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The British Journal of Psychiatry (2004) 185: 452-459
© 2004 The Royal College of Psychiatrists

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

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 SW17 0RE, UK. Tel: +44 208 725 3390; fax: +44 208 725 3538; e-mail: s.singh{at}sghms.ac.ac.uk

Declaration of interest None.

Funding detailed in Acknowledgements.

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.




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