Acute and Transient Psychotic Disorder (ATPD) Dynamic Development and Particularities in Diagnostics and Treatment in Latvia. Summary of the Doctoral Thesis

Abstract

Acute and transient psychotic disorder (ATPD; F23, ICD-10) has been described as an acute psychosis with brief onset and polymorphous symptomatology. (1, 2) To explore the first episode of ATPD in patients in Latvia by describing premorbid personality, association with stressful life events, the clinical features, analyzing the longitudinal changes of diagnosis and associated socio-demographic characteristics to provide the possible basis for potential changes to ICD-11. Material and Methods: 1) Retrospective chart review of all first-time hospitalized patients fulfilling the ICD-10 criteria for ATPD treated at the Riga Centre of Psychiatry and Addiction Disorders (RCPAD), Latvia during a 3-year period (from 01.01.2004. to 31.12.2006.). Later patients were followed-up about 6.1 years (to 31.12.2010.). 2) Prospective follow-up of all first-time hospitalized patients from RCPAD in Latvia who fulfilled the ICD-10 criteria for ATPD, during the 15 month period (from 09.01.2010. to 30.03.2011.). Cohort follow-up period was on average 26.5 months (to 31.10.2012.). Results: 1) during a 3-year period, 294 patients were first-time hospitalized with an ATPD diagnosis, 54.0% were women. The average age at first psychotic episode was 35.7 ± 12.3 years for women, and 30.0 ± 10.8 years for men, (p < 0.0001). Over an average of 6.1 years follow-up period 51.0% of patients were not re-hospitalized. Later diagnosis was changed to schizophrenia in 73.0% of the re-hospitalized patients, mostly within the first two years of illness. The overall stability rate of ATPD diagnosis reached 58.0%. Stressful life events in the 6 months prior to the first episode were found in 44.0% of patients. 2) 102 patients were hospitalized with first-episode ATPD. 60.7% were females (p = 0.003). Over an average 26.5-month follow-up period, 59.8% of patients were not re-hospitalized. In the subgroup of patients who were re-hospitalized, 70.7% had their diagnosis converted to schizophrenia in subsequent visits. Stressful life events before the first episode were found in 49.0% of patients. Conclusions. Certain differences in clinical symptoms during first episode of psychosis in patients between “pure” ATPD and ATPD which later diagnosed schizophrenia were observed. Thought disorder during the index episode was the main statistically significant “predictor” of schizophrenia. Overall stability of ATPD diagnosis was about 50.0%. Large group of ATPD patients had stressful fife events before first episode of psychosis. Personality traits did not show any statistically significant with ATPD.