DSM-IV BPD is a psychotic disorder with broad concordance with ATPD as defined by ICD-10. However, the DSM-IV time criteria for BPD may be too narrow. The group of acute psychotic disorders with good prognosis extends beyond the borders of BPD and includes a subgroup of DSM-IV schizophreniform disorder.

ATPD are not a sharply demarcated and unchanging nosological entity. Nevertheless, the present data support a delineation of ATPD as a diagnostic category with specific clinical features and with a usually favourable prognosis. Further research on the topic is necessary.

ATPD show a characteristic psychopathological picture consistent with earlier concepts such as cycloid psychoses and bouffée délirante. Nevertheless, psychopathology alone is not enough to establish ATPD as an independent nosological entity.

Acute and transient psychotic disorder (ATPD) is supposed to differ from schizophrenia, but little research has been done on the subject. In a prospective longitudinal case control study we compared all inpatients with ATPD (ICD-10 F23) treated at Halle University Hospital during a 5-year period with matched controls with "positive" schizophrenia (PS) and with mentally healthy controls. Followup investigations were performed at a mean of 2.2 years after the index episode or 8.2 years after the first episode. Female preponderance in ATPD was marked (78.6%). ATPD and PS patients were similar to each other (but different from healthy controls) in the prevalence of a "broken home" situation and a family history for mental disorders. Compared with PS patients, ATPD patients showed better premorbid social adaptation, and they more often displayed rapidly changing symptoms in the index episode and a negative life event preceding the episode. Despite comparable relapse rates, at followup ATPD patients showed better social adaptation, less psychological impairment, and better global functioning than PS patients. These data support the delineation of ATPD from schizophrenia.

Objective: We prospectively investigated a sample of 42 patients with acute and transient psychotic disorder (ATPD) as defined by the 10th revision of the International Classification of Diseases (ICD-10; F23) to determine the clinical and demographic features of this entity and its relationship to cycloid psychoses. Methods: During a 5-year period, all in-patients with ATPD were identified. We systematically evaluated demographic and clinical features and carried out follow-up investigations on average 2 years after the index episode, using standardised instruments. Results: We found 42 cases of ATPD (4.1%) among 1,036 patients treated for psychotic disorders or a major affective episode. There was a marked female preponderance in ATPD (79%). Fifty-five percent of cases concurrently met the criteria of cycloid psychosis according to Perris and Brockington [in Perris C, Struwe G, Jansson B (eds): Biological Psychiatry. Amsterdam, Elsevier, 1981, pp 447–450]. There was no difference in gender distribution between cycloid and non-cycloid ATPD. As expected, abrupt onset and polymorphic features were significantly more common in cycloid than in non- cycloid ATPD. At follow-up, patients with cycloid ATPD showed less persistent alterations and better social functioning. Conclusion: ATPD as defined by ICD-10 is a heterogeneous category. A diagnosis of cycloid psychosis is made in half of the cases of ATPD, and in these cases, the prognosis is more favourable.

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Although a particularly vulnerable personality has been postulated by some authors as a pathogenetic factor in acute and transient psychotic disorders (ATPD) as introduced with ICD-10, little empirical work has been done on the subject. We therefore evaluated personality features and social interactions in a comparative study of patients with ATPD. We recruited all consecutive inpatients fulfilling the ICD-10 criteria of ATPD (F23) during a 5-year period, as well as control groups with "positive" schizophrenia (PS) and bipolar schizoaffective disorder (BSAD) matched for gender and age at index episode. For assessment of personality features and premorbid social contacts, we administered the NEO Five-Factor Inventory and a semi-structured interview. The assessment of the "Big Five" personality dimensions (neuroticism, extraversion, openness to experience, agreeableness, conscientiousness) with the NEO-FFI did not show any significant difference between ATPD patients and healthy controls. BSAD patients differed from mentally healthy controls on 2 of 5 subscales of the NEO-FFI (neuroticism, extraversion), but were otherwise indiscernible from ATPD patients and mentally healthy controls. In contrast, PS patients showed the most pronounced differences from the mentally healthy controls on the NEO-FFI, and had significantly less premorbid social interaction than the clinical controls. Within the limits of retrospective assessment, the present findings indicate that (1) patients with ATPD do not share the premorbid social impairment characteristic of schizophrenic patients and (2) the personality of patients with ATPD does not differ substantially from the general population.

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