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

Abstract

The prognostic role of catatonia, hallucinations, and symptoms of schizophrenia in acute and transient psychosis L opez-D ıaz A, Fern andez-Gonz alez JL, Lara I, Crespo-Facorro B, Ruiz-Veguilla M. The prognostic role of catatonia, hallucinations, and symptoms of schizophrenia in acute and transient psychosis.Objectives: To examine the prospective temporal stability of acute and transient psychotic disorders (ATPDs) and analyze whether there are clinical, psychopathological, or sociodemographic characteristics that predict ATPD diagnostic stability. Method: We conducted a prospective, 2-year, observational study of patients presenting a first-episode ATPD. A multivariate logistic regression model was developed to identify independent variables associated with ATPD diagnostic stability. Well-established predictive factors of diagnostic stability, as well as all the psychopathological features included in the ICD-10 Diagnostic Criteria for Research (DCR) descriptions of ATPD, were analyzed. Results: Sixty-eight patients with a first episode of ATPD completed the study with a diagnostic stability rate as high as 55.9% (n = 38) at the end of the follow-up period. Multivariate analysis revealed that diagnostic stability was independently significantly associated with the baseline presence of motility disturbances (OR = 6.86, 95% CI = 1.10-42.62; P = 0.039), the absence of hallucinations (OR = 5.75, 95% CI = 1.51-21.98; P = 0.010), and the absence of schizophrenic features (OR = 7.13, 95% CI = 1.38-36.90; P = 0.019). Conclusion: A symptom checklist assessing these psychopathological features would enable early identification of those subjects whose initial ATPD diagnosis will remain stable over time. Significant outcomes• The ATPD stability rate in our sample was moderate and as high as 55.9%. • ATPD diagnostic stability was independently significantly associated with the baseline presence of motility disturbances.• Diagnostic shifts were independently significantly associated with hallucinations and schizophrenia symptoms at the onset of ATPD. Limitations • Our small sample size and relatively short length of our follow-up compared to other large-scale epidemiological studies.• The lack of standardized psychometric assessment scales for measuring the severity of baseline ATPD psychotic symptomatology.• This study did not analyze the prognostic role of antipsychotic maintenance treatment or the impact of psychotic relapse.

Predictors of diagnostic stability in brief psychotic disorders: Findings from a 3‐year longitudinal study

“…Fewer hallucinations at PAFIP admission were a significant independent predictor of BPD diagnostic stability in our study. Similar findings have been reported both in patients with ICD‐10 ATPD 30 and in those identified as having non‐affective acute remitting psychosis (NARP) 31 . Moreover, hallucinations have been found to be a highly predictive clinical feature for a diagnostic outcome of schizophrenia spectrum disorders in FEP 32,33 .…”

“…The prognostic value of DSM specifiers for BPD was not examined either. In this vein, the presence of catatonic features seems to be a predictor of a favorable outcome in patients with short‐lived psychotic disorders, 30 the relationship between puerperal psychoses and bipolar disorders is well‐known, 47 and the literature on the prognostic role of stressful triggers in brief psychotic episodes has yielded mixed results 3,8 . Data regarding the length of hospitalization and the type of antipsychotic treatment received, which were lacking in this study, have demonstrated a significant influence on the temporal stability of these psychotic disorders, insofar as shorter hospitalization and lower antipsychotic load at discharge could be prognostic indicators of good outcome in BPD patients 48,49 .…”

Reactive psychoses in the context of the COVID-19 pandemic: Clinical perspectives from a case series

“…1,14 The presence of hallucinations and schizophreniform symptomatology at the onset of psychosis, as well as later relapse, are factors associated with an increased risk of developing chronic psychotic disorders during follow-up. 15,16 Moreover, long hospitalizations and the prescription of high dosages of antipsychotic medication seem to be predictors of poor prognosis in these short-lived psychotic disorders. 17,18 It would therefore be necessary to prepare preventive approaches and close follow-up of this population with reactive psychosis when the COVID-19 crisis has ended, due to the abovementioned risk of recurrences and transition to long-lasting psychotic disorders of these individuals.…”

A Study on Clinical Characteristics and Diagnostic Stability in Acute and Transient Psychotic Disorders

“…At one year follow up, Jorgensen et al discovered that half of the patients (48%) suffering from acute and transient psychotic disorder had diagnostic change, most frequently to schizophrenia (15%) and affective disorder (28%). As a result, they reported that their findings highlight the importance of validating the ATPD concept [23,24].…”