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Diagnostic Stability of Acute and Transient Psychotic Disorders in Developing Country Settings: An Overview
Diagnostic Stability of Acute and Transient Psychotic Disorders in Developing Country Settings: An Overview
Table 1. International Classification of Diseases nomenclature of acute and transient psychotic disorders.
ICD-10 code Diagnostic subcategory of ATPD (F23) Duration, months
F23.0 Acute polymorphic psychotic disorder without symptoms of schizophrenia <3
F23.1 Acute polymorphic psychotic disorder with symptoms of schizophrenia <1
F23.2 Acute schizophrenia-like psychotic disorder <1
F23.3 Other acute predominantly delusional psychotic disorders <3
F23.8 Other acute and transient psychotic disorders <3
F23.9 Acute and transient psychotic disorders, unspecified <3
ICD-10, International Classification of Diseases; ATPD, acute and transient psychotic disorders.
Table 2. Studies assessing the diagnostic stability of acute and transient psychotic disorders.
Author Number of patients Duration of follow-up Study method Stability percentage
(in months)
Sajith et al.3 45 36 Prospective follow-up 73.3
Amini et al.12 10 cases of ATPD out of total 60 cases 12 Prospective follow-up 100
Thangadurai et al.13 87 13 Retrospective medical record review 64
Narayanaswamy et al.14 57 24 Retrospective medical record review 63.2
ATPD, acute and transient psychotic disorders.
their analysis was 13.2 months. The diagnosis nostic stability of ATPD in developing country difficult to make definitive conclusions. Also,
was revised to affective disorder in 8 patients settings and thus to build an understanding of the studies reviewed in this report have differ-
(9.2%), schizophrenia in 23 (26.4%), and 10 how this entity affects patients chronically. ences in design (prospective vs. retrospective
patients (11.5%) presented with recurrent Surprisingly, only four studies have evaluat- study designs) and length of follow-ups.
episodes of acute psychosis. In an another ed the diagnostic stability of ATPD in the con- Therefore, meaningful comparison is difficult.
recent study from India,14 records of 57 text of developing country settings with follow- Future research is required to further eluci-
patients who presented with the first episode up period ranging from 12-36 months. 63-100% date this diagnostic dilemma because certain
of acute and transient disorder over one year of patients retained their diagnosis of ATPD at important questions still remain unanswered:
were analyzed, and the follow-up data at the follow-up, suggesting a high diagnostic stabili- i) What are the biological validators of the
end of 1 and 2 years were recorded. The ty of this diagnosis. The factors which predict- diagnosis of ATPD, considering the diagnostic
records of 44 patients were available at the ed a stable diagnosis of ATPD, APPD to be stability of ATPD to be as high as 63-100%? ii)
conclusion of one year out of which 40 patients more specific, were shorter duration of illness What are the standard guidelines for the treat-
(70.2%) retained their diagnosis; 14% convert- (<1 month) and abrupt onset (<48 h) as sug- ment of ATPD? Antipsychotics are currently
ed to bipolar disorder, 8.8% to schizophrenia gested by an Indian study.3 used but there is no evidence base for this. iii)
and 7% were diagnosed as psychosis unspeci- On the other hand, in industrialized nations Considering high mortality in ATPD particular-
fied. Out of 43 patient records available at the like Europe, more than 50% of cases with ATPD ly from suicide,18 what prevention strategies
end of 2 years, 63.2% retained their diagnosis; tend to change diagnosis into another F2 cate- can be framed to reduce this?
21% were diagnosed as bipolar disorder, 8.8% gory schizophrenia and related disorders or These questions can serve as guide for the
as schizophrenia and 7% were diagnosed as affective disorders as revealed in a review by future research.
psychosis unspecified. However, unlike the Castagnini and Berrios.15
study of Sajith et al., these two studies did not Patients who had their diagnosis changed at
specify the subcategory of ATPD. A study from follow-up most commonly received a diagnosis References
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