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

Abstract

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.

The prognostic role of catatonia, hallucinations, and symptoms of schizophrenia in acute and transient psychosis

“…Along this line, the Diagnostic and Statistical Manual of Mental Disorders‐Fourth Edition (DSM‐IV) introduced the brief psychotic disorder (BPD) as a sudden onset and short‐lived psychotic syndrome . Nevertheless, although ATPD and BPD could be considered analogous categories, it should be noted that the two disorders only partially overlap due to operational differences in onset, duration, and symptomatology .…”

“…In addition, although severe emotional changes, psychomotor disturbances, attentional impairments, and transient states of perplexity or misidentification may be present in the clinical picture, the diagnostic criteria for ATPD exclude organic mental diseases, substance‐induced disorders, and major affective disorders . The annual incidence of ATPD ranges from 4 to 10 per 100 000 people, whereas prevalence may vary across different cohorts of first‐episode psychosis (FEP) patients from 5.8% to 19.0% . The diagnosis of ATPD is slightly more frequent in females in early–middle adulthood and migrant populations .…”

“…The annual incidence of ATPD ranges from 4 to 10 per 100 000 people, whereas prevalence may vary across different cohorts of first‐episode psychosis (FEP) patients from 5.8% to 19.0% . The diagnosis of ATPD is slightly more frequent in females in early–middle adulthood and migrant populations . The disorder tends to have an episodic‐remitting course in about half of the cases , and the associated acute stress is more likely to be a precipitating factor in developing countries than in industrialized countries .…”

“…The diagnosis of ATPD is slightly more frequent in females in early–middle adulthood and migrant populations . The disorder tends to have an episodic‐remitting course in about half of the cases , and the associated acute stress is more likely to be a precipitating factor in developing countries than in industrialized countries . Furthermore, even though, given their brief duration and rapid remission, ATPD has traditionally been considered psychoses with a potentially good prognosis , they have been associated with a high risk of suicidal behavior and increased mortality from natural causes .…”

“…On the contrary, those subtypes featuring symptoms of schizophrenia will be collected within the new F2 section under the name ‘unspecified primary psychotic disorders’ while the predominantly delusional subtype will be collapsed into the revised category ‘delusional disorder’ . Notwithstanding, although these changes would be aimed at increasing the predictive validity of the new ATPD category, several authors have suggested that the current APPD definition could hinder a reliable diagnosis due to the intrinsic instability of its shifting polymorphic psychopathology . Hence, selection of those distinctive clinical and sociodemographic characteristics of ATPD that would allow physicians easier, objective assessment has been proposed as a more practical solution for better diagnostic reliability .…”