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

SINGH, SWARAN P.
BURNS, TOM
AMIN, SHAZAD
JONES, PETER B.
HARRISON, GLYNN

SWARAN P. SINGH, DM, St George's Hospital Medical School, London; TOM BURNS, MD, Department of Psychiatry, University of Oxford; SHAZAD AMIN, MRCPsych, Trafford General Hospital, Manchester; PETER B. JONES, MRCPsych, Department of Psychiatry, University of Cambridge; GLYNN HARRISON, FRCPsych, Division of Psychiatry, University of Bristol, UK

Correspondence: Dr Swaran P. Singh, Department of Mental Health, Jenner Wing, St George's Hospital Medical School, London SWI7 0RE, UK. Tel: +44 208 725 3390; fax: +44 208 725 3538; e-mail: [email protected]

(First received 27 January 2004, final revision 1 June 2004, accepted 26 June 2004)

British Journal of Psychiatry 185:p 452-459, December 2004.

Background

ICD-10 has introduced the diagnostic group acute and transient psychotic disorders (ATPDs;F23).

Aims

To validate the nosological distinctiveness of ICD-10 ATPDs by following up an inception cohort with first-episode psychosis.

Method

All patients with first-episode psychosis identified in Nottingham between 1992 and 1994 and diagnosed using ICD-10 criteria were reassessed 3 years later. ATPD outcomes were compared with schizophrenia and affective psychosis. Multivariate analyses were conducted to determine whether acute onset and early remission predicted favourable 3-year outcome in first-episode psychosis.

Results

Of 168 cases of first-episode psychosis, 32 (19%) received an intake diagnosis of ATPD. The diagnosis of ATPD was stable in women over 3 years, but not in men. Outcomes in ATPD were better than in schizophrenia and similar to affective psychosis. In non-affective psychoses, favourable outcomes were a function of gender and premorbid functioning rather than acute onset and early remission.

Conclusions

The ICD-10 criteria for ATPDs identify a diagnostically unstable group of disorders. Acute onset and early remission do not independently predict favourable outcome over 3 years in first-episode psychosis.

Declaration of interest

None. Funding detailed in Acknowledgements.