Academic journal article East Asian Archives of Psychiatry

Onset of Acute and Transient Psychotic Disorder in India: A Study of Socio-Demographics and Factors Affecting Its Outcomes

Academic journal article East Asian Archives of Psychiatry

Onset of Acute and Transient Psychotic Disorder in India: A Study of Socio-Demographics and Factors Affecting Its Outcomes

Article excerpt

Introduction

Before the advent of the ICD-10, (1) acute psychosis as a group did not exist separately and was classified under the broad category of schizophrenia. In India, Wig and Singh (2) made the first observation regarding the existence of acute psychosis as a separate nosological entity. Their work pointed towards an acute-onset psychosis having florid symptomatology and good prognosis and also highlighted that the equivalent nosological entities in ICD were acute psychosis of uncertain origin and hysterical psychosis. Another study from India (3) considered the existence of 2 types of acute psychosis, namely, acute psychosis with and without stress. Singh and Sachdeva (4) suggested that "acute schizophrenia episode" was different from schizophrenia and manic depressive psychosis (MDP) and stressed that it should not be included under schizophrenia. One study (5) described reactive psychosis which had manifested psychopathology, personality traits, life events, and family history. The landmark Indian Council of Medical Research (ICMR) acute psychosis study (6) found that 35% of cases were categorised as schizophrenia, 25% as MDP, and 40% as non-organic psychosis as per ICD-9. Moreover, 52% of the cases of acute psychosis could not be classified into any of the diagnostic categories. (6)

Acute and transient psychotic disorder (ATPD) as a descriptive entity was recognised for the first time in 1992 when ICD-10 included it under psychotic disorder (F23) as a three-digit code. (1) Acute and transient psychotic disorder has certain key features, such as acute onset (within 2 weeks) and rapidly changing, variable polymorphic picture, which are accepted as defining criteria; stress may or may not be present with the condition. Recovery is complete within 2 to 3 months in most cases. (1)

Epidemiological data on the incidence of acute psychosis suggest that acute and transient psychosis is 10 times more common in developing countries than in developed countries. (7) Despite the long period since ATPD received a distinct nosological status, its status as a separate diagnostic entity has been questioned time and time again because of its diagnostic instability due to overlap of symptoms with schizophrenia and affective psychosis in many cases. Relatively few studies from India have examined the diagnostic validators of ATPD and conclusive data are lacking. In view of the need to define this category more precisely, the current study aimed to delineate socio-demographics (an antecedent diagnostic validator as per schema of Robin and Guze (8)) and clinical variables associated with the onset of ATPD, and how these affect the outcome (a predictive diagnostic validator) of the same.

Methods

A retrospective study was conducted in the Department of Psychiatry, SMS Medical College and Hospital, Jaipur, India. Case notes of all inpatients diagnosed with ATPD (according to the ICD-10 diagnostic criteria) from 1 January 2012 to 31 December 2012 were analysed. A total of 191 such subjects were identified. Of these, patients who were discharged against medical advice (n = 2) or absconded (n = 4) were excluded as clinical improvement could not be established in these patients. The socio-demographic data of the patients were collected on a self-designed performa. Information regarding presence of a stressor prior to the onset of illness, family history of any psychiatric illness, history of substance abuse, duration of untreated illness (DUI), month of onset of psychosis, and duration of hospital stay was recorded. Stressors were categorised into biological (i.e. causing hormonal and biochemical changes) and psychosocial (i.e. changes in social environment).

For the purpose of analysis, duration of hospital stay was used as a proxy for clinical outcome and treatment response. The response was arbitrarily divided into 2 groups: early response (duration of stay < 7 days) and late response (duration of stay [greater than or equal to] 7 days). …

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