◽  
pp. 525-533 ◽  
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.

scholarly journals Religious delusions: Definition, diagnosis and clinical implications

Psychiatriki ◽  
2021 ◽  
Author(s):  
Natasa Sofou ◽  
Orestis Giannakopoulos ◽  
Εva Arampatzi ◽  
George Konstantakopoulos
Keyword(s):  
Clinical Practice ◽  
Mental Health Professionals ◽  
Family Environment ◽  
Psychotic Disorders ◽  
Genetic Load ◽  
Religious Communities ◽  
Psychotic Symptoms ◽  
Religion And Spirituality ◽  
Psychiatric Symptomatology ◽  
The Individual

The prevalence of the biopsychosocial model in psychiatry highlights the importance of investigating the clinical significance of religiosity in patients with psychotic disorders. Due to the spiritual and supernatural nature of religious beliefs, distinguishing them from religious delusions is a challenging endeavour. The self-referential nature of the beliefs, the presence of concomitant psychiatric symptomatology and the effect on functionality seem to play a key role in differential diagnosis. Religious psychotic symptoms are common in clinical practice. The study of these symptoms often becomes difficult due to varying definitions, the fluctuation they present over time and space and the strong influences of the social and cultural environment on them. There seems to be a positive correlation between religiosity and the occurrence of religious delusions in psychotic patients, but it is not clear that this indicates a causal relationship. The content of religious delusions seems to be significantly influenced by the immediate social environment rather than cultural background of the individual, as well as by the beliefs and attitudes of the patient's family environment. Religious delusions are characterized by increased conviction and pervasiveness, permeating to a greater extent the individual's whole experience. Their presence is associated with more severe symptoms, higher medication dosage, and poorer prognosis. The increased severity of psychosis with religious content symptomatology seems to be associated with genetic factors and greater genetic load. In addition, the increased duration of untreated psychosis is a determinant of prognosis. This may reflect a reduced alertness of the immediate environment of patients who develop psychotic symptoms with religious content for the first time. Other important prognostic factors are patients' lack of adherence to treatment, their greater resistance to psychiatric approach of the disorder and their exclusion from religious communities, as well as the special characteristics of religious delusions, which seem more corrosive to the patients' psyche than other delusions. Religion and spirituality are prominent in the lives of the majority of patients with psychosis, but they are often underestimated in clinical practice. Raising the awareness of mental health professionals on issues of a religious and spiritual nature can be beneficial in both preventing and treating psychotic disorders.

Long-term course of acute brief psychosis in a developing country setting

1998 ◽  
Vol 173 (3) ◽  
pp. 226-230 ◽  
Author(s):  
Ezra Susser ◽  
Vijoy K. Varma ◽  
S. K. Mattoo ◽  
Molly Finnerty ◽  
Ramin Mojtabai ◽  
...  
Keyword(s):  
Developing Country ◽  
Psychotic Disorders ◽  
Comparison Group ◽  
Acute Onset ◽  
North India ◽  
Separable Group ◽  
Early Relapse ◽  
Icd 10

BackgroundThis study in North India compared acute brief psychosis – defined by acute onset, brief duration and no early relapse – with other remitting psychoses, over a 12-year course and outcome.MethodIn a cohort of incident psychoses, we identified 20 cases of acute brief psychosis and a comparison group of 43 other remitting psychoses based on two-year follow-up. Seventeen people (85%) in the acute brief psychosis group and 36 (84%) in the comparison group were reassessed at five, seven and 12 years after onset, and were rediagnosed using ICD–10 criteria.ResultsAt 12-year follow-up, the proportion with remaining signs of illness was 6% (n=1) for acute brief psychosis versus 50% (n=18) for the comparison group (P=0.002). Using ICD–10 criteria, the majority in both groups were diagnosed as having schizophrenia.ConclusionsAcute brief psychosis has a distinctive and benign long-term course when compared with other remitting psychoses. This finding supports the ICD– 10 concept of a separable group of acute and transient psychotic disorders. To effectively separate this group, however, the ICD–10 criteria need modification.

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

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.

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

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

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 (&lt;1 month) and abrupt onset (&lt;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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