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Castagnini A, Foldager L, Caffo E, Berrios GE. The predictive validity and outcome of ICD-10 and DSM-5 short-lived psychotic disorders: a review and meta-analysis. Eur Arch Psychiatry Clin Neurosci 2022; 272:1157-1168. [PMID: 34988647 DOI: 10.1007/s00406-021-01356-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 11/08/2021] [Indexed: 11/30/2022]
Abstract
The ICD-10 Classification of Mental and Behavioural Disorders introduced the category of 'acute and transient psychotic disorders' (ATPDs) encompassing polymorphic, schizophrenic and predominantly delusional subtypes, and the forthcoming ICD-11 revision has restricted it to polymorphic psychotic disorder, while the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) listed 'brief psychotic disorder' (BPD). To assess the predictive validity and outcome of ATPDs and BPD, relevant papers in English, French and German were searched in PubMed and Web of Science. Where possible meta-analysis of prognostic validators (diagnostic stability, course, outcome and response to treatment) was conducted. Fifty studies published between January 1993 and July 2019 were found. The clinical and functional outcome of ATPDs proved better than in schizophrenia and related disorders, but mortality risk is high, particularly suicide, and treatment trials provide little evidence. Meta-analysis of 25 studies (13,507 cases) revealed that 55% (95% CI 49-62) do not change diagnosis, 25% (95% CI 20-31) converted into schizophrenia and related disorders, and 12% (95% CI 7-16) into affective disorders on average over 6.3 years. Subgroup meta-analysis estimated prospective consistency of polymorphic psychotic disorder (55%; 95% CI 52-58) significantly greater than that of the ATPD subtypes with schizophrenic (OR 1.7; 95% CI 1.4-2.0) and predominantly delusional (OR 1.3; 95% CI 1.1-1.5) symptoms. Moreover, the diagnostic stability of BPD (13 studies; 294 cases) was 45% (95% CI 32-50) over a mean 4.2 years. Although these findings indicate that short-lived psychotic disorders have little predictive validity, significant differences among the ATPD subtypes support the revised ICD-11 ATPD category.
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Affiliation(s)
- Augusto Castagnini
- School of Child Neuropsychiatry, University of Modena and Reggio Emilia, Modena, Italy.
| | - Leslie Foldager
- Health Research Unit, Department of Animal Science, Aarhus University, Tjele, Denmark.,Bioinformatics Research Centre, Aarhus University, Aarhus, Denmark
| | - Ernesto Caffo
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - German E Berrios
- Department of Psychiatry and Robinson College, University of Cambridge, Cambridge, UK
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2
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López-Díaz Á, Fernández-González JL, Lara I, Ruiz-Veguilla M. Predictors of diagnostic stability in acute and transient psychotic disorders: validation of previous findings and implications for ICD-11. Eur Arch Psychiatry Clin Neurosci 2020; 270:291-299. [PMID: 31062078 DOI: 10.1007/s00406-019-01014-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 04/16/2019] [Indexed: 01/03/2023]
Abstract
Acute and transient psychotic disorders (ATPD) have moderate prospective diagnostic stability. Female gender, older age at onset, good premorbid adjustment, abrupt onset, shifting polymorphic symptomatology and absence of schizophrenic features have been found to be predictive factors of diagnostic stability in ATPDs. Nevertheless, most of these findings need to be replicated. The purpose of this study was to evaluate the diagnostic stability of patients with ATPD, and to determine whether previously accepted predictors of diagnostic stability for ATPD could be externally validated in our cohort. To that end, a prospective 2-year observational study was conducted on patients with first-episode ATPD. Multivariate analysis was performed to determine factors associated with ATPD diagnostic stability at the end of the follow-up period. The following prior knowledge variables were analyzed: female gender, older age at onset, good premorbid adjustment, abrupt onset, shifting polymorphic symptomatology and absence of schizophrenic features. Sixty-eight patients with first-episode ATPD completed the follow-up, of whom 55.9% (n = 38) retained their diagnosis of ATPD at the end of the study. Multivariate analysis revealed that diagnostic stability was independently significantly associated with the presence of shifting polymorphic symptomatology (OR = 7.42, 95% CI 1.65-33.30; p = 0.009) and the absence of schizophrenic features (OR = 6.37, 95% CI 1.47-27.54; p = 0.013) at the onset of the psychotic disorder. Our findings provide empirical support for the ICD-11 proposal restricting the new ATPD category to the acute polymorphic disorder without schizophrenia symptoms.
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Affiliation(s)
- Álvaro López-Díaz
- UGC Salud Mental, Hospital Universitario Virgen Macarena, Seville, Spain
| | | | - Ignacio Lara
- UGC Salud Mental, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Miguel Ruiz-Veguilla
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Seville, Spain. .,Departamento de Psiquiatría, Universidad de Sevilla, Seville, Spain. .,UGC Salud Mental, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot sn. 41013, Seville, Spain.
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3
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López-Díaz Á, Fernández-González JL, Lara I, Crespo-Facorro B, Ruiz-Veguilla M. The prognostic role of catatonia, hallucinations, and symptoms of schizophrenia in acute and transient psychosis. Acta Psychiatr Scand 2019; 140:574-585. [PMID: 31436311 DOI: 10.1111/acps.13092] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To examine the prospective temporal stability of acute and transient psychotic disorders (ATPDs) and analyze whether there are clinical, psychopathological, or sociodemographic characteristics that predict ATPD diagnostic stability. METHOD We conducted a prospective, 2-year, observational study of patients presenting a first-episode ATPD. A multivariate logistic regression model was developed to identify independent variables associated with ATPD diagnostic stability. Well-established predictive factors of diagnostic stability, as well as all the psychopathological features included in the ICD-10 Diagnostic Criteria for Research (DCR) descriptions of ATPD, were analyzed. RESULTS Sixty-eight patients with a first episode of ATPD completed the study with a diagnostic stability rate as high as 55.9% (n = 38) at the end of the follow-up period. Multivariate analysis revealed that diagnostic stability was independently significantly associated with the baseline presence of motility disturbances (OR = 6.86, 95% CI = 1.10-42.62; P = 0.039), the absence of hallucinations (OR = 5.75, 95% CI = 1.51-21.98; P = 0.010), and the absence of schizophrenic features (OR = 7.13, 95% CI = 1.38-36.90; P = 0.019). CONCLUSION A symptom checklist assessing these psychopathological features would enable early identification of those subjects whose initial ATPD diagnosis will remain stable over time.
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Affiliation(s)
- Á López-Díaz
- UGC Salud Mental, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - I Lara
- UGC Salud Mental, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - B Crespo-Facorro
- UGC Salud Mental, Hospital Universitario Virgen del Rocío, Sevilla, Spain.,Departamento de Psiquiatría, Universidad de Sevilla, Sevilla, Spain.,Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), Barcelona, Spain
| | - M Ruiz-Veguilla
- UGC Salud Mental, Hospital Universitario Virgen del Rocío, Sevilla, Spain.,Departamento de Psiquiatría, Universidad de Sevilla, Sevilla, Spain.,Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), Barcelona, Spain.,Instituto de Biomedicina de Sevilla (IBIS), Grupo Psicosis y Neurodesarrollo, Sevilla, Spain
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Strålin P, Hetta J. Medication, hospitalizations and mortality in 5 years after first-episode psychosis in a Swedish nation-wide cohort. Early Interv Psychiatry 2019; 13:902-907. [PMID: 29888512 DOI: 10.1111/eip.12697] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/03/2018] [Accepted: 05/16/2018] [Indexed: 12/13/2022]
Abstract
AIM To investigate medication, rehospitalizations and mortality after first-episode hospital-treated psychosis. METHODS A population-based nation-wide cohort (n = 2488) with a first hospitalization for psychosis at ages between 16 and 25 was identified. Cases were followed for up to 5 years after the first psychosis hospitalization with regard to mortality, hospitalizations and dispensations of antipsychotics and benzodiazepines. RESULTS The proportion of patients dispensing antipsychotics decreased from 80% year 1 after first discharge to 55% year 5. The proportion of patients having episodes of inpatient care also decreased year by year from 46% year 1 to 27% year 5. Of 863 cases with 5 years of observation time 41% had dispensations of antipsychotics every year; 21% had no dispensation of antipsychotics or hospitalization after the first year. The cumulative 5-year mortality was 3.9%. Cumulative suicide mortality was 2.4%. Incidence of suicide was highest in the first year. Male gender, benzodiazepines, recent hospital-discharge and self-harm were identified as risk factors for suicide. CONCLUSIONS The proportion of cases dispensing antipsychotics decreases year by year after first discharge. Mortality and rates of rehospitalization also decrease year by year from high levels the first year.
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Affiliation(s)
- Pontus Strålin
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Jerker Hetta
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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5
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López-Díaz Á, Lorenzo-Herrero P, Lara I, Fernández-González JL, Ruiz-Veguilla M. Acute stress and substance use as predictors of suicidal behaviour in acute and transient psychotic disorders. Psychiatry Res 2018; 269:414-418. [PMID: 30173049 DOI: 10.1016/j.psychres.2018.08.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 06/23/2018] [Accepted: 08/13/2018] [Indexed: 11/28/2022]
Abstract
Several authors have reported high rates of suicidal behaviour in acute and transient psychotic disorders (ATPD). However, the literature in this area remains scarce. We wanted to find out whether there are predictors of suicidal behaviour in ATPD. Of 1032 psychosis admissions examined over a five-year period, ATPD was confirmed in 39 patients according to the International Classification of Diseases (ICD-10) diagnostic criteria. These patients were classified as suicidal behaviour (20.5%) or non-risk (79.5%) using a structured interview to assess suicidal risk. The following variables were analysed: previous history of suicide attempt or deliberate self-harm, history of depressive episodes, previous substance use history, education, ATPD subtype (polymorphic vs. non-polymorphic), type of onset (abrupt vs. acute), and presence of associated acute stress. Multivariate analysis revealed that acute stress and substance use are significantly associated with suicidal behaviour in ATPDs. To our knowledge, this is the first study identifying independent risk factors that could predict suicidal behaviour in individuals with ATPD.
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Affiliation(s)
- Álvaro López-Díaz
- UGC Salud Mental, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Ignacio Lara
- UGC Salud Mental, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Miguel Ruiz-Veguilla
- UGC Salud Mental, Hospital Universitario Virgen del Rocío. IBIS, Grupo Psicosis y Neurodesarrollo, Avda.Manuel Siurot sn, Sevilla 41013, Spain.
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6
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Hamilton JE, Heads AM, Meyer TD, Desai PV, Okusaga OO, Cho RY. Ethnic differences in the diagnosis of schizophrenia and mood disorders during admission to an academic safety-net psychiatric hospital. Psychiatry Res 2018; 267:160-167. [PMID: 29908484 DOI: 10.1016/j.psychres.2018.05.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 03/24/2018] [Accepted: 05/18/2018] [Indexed: 01/26/2023]
Abstract
U.S. Hispanics, now the single largest minority group in the country, face unique mental health disparities. The current study utilizes Andersen's Behavioral Model of Health Service Use to examine ethnic disparities in receiving a schizophrenia or mood disorder diagnosis at psychiatric hospital admission. Our retrospective cohort study examined electronic health record data at an academic safety-net psychiatric hospital for adult patients (n = 5571) admitted between 2010 and 2013. Logistic regression with block-wise entry of predisposing, enabling and need variables was used to examine ethnic disparities in receiving a schizophrenia diagnosis at admission. The block of need factors was the strongest predictor of receiving a schizophrenia diagnosis compared to predisposing and enabling factors. Compared to non-Hispanic whites, Hispanics and African Americans had a greater likelihood of receiving a schizophrenia diagnosis at admission. Additionally, patients diagnosed with schizophrenia had elevated positive and negative symptoms and were more likely to be male, single/unmarried, homeless, high inpatient service utilizers, involuntarily hospitalized, and to exhibit functional impairment at psychiatric hospital admission. To address elevated positive and negative symptoms of schizophrenia, functional impairment, social withdrawal, and high inpatient service utilization, promising psychosocial interventions should be adapted for racial and ethnic minority populations and utilized as an adjuvant to antipsychotic medication.
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Affiliation(s)
- Jane E Hamilton
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA; UTHealth Harris County Psychiatric Center, Houston, TX, USA.
| | - Angela M Heads
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Thomas D Meyer
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Pratikkumar V Desai
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Olaoluwa O Okusaga
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey VA Medical Center, Houston,TX, USA
| | - Raymond Y Cho
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey VA Medical Center, Houston,TX, USA
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7
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Abstract
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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8
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Castagnini AC, Fusar-Poli P. Diagnostic validity of ICD-10 acute and transient psychotic disorders and DSM-5 brief psychotic disorder. Eur Psychiatry 2017; 45:104-113. [PMID: 28756108 DOI: 10.1016/j.eurpsy.2017.05.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/17/2017] [Accepted: 05/22/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND 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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Affiliation(s)
- A C Castagnini
- School of Child Neuropsychiatry, University of Modena and Reggio Emilia, Modena, Italy.
| | - P Fusar-Poli
- King's College London, Institute of Psychiatry, and OASIS Service, South London and the Maudsley NHS Foundation Trust, London, UK
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9
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Poon JYK, Leung CM. Outcome of first-episode acute and transient psychotic disorder in Hong Kong Chinese: a 20-year retrospective follow-up study. Nord J Psychiatry 2017; 71:139-144. [PMID: 27834101 DOI: 10.1080/08039488.2016.1252426] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND 'Acute and transient psychotic disorder' (ATPD) is a category in ICD-10 marked by psychosis with acute onset and early remission. It remains relatively under-researched, despite controversies over its nosological status in the current classification system. AIMS (1) To assess the changes in diagnosis over time in patients initially diagnosed as ATPD. (2) To identify factors predicting changes in diagnosis, and compare the long-term outcomes of various patterns of diagnostic shift. (3) To make recommendations on the classification and treatment of ATPD based on the findings of the study. METHODS This was a retrospective longitudinal study based on review of medical records of patients first admitted to a regional hospital in Hong Kong for ATPD during the period from 1990-2000. RESULTS Of the 87 subjects initially diagnosed as ATPD, 64.4% had their diagnoses revised over an average of 20 years, mostly to bipolar disorder and schizophrenia. Among those with diagnosis of ATPD unchanged, 54.8% had one single episode, while the remaining 45.2% had recurrence. Subjects with diagnostic shift had significantly younger age of onset, more first-degree relatives with a history of mental illness, and more subsequent psychiatric admissions. CONCLUSIONS ATPD is likely a composite category consisting of clinically distinct outcome groups, for which further research is warranted to identify diagnostic features that distinguish them at initial presentation and revise the current nosological status of ATPD. Long-term follow-up, judicial use of antipsychotics, and education on prognosis are of paramount importance in managing patients diagnosed with ATPD.
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Affiliation(s)
| | - Chi Ming Leung
- a Department of Psychiatry , Shatin Hospital , Hong Kong SAR , PR China
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Petkari E, Mayoral F, Moreno-Küstner B. Gender matters in schizophrenia-spectrum disorders: Results from a healthcare users epidemiological study in Malaga, Spain. Compr Psychiatry 2017; 72:136-143. [PMID: 27816847 DOI: 10.1016/j.comppsych.2016.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/28/2016] [Accepted: 09/30/2016] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Women suffering from schizophrenia-spectrum disorders may differ from men in clinical course and outcome. Still, those differences can only be portrayed accurately by means of studies that derive information from multiple sources. One such study was performed in a well-defined area supported by a Mental Health Clinical Management Unit in Malaga, Spain. METHODS Data from 1640 patients (1048 men and 592 women) that were in contact with services during 2008 were examined for the purpose of the present analysis. Gender differences in sociodemographic and clinical characteristics and the role of gender for explaining clinical characteristics (diagnosis, disease severity and service use) beyond potential sociodemographic confounders were explored. RESULTS The chi-squared analysis results revealed that in comparison to men, women were older, married or widowed/divorced and living as housewives with their families in cities. Genders also differed across diagnoses, with men being at higher risk for suffering from paranoid schizophrenia, while women being at higher risk for persistent delusional, acute/transitory and schizoaffective disorders. Furthermore, men had greater disease severity and higher chances to visit the mental health rehabilitation unit (MHRU). Further regression analyses revealed that after controlling for confounders, gender differences remained significant across diagnoses and severity. However, they lost their significance under the influence of marital, living and occupational status when predicting the use of MHRU. CONCLUSION Results confirm the existence of gender differences and highlight the importance of other factors for designing effective psychosocial services that are tailor-made to the patients' needs.
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Affiliation(s)
- Eleni Petkari
- Department of Psychology, School of Humanities and Social Sciences, European University of Cyprus, Nicosia, Cyprus; Department of Psychology, School of Science and Technology, Middlesex University Dubai, Dubai, United Arab Emirates; International Maristan Network.
| | - Fermín Mayoral
- Regional Hospital of Malaga, Spain, Galvez Ginachero Avenue s/n, Malaga 29009, Spain; Biomedicine Institute of Malaga-IBIMA, Avda Jorge Luis Borges, 15, 3,3ª, Malaga, 29019, Spain; International Maristan Network.
| | - Berta Moreno-Küstner
- Biomedicine Institute of Malaga-IBIMA, Avda Jorge Luis Borges, 15, 3,3ª, Malaga, 29019, Spain; Department of Personality, Assessment and Psychological Treatment, University of Malaga, Campus Teatinos s/n, Malaga 18071, Spain; Andalusian Psychosocial Research Group-GAP, Malaga, Spain; International Maristan Network.
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Lee EHM, Hui CLM, Chang WC, Chan SKW, Lin J, Chen EYH. Letter to the Editor: Comparison of cognitive functions, pre-morbid conditions and clinical characteristics between brief psychotic disorder and schizophrenia. Psychol Med 2016; 46:2011-2013. [PMID: 27181416 DOI: 10.1017/s0033291716000623] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- E H M Lee
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,People's Republic of China
| | - C L M Hui
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,People's Republic of China
| | - W C Chang
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,People's Republic of China
| | - S K W Chan
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,People's Republic of China
| | - J Lin
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,People's Republic of China
| | - E Y H Chen
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,People's Republic of China
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Grifell M, Galindo L, Campillo M, Gonzalez L, Palomo A, Diez-aja C, Grau A, San-Emeterio L, Ibarra M, Sanchez R, Martín L, García L, Orejas O, Salvador T, Manteca H, Pérez V. Evolution of diagnostic frequency in schizophrenia spectrum disorders in Acute Psychiatric Unit in Barcelona. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.1301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
IntroductionSeveral studies have suggested variations in the prevalence of schizophrenia spectrum disorders diagnosis across time. This could be due to a change in diagnostic practice motivated either for changes in DSM criteria as for local culture factors. The aim of this study is to explore the evolution of the schizophrenia spectrum disorders. We hypothesize that we would observe a transference from the schizophrenia diagnosis to psychosis not otherwise specified.MethodsA retrospective review of all psychiatric discharges in acute unit in the INAD of Parc de Salut Mar of Barcelona, between 2002 and 2014 was performed, relating each discharge to its axis I psychiatric diagnostic. An ANOVA analysis was used to calculate the differences between the months and the frequency of the diagnosis.ConclusionWe have not been able to observe any transference between diagnoses across years. We observe a decrease of the proportion of schizophrenic spectrum disorders in its prevalence at discharge from 2012 to 2014. The proportion of not otherwise specified psychosis remains quite constant as a third of the schizophrenia diagnoses.Disclosure of interestThe authors report no conflict of interest in this study. LG is funded by the Instituto.de.Salud.Carlos.III (CM14/00111).
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13
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Farooq S, Rehman M, Naeem F. Pharmacological interventions for acute and transient psychotic disorder (ATPD). Hippokratia 2015. [DOI: 10.1002/14651858.cd011974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Saeed Farooq
- Staffordshire University & Black Country Social Partnership NHS Foundation Trust; Centre for Ageing and Mental Health; Dunstall Road Wolverhampton UK WV6 0NZ
| | | | - Farooq Naeem
- Queen's University; Department of Psychiatry; Kingston ON Canada
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14
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Yu E, Li H, Fan H, Gao Q, Tan Y, Lou J, Zhang J, Wang W. Relationship between Chinese adjective descriptors of personality and emotional symptoms in young Chinese patients with bipolar disorders. J Int Med Res 2015; 43:790-801. [PMID: 26546582 DOI: 10.1177/0300060515594192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 06/10/2015] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To investigate whether personality traits are related to emotional symptoms (mania, hypomania, and depression) in Chinese patients with bipolar disorders. METHODS Patients with bipolar I and II disorders, and healthy volunteers, were assessed using the Chinese Adjective Descriptors of Personality (CADP) questionnaire, Mood Disorder Questionnaire (MDQ), Hypomanic Checklist (HCL-32), and Plutchik-van Praag Depression Inventory (PVP). RESULTS Seventy-three patients with bipolar I disorder, 35 with bipolar II disorder and 216 healthy controls were included. Bipolar I and II groups scored significantly higher on MDQ, HCL-32 and PVP scales than controls; the bipolar II group scored lower on the MDQ, but higher on the HCL-32 and PVP than bipolar I. In the bipolar I group, the CADP Intelligent trait (β, 0.25) predicted MDQ; Intelligent (β, -0.24), Agreeable (β, 0.22) and Emotional (β, 0.34) traits predicted PVP. In the bipolar II group, Intelligent (β, 0.22), Agreeable (β, -0.24) and Unsocial (β, 0.31) traits predicted MDQ; Intelligent (β, -0.20), Agreeable (β, -0.31) and Emotional (β, -0.26) traits predicted HCL-32. CONCLUSIONS Four out of five Chinese personality traits were associated with emotional symptoms in patients with bipolar I or II disorder, but displayed different associations depending on disorder type.
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Affiliation(s)
- Enyan Yu
- Department of Psychiatry, Zhejiang Provincial People's Hospital, Zhejiang University College of Medicine, Hangzhou, China
| | - Huihui Li
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Hongying Fan
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Qianqian Gao
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Yunfei Tan
- Department of Psychiatry, Zhejiang Provincial People's Hospital, Zhejiang University College of Medicine, Hangzhou, China
| | - Junyao Lou
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Jie Zhang
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Wei Wang
- Department of Psychiatry, Zhejiang Provincial People's Hospital, Zhejiang University College of Medicine, Hangzhou, China Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
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15
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Mehta S. Diagnostic Stability of Acute and Transient Psychotic Disorders in Developing Country Settings: An Overview. Ment Illn 2015; 7:5640. [PMID: 26266021 PMCID: PMC4508627 DOI: 10.4081/mi.2015.5640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 01/10/2015] [Accepted: 02/03/2015] [Indexed: 11/23/2022] Open
Abstract
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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Affiliation(s)
- Shubham Mehta
- Department of Psychiatry, Maharaja Agrasen Medical College , Agroha (Hisar), Haryana, India
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Gender differences in individuals at high-risk of psychosis: a comprehensive literature review. ScientificWorldJournal 2015; 2015:430735. [PMID: 25685840 PMCID: PMC4312997 DOI: 10.1155/2015/430735] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 12/07/2014] [Accepted: 12/08/2014] [Indexed: 01/29/2023] Open
Abstract
Introduction. To date, few studies have focused on the characterization of clinical phenomenology regarding gender in population at high-risk of psychosis. This paper is an attempt to summarize the findings found in the scientific literature regarding gender differences in high-risk populations, taking into account parameters studied in populations with schizophrenia and other psychotic disorders, such as incidence, clinical expression, duration of untreated illness (DUI), social functioning, and cognitive impairment prior to full-blown psychosis development. Method. Studies were systematically searched in PubMed. Studies using gender variable as a control variable were excluded. 12 studies met inclusion criteria. Results. Most of the studies found a differential pattern between women and men as regards clinical, social, and cognitive variables in the prodromal phase, with worse performance in men except in cognitive functioning (more severe negative symptoms, worse social functioning, and longer DUI in men). Similar conversion rates over time were found between men and women. Conclusions. Many of the studies analyzed suggest that differences between men and women in the expression of psychosis extend across a continuum, from the subclinical forms of illness to the debut of psychosis. However, the small number of studies and their significant methodological and clinical limitations do not allow for firm conclusions.
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Vermersch C, Geoffroy PA, Fovet T, Thomas P, Amad A. [Travel and psychotic disorders: clinical aspects and practical recommendations]. Presse Med 2014; 43:1317-24. [PMID: 25220438 DOI: 10.1016/j.lpm.2014.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 04/25/2014] [Accepted: 05/05/2014] [Indexed: 11/30/2022] Open
Abstract
Psychotic disorders are frequent among travelers (10 to 20 % of medical evacuations). The travel is a concentrate of stressors. Psychotic disorders are not a contraindication to travel. Special precautions should be taken for patients with psychotic disorders wishing to travel. These precautions could apply to patients at risk of transition to a psychotic disorder.
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Affiliation(s)
- Charles Vermersch
- CHRU de Lille, université Lille Nord-de-France, pôle de psychiatrie, 59000 Lille, France
| | - Pierre Alexis Geoffroy
- CHRU de Lille, université Lille Nord-de-France, pôle de psychiatrie, 59000 Lille, France
| | - Thomas Fovet
- CHRU de Lille, université Lille Nord-de-France, pôle de psychiatrie, 59000 Lille, France
| | - Pierre Thomas
- CHRU de Lille, université Lille Nord-de-France, pôle de psychiatrie, 59000 Lille, France
| | - Ali Amad
- CHRU de Lille, université Lille Nord-de-France, pôle de psychiatrie, 59000 Lille, France.
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Manrique-Garcia E, Zammit S, Dalman C, Hemmingsson T, Andreasson S, Allebeck P. Prognosis of schizophrenia in persons with and without a history of cannabis use. Psychol Med 2014; 44:2513-2521. [PMID: 25055170 PMCID: PMC4108251 DOI: 10.1017/s0033291714000191] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 01/16/2014] [Accepted: 01/16/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND The aim of the study was to determinate whether schizophrenia patients with a history of cannabis use have a different prognosis, with regards to readmission and hospital duration, compared with those without a history of cannabis use. METHOD The present investigation was a cohort study of 50,087 Swedish men with data on cannabis use at the ages of 18-20 years. A total of 357 cases of schizophrenia were identified from in-patient care and followed up from 1973 to 2007. RESULTS Schizophrenia patients with a history of cannabis use had a higher median duration of first hospital episode (59 days v. 30 days). Patients with a history of cannabis use had a higher median rate of readmission (10 times v. four times). Also, total number of hospital days was higher in patients with a history of cannabis use compared with those without (547 days v. 184 days). Patients with a history of cannabis use had an increased odds of having more than 20 hospital readmissions compared with non-users [3.1, 95% confidence interval (CI) 1.3-7.3] as well as an increased odds of hospital admission lasting more than 2 years (2.4, 95% CI 1.1-7.4) after controlling for diagnosis of personality disorders, family socio-economic position, IQ score, civil status, place of residence, risky use of alcohol and use of other drugs. Patients with a history of cannabis use were less likely to have paranoid schizophrenia compared with never users (8% v. 17%) in the first admission. CONCLUSIONS Schizophrenia patients with a history of cannabis use had a significantly higher burden of lifetime in-patient care than non-cannabis users. Not only does cannabis increase the risk of schizophrenia, but also our findings indicate that the course and prognosis of schizophrenia may be more severe than schizophrenia cases in general.
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Affiliation(s)
- E. Manrique-Garcia
- Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden
| | - S. Zammit
- Department of Psychological Medicine and Neurology, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - C. Dalman
- Department of Public Health Sciences, Division of Public Health Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - T. Hemmingsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
| | - S. Andreasson
- Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden
| | - P. Allebeck
- Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden
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Abstract
BACKGROUND Acute and transient psychotic disorders (ATPDs) are relatively under-researched. There is therefore a dearth of information on the disorders especially in developing countries, where they have been shown to be relatively common. AIM To describe the socio-demographic and clinical characteristics of patients with ATPD, as well as to examine the factors that are associated with early recovery in patients with ATPD in a developing country. METHODS A review of 124 cases of untreated first episode of ATPD that presented at the University College Hospital, Ibadan, Nigeria over a five-year period. RESULTS Of the new cases that presented at the psychiatry department of the hospital, 10.1% were ATPDs. There was no significant difference between the proportions of males and females presenting at the hospital (50.8% vs 49.2%). Mean age at presentation was 29.5 (SD = 9.6) years, while the mean duration of illness before presentation was 7.3 (SD = 6.1) days. Female gender was significantly associated with earlier recovery (p = .047). CONCLUSION ATPDs are common in developing countries. The epidemiology in developing countries is probably different from that of the developed countries.
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Affiliation(s)
- Oluyomi Esan
- Department of Psychiatry, University of Ibadan, University College Hospital, Ibadan, Nigeria
| | - Olufunmilayo I Fawole
- Department of Epidemiology and Medical Statistics, University of Ibadan, University College Hospital, Ibadan, Nigeria
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Rusaka M, Rancāns E. A prospective follow-up study of first-episode acute transient psychotic disorder in Latvia. Ann Gen Psychiatry 2014; 13:4. [PMID: 24502369 PMCID: PMC3922543 DOI: 10.1186/1744-859x-13-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 01/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute and transient psychotic disorder (ATPD) has been described as an acute psychosis with brief onset and polymorphous symptomatology (WHO, 1993). The study of ATPD is growing increasingly relevant as scientists start an active discussion of the possibility of changing the ATPD classification in the next International Classification of Diseases (ICD-11). The aims of this study were to describe the clinical features of the index episode of ATPD in patients in Latvia, to analyse the stability and longitudinal changes of the diagnosis, to explore potential correlations between the sociodemographic and disease characteristics and to describe stressful life events before the first ATPD episode. METHODS A prospective follow-up study of all first-time admitted patients from the Riga Centre of Psychiatry and Addiction Disorders who fulfilled the ICD-10 criteria for ATPD (WHO, 1993) during the 15-month period from 9 January 2010 to 30 March 2011 and followed up until 31 October 2012. Stressful life events, demographics and clinical features during the index episode were assessed. RESULTS One hundred two patients were admitted with first-episode ATPD. The majority were females (60.7%). Over an average 26.5-month follow-up period, 59.8% of the patients were not readmitted. The overall stability rate of ATPD diagnosis in our sample was 67.4% (p = 0.0001). In the subgroup of patients who were readmitted, 70.7% had their diagnosis converted to schizophrenia in subsequent visits. Stressful life events before the first episode were found in 49.0% of first-episode ATPD patients. Thought disorder was found to be the strongest statistically significant predictor of ATPD diagnosis conversation to schizophrenia (odds ratio 4.3), with high Wald's criterion (9.435) in binary logistic regression. CONCLUSIONS ATPD is prevalent in Latvia, with rather high overall stability rate. Combining these data from first-episode ATPD patients in Latvia with data from other countries may help predict the development of the disease and provide a basis for potential changes to ICD-11.
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Affiliation(s)
- Marija Rusaka
- Riga Centre of Psychiatry and Addiction Disorders, Tvaika str, 2, Riga LV 1005, Latvia.
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Rusaka M, Rancāns E. First-episode acute and transient psychotic disorder in Latvia: a 6-year follow-up study. Nord J Psychiatry 2014; 68:24-9. [PMID: 23383651 DOI: 10.3109/08039488.2012.761726] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Acute and transient psychotic disorder (ATPD; F23, ICD-10) is an acute, short-lived psychosis, which has variable prevalence worldwide and has not been extensively studied. AIMS To explore the first episode of ATPD in patients in Latvia by describing the clinical features, analyzing the longitudinal changes of diagnosis and associated socio-demographic characteristics. MATERIAL AND METHODS Retrospective chart review of all first-time hospitalized patients fulfilling the ICD-10 criteria for ATPD treated at the Riga Centre of Psychiatry and Addiction Disorders, Latvia, during a 3-year period. Patients were followed-up and assessed using standardized instruments. RESULTS During a 3-year period, 294 patients were first-time hospitalized with a ATPD diagnosis; 54% were women. The average age at first psychotic episode was 35.7 ± 12.3 years for women, and 30.0 ± 10.8 years for men (P < 0.0001). Over an average of 5.6 years follow-up period, 51% of patients were not re-hospitalized. Later diagnosis was changed to schizophrenia in 73% of the re-hospitalized patients, mostly within the first 2 years of illness. The overall stability rate of ATPD diagnosis reached 58%. Typical polymorphic symptomatology, abrupt onset (i.e. within 48 h), less frequent anxiety, but more frequent hallucinations were observed in ATPD patients that later developed schizophrenia (P < 0.05). Stressful life events in the 6 months prior to the first episode were found in 44% of patients. CONCLUSIONS Combining these assessments from first-episode ATPD patients in Latvia, with data from other countries may help to predict the development of disease and provide the possible basis for potential changes to ICD-11.
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Affiliation(s)
- Marija Rusaka
- Riga Centre of Psychiatry and Addiction Disorders , Riga , Latvia
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Kingston T, Scully PJ, Browne DJ, Baldwin PA, Kinsella A, Russell V, O'Callaghan E, Waddington JL. Diagnostic trajectory, interplay and convergence/divergence across all 12 DSM-IV psychotic diagnoses: 6-year follow-up of the Cavan-Monaghan First Episode Psychosis Study (CAMFEPS). Psychol Med 2013; 43:2523-2533. [PMID: 23480983 DOI: 10.1017/s003329171300041x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The boundaries of psychotic illness and the extent to which operational diagnostic categories are distinct in the long term remain poorly understood. Clarification of these issues requires prospective evaluation of diagnostic trajectory, interplay and convergence/divergence across psychotic illness, without a priori diagnostic or other restrictions. METHOD The Cavan-Monaghan First Episode Psychosis Study (CAMFEPS), conducted using methods to attain the closest approximation to epidemiological completeness, incepts all 12 DSM-IV psychotic diagnoses. In this study we applied methodologies to achieve diagnostic reassessments on follow-up, at a mean of 6.4 years after first presentation, for 196 (97%) of the first 202 cases, with quantification of prospective and retrospective consistency. RESULTS Over 6 years, the 12 initial psychotic diagnoses were characterized by numerous transitions but only limited convergence towards a smaller number of more stable diagnostic nodes. In particular, for initial brief psychotic disorder (BrP), in 85% of cases this was the harbinger of long-term evolution to serious psychotic illness of diagnostic diversity; for initial major depressive disorder with psychotic features (MDDP), in 18% of cases this was associated with mortality of diverse causality; and for initial psychotic disorder not otherwise specified (PNOS), 31% of cases continued to defy DSM-IV criteria. CONCLUSIONS CAMFEPS methodology revealed, on an individual case basis, a diversity of stabilities in, and transitions between, all 12 DSM-IV psychotic diagnoses over 6 years; thus, psychotic illness showed longitudinal disrespect to current nosology and may be better accommodated by a dimensional model. In particular, a first episode of BrP or MDDP may benefit from more vigorous, sustained interventions.
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Affiliation(s)
- T Kingston
- Cavan-Monaghan Mental Health Service, St Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland
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Fusar-Poli P, Van Os J. Lost in transition: setting the psychosis threshold in prodromal research. Acta Psychiatr Scand 2013; 127:248-52. [PMID: 23136851 DOI: 10.1111/acps.12028] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2012] [Indexed: 12/13/2022]
Affiliation(s)
- P Fusar-Poli
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK.
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Udomratn P, Burns J, Farooq S. Acute and transient psychotic disorders: an overview of studies in Asia. Int Rev Psychiatry 2012; 24:463-6. [PMID: 23057982 DOI: 10.3109/09540261.2012.715579] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Acute and transient psychotic disorders (ATPD), introduced in the International Classification of Diseases (ICD-10) diagnostic system, have not received much attention in Asia. As the World Health Organization (WHO) is in the process of revising the ICD-10 and ICD-11 is expected to be published in the near future, it seems appropriate to review the status of ATPD in this region. A PubMed search using appropriate keywords was conducted to identify literature describing samples from Asian countries with the diagnosis of ATPD for evidence of ATPD as a distinct diagnostic group. A total of 103 papers were found, but only nine publications were specifically related to ATPD and the ICD-10 criteria. The total number of patients receiving a diagnosis of ATPD in these studies was 390. Immigrants appear prone to ATPD, especially foreign domestic workers. When compared to schizophrenia, ATPD as a group had a different family history, course and outcome. However, ATPD was diagnostically unstable over time. A range of 35.5% to 73.3% in Asian patients with baseline ATPD retained their diagnoses over 3-12 years. Most individuals with polymorphic subtypes of ATPD in India and Hong Kong were rediagnosed with bipolar disorder after 3-5 years. In Japan, 31.2% of polymorphic cases were diagnosed as schizophrenia after 12 years of follow-up. This review supports the ICD-10 concept of separating ATPD into its own group; however, polymorphic subtypes may need revision in ICD-11. Before firm suggestions are submitted to the WHO, further research and data review from other regions is necessary.
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Affiliation(s)
- Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
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Manrique-Garcia E, Zammit S, Dalman C, Hemmingsson T, Andreasson S, Allebeck P. Cannabis, schizophrenia and other non-affective psychoses: 35 years of follow-up of a population-based cohort. Psychol Med 2012; 42:1321-1328. [PMID: 21999906 DOI: 10.1017/s0033291711002078] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is now strong evidence that cannabis use increases the risk of psychoses including schizophrenia, but the relationship between cannabis and different psychotic disorders, as well as the mechanisms, are poorly known. We aimed to assess types of psychotic outcomes after use of cannabis in adolescence and variation in risk over time. METHOD A cohort of 50 087 military conscripts with data on cannabis use in late adolescence was followed up during 35 years with regard to in-patient care for psychotic diagnoses. RESULTS Odds ratios for psychotic outcomes among frequent cannabis users compared with non-users were 3.7 [95% confidence interval (CI) 2.3-5.8] for schizophrenia, 2.2 (95% CI 1.0-4.7) for brief psychosis and 2.0 (95% CI 0.8-4.7) for other non-affective psychoses. Risk of schizophrenia declined over the decades in moderate users but much less so in frequent users. The presence of a brief psychosis did not increase risk of later schizophrenia more in cannabis users compared with non-users. CONCLUSIONS Our results confirm an increased risk of schizophrenia in a long-term perspective, although the risk declined over time in moderate users.
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Affiliation(s)
- E Manrique-Garcia
- Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden
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Abstract
BACKGROUND There are subtle differences in the presentation of psychosis that depend on the biological sex of the person exhibiting the symptoms. Because much of the early research in the field was conducted on male animals and on men, several issues of importance to women have been relatively neglected until recently. Current research into psychotic illness is beginning to analyze results for men and women separately and greater emphasis on qualitative methods has allowed the experiences of women patients to be documented. METHODS The last decade of research into the many facets of psychosis in women were reviewed for this paper by introducing the relevant search terms into PubMed, PsycINFO and SOCINDEX. RESULTS Subtle differences are reported in several areas, with important ramifications for treatment. CONCLUSIONS It is important for service providers to devise treatment programs that address the different needs of the two sexes. Effective treatment of women with psychosis is especially important in that these women are often mothers, whose well being impacts on the health of the next generation.
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Affiliation(s)
- Mary V Seeman
- University of Toronto and Centre for Addiction & Mental Health, Toronto, ON, Canada.
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Bauer J, Pedersen MØ, Jørgensen MB. Should the term catatonia be explicitly included in the ICD-10 description of acute transient psychotic disorder F23.0? Nord J Psychiatry 2012; 66:68-9. [PMID: 21830848 DOI: 10.3109/08039488.2011.598555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Aadamsoo K, Saluveer E, Küünarpuu H, Vasar V, Maron E. Diagnostic stability over 2 years in patients with acute and transient psychotic disorders. Nord J Psychiatry 2011; 65:381-8. [PMID: 21438790 DOI: 10.3109/08039488.2011.565800] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The nosological entity of acute and transient psychotic disorders (ATPD) as an independent diagnostic category has become a subject of controversial opinions. The present study aimed to follow-up the diagnostic stability of index episode of ATPD and to examine the influence of clinical and socio-demographic factors on the ATPD prognosis. METHOD A sample of 153 (60.1% females; mean age 27.8 ± 8.2) first-admitted patients with ATPD was followed over 2 years. The clinical manifestations, global functioning and quality of life were regularly evaluated during follow-up period. RESULTS At the end of follow-up, the overall stability rate of ATPD, excluding the cases not readmitted until last assessment, reached 34%. The diagnostic transition was observed in 35.9% of the patients, mostly to schizophrenia and schizoaffective disorders. There was a significant deterioration in several clinical and social indicators among the patients who developed schizophrenia, compared with those with stable ATPD, whereas no reliable predictors were found for diagnostic transition to schizophrenia, except younger age, unmarried status and period of the first hospitalization. CONCLUSION 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.
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Affiliation(s)
- Kaire Aadamsoo
- North Estonia Medical Centre Foundation , Psychiatry Clinic, Tallinn , Estonia
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Legesse B, Freudenreich O, Murray E, Price B. A case report of confusional psychosis with abrupt onset and rapid resolution of symptoms. PSYCHOSOMATICS 2011; 52:468-71. [PMID: 21907068 DOI: 10.1016/j.psym.2011.01.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 05/12/2010] [Accepted: 05/14/2010] [Indexed: 11/25/2022]
Affiliation(s)
- Benalfew Legesse
- Dept. of Neurology, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA.
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Nugent KL, Paksarian D, Mojtabai R. Nonaffective acute psychoses: uncertainties on the way to DSM-V and ICD-11. Curr Psychiatry Rep 2011; 13:203-10. [PMID: 21344285 PMCID: PMC3662493 DOI: 10.1007/s11920-011-0190-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Since the early 20th century, a group of nonaffective psychoses with acute onset and brief duration have been described in different countries under various names, including cycloid psychosis, bouffée délirante, and reactive psychosis. These psychoses share several characteristics, including benign course, greater prevalence in women than men and in developing countries than in industrialized countries, and high prevalence of premorbid psychological and physiologic stressors. However, the variations in names and minute details of symptomatology have overshadowed the basic similarities across these various descriptions. Confusion in classification persists in the two contemporary diagnostic systems, the DSM-IV and the ICD-10. We believe that most cases of these psychoses could be captured under a broad, unified category of nonaffective psychosis with acute onset and brief duration, and urge the authors of the upcoming revisions of the DSM and ICD to create such a category. A unified diagnostic category for these disorders would reduce unnecessary fragmentation in the diagnostic systems and assist in the progress of research on these rare conditions.
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Affiliation(s)
- Katie L. Nugent
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Diana Paksarian
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Ramin Mojtabai
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
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