Acute psychiatric disorders in foreign domestic workers in Hong Kong: a pilot study

Reactive Psychosis: Discrepancy Between Nosological Concepts and Descriptive Categories

ABSTRACT

Reactive psychosis (RP) is a trauma-induced category whose meaning has varied in relation to the role attributed to lived experiences or vulnerable personality. It has long been described in different countries, but seldom investigated under the influence of symptom-based psychiatric classifications. This article aims to examine the development of RP since the early 20th century, outline how it has been incorporated in modern diagnostic classifications, and set out empirical findings. It is likely that variations in terminology and diagnostic practice have affected estimates of the frequency and hampered the validity of RP in earlier studies. To enhance reliability, RP underwent several changes in successive Diagnostic and Statistical Manual of Mental Disorders and ICD versions and was eventually replaced with descriptive categories for short-lived psychotic disorders. Clinical observations during the COVID-19 pandemic attest the durability of RP, but the current categories prove unhelpful in identifying it and have failed to encourage research.

Diagnosis, prognosis, and treatment of brief psychotic episodes: a review and research agenda

Brief psychotic episodes represent an intriguing paradox in clinical psychiatry because they elude the standard knowledge that applies to the persisting psychotic disorders such as schizophrenia. This Review describes key diagnostic considerations such as conceptual foundations, current psychiatric classification versus research-based operationalisations, epidemiology, and sociocultural variations; prognostic aspects including the risk of psychosis recurrence, types of psychotic recurrences, other clinical outcomes, prognostic factors; and therapeutic issues such as treatment guidelines and unmet need of care. The advances and challenges associated with the scientific evidence are used to set a research agenda in this area. We conclude that brief psychotic episodes can be reconceptualised within a clinical staging model to promote innovative translational research and improve our understanding and treatment of psychotic disorders.

Structure as Depressant: Theorizing Narratives of Mental Health among Migrant Domestic Workers

Articulating that domestic workers in Singapore are marked by their subalternity, erased from the hegemonic discursive spaces in spite of their visibility as objects in the neoliberal economy, this manuscript draws on the culture-centered approach to conceptualize listening as a structurally transformative anchor to theorizing mental health. The narratives offered by workers reveal critical insights into the way structure functions to create conditions of mental health suffering in the performance of precarious domestic work, intricately tied to the erasure of voice. The material violence on the bodies of workers relates to the everyday challenges to mental health. A lack of access to infrastructures of information and communication add to the conditions of marginality. In listening to these storied descriptions of suffering in precariousness, we hear voices revealing limited alternatives to mental health care in poor working conditions, with workers entrapped in a cycle of stress, worry, and fear.

Development of mental health services for lower-skilled migrant workers in Qatar

The largest group of migrants in Gulf Cooperation Council (GCC) countries are lower-skilled migrant workers. GCC countries have witnessed significant healthcare infrastructure investments over recent decades. Despite this, they are lagging to mainstream the mental health needs of lower-skilled migrants into national health policy frameworks. Qatar is one of the GCC countries where lower-skilled migrants constitute 50 per cent of population. In this article,we provide an overview of the development of specialist mental health service for lower-skilled migrants' and discuss the challenges, and measures taken by the State of Qatar to mainstream their health needs into national health policy framework.

A feminist phenomenology on the emotional labor and morality of live-in migrant care workers caring for older people in the community

Background

Global societal changes, such as increasing longevity and a shortage of family caregivers, have given rise to a popular worldwide trend of employing live-in migrant care workers (MCWs) to provide homecare for older people. However, the emotional labor and morality inherent in their interactions with older people are largely unknown. The aim of the present study is to understand the corporeal experiences of live-in migrant care workers in the delivery of emotional labor as seen in their interactions with older people by: (1) describing the ways by which they manage emotional displays with older people; and (2) exploring their morality as enacted through emotional labor.

Methods

We performed a secondary analysis drawing on feminist phenomenology to thematically analyze data from interviews with 11 female MCWs. Follow-up interviews were conducted with 10 participants. The participants had two to 15 years of experience in caring for older people in their homes in Hong Kong.

Results

Performing emotional labor by suppressing and inducing emotions is morally demanding for live-in MCWs, who experience socio-culturally oppressive relationships. However, developing genuine emotions in their relationships with older people prompted the MCWs to protect the interests of older people. Through demonstrating both fake and genuine emotions, emotional labor was a tactic that live-in MCWs demonstrated to interact morally with older people.

Conclusions

Emotional labor allowed live-in MCWs to avoid conflict with older people, and to further protect their own welfare and that of others. This study highlights the significance of empowering live-in MCWs by training them in ways that will help them to adapt to working conditions where they will encounter diverse customs and older people who will develop an increasing dependence on them. Thus, there is a need to develop culturally appropriate interventions to empower live-in MCWs to deliver emotional labor in a moral manner.

Acute and Transient Psychotic Disorders: Newer Understanding

PURPOSE OF REVIEW

We review the ongoing research in the area of acute and transient psychotic disorders (ATPDs) with regard to their nosology, epidemiology, clinical description, genetics, and neurobiology, examining evidence for distinctiveness or otherwise of ATPDs. We further highlight the lacuna in research in ATPDs.

RECENT FINDINGS

Studies on ATPDs as defined in the ICD 10 have been reported from different parts of the world, more so from the developing countries. There is consistent evidence that there exist a group of ATPDs that occur more commonly among females, are often precipitated by stressful life events or exposure to physiological stresses like fever, child birth, are associated with well-adjusted premorbid personality, and show complete recovery in a short period. Although in some cases of ATPDs, there is symptomatic overlap with schizophrenic symptoms in the acute phase, they follow a completely different course and outcome, exhibit genetic distinctiveness, and do not share genetic relationship with schizophrenias or bipolar affective disorder (BPAD). Comparative studies on neurophysiology and neuroimaging in ATPDs and schizophrenias have demonstrated evidence of hyper arousal and hyper metabolism in ATPDs vs hypo arousal and hypo metabolism as noted in the P300 response and on FDG PET studies, respectively. Immune markers such as IL-6, TNF-alpha, and TGF-beta show higher levels in ATPDs as compared to healthy controls. Findings on the neurobiological mechanisms underlying ATPDs, so far, point towards significant differences from those in schizophrenia or BPAD. Although the studies are few and far between, nevertheless, these point towards the possibility of ATPDs as a distinct entity and underscore the need for pursuing alternate hypothesis such as neuro inflammatory or metabolic. Research on ATPDs is limited due to many reasons including lack of harmony between the ICD and DSM diagnostic systems and clinician biases. Available research data supports the validity of ATPDs as a distinct clinical entity. There is also evidence that ATPDs are different from schizophrenias or BPAD on genetic, neuroimaging, neurophysiological, and immunological markers and require further studies.

The effect of discrimination on depression and anxiety symptoms and the buffering role of social capital among female domestic workers in Macao, China

Foreign migrant domestic workers experience an increased burden of mental disorders. Discrimination contributes to this burden. Social resources may buffer migrants from the effects of this discrimination. The present study explored the relationship between discrimination and common mental disorder (CMD) symptoms, anxiety and depression, and examined whether social capital (cognitive and structural) modified this association. A total of 131 female migrant Filipina domestic workers in Macao, China (M_age = 39.7) were sampled using snowball methods. Self-report data were obtained using tablet devices. Correlation analyses demonstrated that discrimination was significantly associated with depression (r_s = 0.43) and anxiety (r_s = 0.42). Mulitvariable regressions showed that cognitive, but not structural, social capital was significantly negatively associated with depression (β = -0.30) and anxiety (β = -0.32). Cognitive social capital modified the association between discrimination and depression (β = 0.39) and anxiety (β = 0.53). Contrary to predictions, as discrimination increased, compared to those with no cognitive social capital, those with moderate or high levels of cognitive social capital experienced worsening CMD symptoms. This finding provides greater nuance to our understanding of how and under what circumstances social resources are protective for mental health for migrant workers.

Justifying abuse of women migrant domestic workers in Lebanon: the opinion of recruitment agencies

OBJECTIVE

Gender-based violence against women migrant domestic workers (WMDW) is a serious public health concern in the Middle East region. The current study is the first to explore abuse of WMDW as perceived by recruitment agency managers.

METHOD

A qualitative study was conducted using 42 personal semi-structural interviews with agency managers in Lebanon. The interview guidelines were designed based on the standards set by the International Labor Organization (ILO) Convention No. 189. The information was transcribed in Arabic, and data was analyzed using thematic analysis.

RESULTS

The interviewees believe that WMDW are subject to abusive practices that represent various violations of the ILO Convention No. 189, including harassment and violence, compulsory labour, misinformation about conditions of employment, denial of periods of rest and restriction of movement and travel documents. In many situations, the interviewees justified some of these practices as being necessary to protect their business and to protect the workers.

CONCLUSION

The results of this study have several policy implications for the protection of WMDW against abuse.

The latent structure of major depressive symptoms and its relationship with somatic disorder symptoms among Filipino female domestic workers in China

Emerging research have investigated the factor structure of major depressive disorder (MDD) symptoms based on DSM-5 nomenclature. However, to date, results have been inconsistent on what symptom-structure best represent MDD. This study examines the best fitting MDD among four competing models in a sample of overseas Filipino domestic helpers (N = 232). The results show that a two-factor model (Model 2b; Krause et al., 2010) provided the best fit. The model consist of two factors: somatic and non-somatic/affective symptoms. Somatic component includes sleep difficulties, fatigue, appetite changes, concentration difficulties, and psychomotor agitation/retardation while non-somatic/affective component covers anhedonia, depressed mood, feelings of worthlessness, and thoughts of death. Further, the results reveal a pattern where PHQ-15 somatic symptom-items have a higher significant relationship with MDD's somatic symptoms than with the MDD's non-somatic/affective symptoms. These findings suggest that the items of model 2b are appropriately embedded in their respective factors. Differentiating MDD factors have important clinical implications, particularly in the diagnosis and treatment of depression among overseas Filipino domestic helpers.

Acute Polymorphic Psychotic Disorder: Concepts, Empirical Findings, and Challenges for ICD-11

The ICD-11 International Classification of Diseases and Related Health Problems will move toward a narrower concept of "acute and transient psychotic disorders" (ATPD) characterized by the remnant "polymorphic psychotic disorder" (APPD) of the current ICD-10 category, also including schizophrenic and predominantly delusional subtypes. To assess the validity of APPD, relevant articles published between January 1993 and September 2017 were found through searches in PubMed and Web of Science. APPD is a rare mental disorder and affects significantly more women than men in early-middle adulthood. Its diagnostic reliability is relatively low, and its consistency reaches just 53.8% on average over 8.8 years, but is significantly greater than either of ATPD subtypes, which are more likely to progress to schizophrenia and related disorders. Although APPD has distinctive features and higher predictive power, its rarity and the fleeting and polymorphic nature of its symptoms could reduce its usefulness in clinical practice and discourage research.

A survey of health problems of Nepalese female migrants workers in the Middle-East and Malaysia

BACKGROUND

Nepal is a key supplier of labour for countries in the Middle East, India and Malaysia. As many more men than women leave Nepal to work abroad, female migrant workers are a minority and very much under-researched. The aim of the study was to explore the health problems of female Nepalese migrants working in the Middle-East and Malaysia.

METHODS

The study was conducted among 1010 women who were registered as migrant returnees at an organisation called Pourakhi Nepal. Secondary data were extracted from the records of the organisation covering the five-year period of July 2009 to July 2014.

RESULTS

The 1010 participants were aged 14 to 51 with a median age of 31 (IQR: 38-25) years. A quarter of respondents (24%) reported having experienced health problems while in the country of employment. Fever, severe illness and accidents were the most common health problems reported. Working for unlimited periods of time and not being able to change one's place of work were independently associated with a greater likelihood of health problems. Logistic regression shows that migrant women who are illiterate [OR = 1.56, 95% CI: 1.02 to 2.38, p = 0.042], who had changed their workplace [OR = 1.63, 95% CI: 1.14 to 2.32, p = 0.007], who worked unlimited periods of time [OR = 1.64, 95% CI: 1.44 to 1.93, p = 0.020], had been severely maltreated or tortured in the workplace [OR = 1.84, 95% CI: 1.15 to 2.92, p = 0.010], were not being paid on time [OR = 2.38, 95% CI: 1.60 to 3.55, p = 0.038] and migrant women who had family problems at home [OR = 3.48, CI 95%: 1.22 to 9.98, p = 0.020] were significantly associated with health problems in their host country in the Middle East.

CONCLUSION

Female migrant workers face various work-related health risks, which are often related to exploitation. The Government of Nepal should initiate awareness campaigns about health risks and rights in relation to health care services in the host countries. Recruiting agencies/employers should provide information on health risks and training for preventive measures. Raising awareness among female migrant workers can make a change in their working lives.

Acute and transient psychoses: clinical and nosological issues

This 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.

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

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.

Outcome of first-episode acute and transient psychotic disorder in Hong Kong Chinese: a 20-year retrospective follow-up study

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.

Domestic helpers as frontline workers in China's home-based elder care: A systematic review

We conducted a systematic review of the existing empirical studies focusing on Chinese domestic helpers in mainland China and foreign domestic helpers in Hong Kong who provide care for community-dwelling older adults. There are very limited studies specifically focusing on this population. The findings synthesized domestic helpers' characteristics, acknowledged their contributions to elder care in China, and showed multiple challenges facing them, such as issues related to their physical health and emotional well-being, lack of legal rights protection, difficulties of adapting life in the host city, lack of training, and risk of abuse and sexual harassment. Our findings support the need for developing training and educational programs about legal rights protection and cultural competency for domestic helpers and the need to promote domestic helpers' access to health care and social welfare and opportunities for career advancement, and provide respectful working conditions.

Filipino Domestic Workers and Their Capacity Development

This study explored the day-to-day experiences of female Filipino domestic workers in Singapore, including their working conditions, employee–employer relationships, and psychological health. In-depth interviews were conducted with 18 women. Using grounded theory, the emergent themes revealed high levels of variation, both within and between women, suggesting that the quality of domestic workers’ lives depends largely on the personal characteristics of their employers or the workers themselves, rather than on any system of protection. More importantly, participants displayed positive and resilient coping strategies which enabled them to thrive despite restrictive circumstances. Implications pertaining to capabilities and empowerment development were discussed.

Short-term course and outcome of acute and transient psychotic disorders: Differences from other types of psychosis with acute onset

BACKGROUND

The category of 'acute and transient psychotic disorders' (ATPDs) appeared in the ICD-10 Classification of Mental and Behavioural Disorders (ICD-10), but its distinctive features remain uncertain.

AIM

To examine the course and outcome of ATPDs, pointing out differences from other types of psychosis.

METHODS

A one-year follow-up investigation of patients enrolled at the former World Health Organization (WHO) Centre for Research and Training in Mental Health in Aarhus (Denmark) for the WHO collaborative study on acute psychoses.

RESULTS

Of 91 patients aged 15-60 years presenting with acute psychosis, 47 (51.6%) were diagnosed with ATPD, and it occurred more commonly in females; yet, the other acute psychoses featured mainly mood disorders and affected equally both genders. After 1 year, the ATPD diagnosis did not change in 28 cases (59.6%); the remaining developed either affective psychoses (27.7%), or schizophrenia and schizoaffective disorder (12.8%). Nearly, all patients with unchanged diagnosis of ATPD enjoyed full recovery, while those with other types of acute psychosis had significantly higher rates of recurrence or incomplete remission. Duration of illness within 4 weeks and stressful events in the 3 months before symptom onset predicted 1-year favourable clinical outcome for acute psychoses.

CONCLUSION

Although ATPDs fared better over the short-term than other acute psychoses, their diagnostic stability is relatively low.

The dynamics of migration-related stress and coping of female domestic workers from the Philippines: an exploratory study

Female domestic workers face many migration-related stressors that affect their mental health, but we know little about the dynamics of stress and coping in different migration phases. This exploratory study aims to assess stress and coping of female migrant domestic workers from the Philippines in different phases of the migration process; prior to migration, in the country of destination and upon return to the Philippines. Data were collected in 2010 using questionnaires (N = 500). Validation of findings took place in a work shop (23 participants) and two focus groups (13 and 8 participants). Stress levels of women were significantly higher abroad than in the Philippines. Stress and coping in the Philippines was primarily related to financial issues, while stress and coping abroad related more strongly loneliness, working conditions and employers. Findings from this study provide insight in the phase-specific and transnational dimensions of stress and coping.

Toward healthy migration: an exploratory study on the resilience of migrant domestic workers from the Philippines

Domestic workers face many migration-related stressors that affect their mental health. Currently there is an emphasis in the literature on these workers' problems and vulnerability, while there is little insight into factors that positively affect their mental health. In this study, we describe a range of factors that potentially contribute to the resilience of female domestic workers from the Philippines, and explore their relation to stress and well-being. The study used an explorative, mixed-methods design. First, data were collected using questionnaires (n = 500) to assess self-perceived stress levels, well-being, personal resources, and social resources. Then, findings from the questionnaires were validated and elaborated on in a workshop (n = 23) and two focus groups (n = 13; n = 8). Results show that participants perceived their well-being abroad as relatively good, while they also experienced high levels of stress. Workers used a variety of resources in dealing with stress. Socially oriented coping strategies and spirituality seemed to play an important role as personal resources, while the influence of reasons for migration was less clear. Employers and (access to) social networks appeared important in determining social resources. Social resources were more often related to stress and well-being than were personal resources. Findings from this study can help to design strengths-based interventions aimed at improving the well-being of female domestic workers and preventing mental health problems. The environmental factors and structural constraints that provide the context for resilience should be further explored as they influence the ability to mobilize resources.

Acute and transient psychotic disorder in a developing country

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.

Psychiatric morbidity, phenomenology and management in hospitalized female foreign domestic workers in Lebanon

40 million female domestic workers worldwide experience the inhumane conditions associated with this unregulated occupation, a situation that induces psychiatric morbidities in many. The case in Lebanon is not any better where it is estimated that one foreign domestic worker (FDW) commits suicide weekly. 33 female FDW and 14 female Lebanese (control group, CG) were enrolled. Brief Psychotic Rating Scale (BPRS) and Clinical Global Impression (CGI) scales were administered on admission and discharge and socio-demographic, living conditions, mental health care data and phenomenological observations were collected. Sexual, physical, and verbal abuses were detected in FDW (12.5, 37.5, and 50.0 %. respectively). 66.7 % of them were diagnosed with brief psychotic episode. The mean duration of hospital stay (13.1 days) was significantly lower in the FDW group. The mean cumulative antipsychotic dose of the FDW was 337.1 mg of chlorpromazine equivalent and the mean BPRS total pre-score of FDW was 66.4 with a much improved state on the CGI global improvement scale, all of which were nonsignificantly different from the CG. Striking phenomenological findings among FDW were acute anorexia (39.4 %), nudity (30.3 %), catatonic features (21.2 %), and delusion of pregnancy (12.1 %). Inpatient FDW are more diagnosed with psychotic than affective disorders and receive approximately similar treatment as controls in spite of the trend to rapidly discharge and deport the worker to limit the costs. Both groups presented with similar severity, although the FDW had peculiar phenomenological observations.

Understanding psychopathology in migrants: a mixed categorical-dimensional approach

BACKGROUND

Literature on mental disorders in migrants is constantly increasing. Only a few studies describe psychopathological dimensions in migrants over their nosographic diagnoses; however, there is a growing literature about the greater utility of a categorical-dimensional approach, rather than a solely categorical approach, in the understanding of mental disorders. The aim of this paper is to describe the phenomenology of mental disorders in migrants referred to the Transcultural Psychiatric Team of Bologna (BoTPT), by analysing the psychopathological dimensions that underlie their clinical diagnoses.

METHODS

We recruited all migrants who attended the BoTPT between May 1999 and July 2009. The psychopathological assessment was conducted with the Association for Methodology and Documentation in Psychiatry (AMDP) and clinical diagnoses were formulated according to ICD-10. We proceeded through a two-step analysis: (1) comparing the prevalence rates of psychopathological symptoms across diagnoses; then (2) conducting a factor analysis to assess how those symptoms configure psychopathological dimensions and how these dimensions underlie clinical diagnoses.

RESULTS

As expected, we found significant associations between diagnoses and the prevalence of their core psychopathological symptoms. Factor analysis revealed a strong polymorphism of the psychopathological presentation of mental disorders and unexpectedly showed that in each diagnostic cluster, the first extracted factor was not composed of core symptoms.

CONCLUSIONS

A mixed categorical-dimensional approach seems to improve the description of the psychopathology among migrants, as it adds relevant information regarding psychopathological dimensions useful to the understanding of the peculiar clinical expressivity of our patients.

Acute and transient psychotic disorders: an overview of studies in Asia

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.

Nonaffective acute psychoses: uncertainties on the way to DSM-V and ICD-11

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.