Skip to main content

Advertisement

SpringerLink
Log in

The predictive validity and outcome of ICD-10 and DSM-5 short-lived psychotic disorders: a review and meta-analysis

  • Original Paper
  • Published:
European Archives of Psychiatry and Clinical Neuroscience Aims and scope Submit manuscript

Abstract

The ICD-10 Classification of Mental and Behavioural Disorders introduced the category of ‘acute and transient psychotic disorders’ (ATPDs) encompassing polymorphic, schizophrenic and predominantly delusional subtypes, and the forthcoming ICD-11 revision has restricted it to polymorphic psychotic disorder, while the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) listed ‘brief psychotic disorder’ (BPD). To assess the predictive validity and outcome of ATPDs and BPD, relevant papers in English, French and German were searched in PubMed and Web of Science. Where possible meta-analysis of prognostic validators (diagnostic stability, course, outcome and response to treatment) was conducted. Fifty studies published between January 1993 and July 2019 were found. The clinical and functional outcome of ATPDs proved better than in schizophrenia and related disorders, but mortality risk is high, particularly suicide, and treatment trials provide little evidence. Meta-analysis of 25 studies (13,507 cases) revealed that 55% (95% CI 49–62) do not change diagnosis, 25% (95% CI 20–31) converted into schizophrenia and related disorders, and 12% (95% CI 7–16) into affective disorders on average over 6.3 years. Subgroup meta-analysis estimated prospective consistency of polymorphic psychotic disorder (55%; 95% CI 52–58) significantly greater than that of the ATPD subtypes with schizophrenic (OR 1.7; 95% CI 1.4–2.0) and predominantly delusional (OR 1.3; 95% CI 1.1–1.5) symptoms. Moreover, the diagnostic stability of BPD (13 studies; 294 cases) was 45% (95% CI 32–50) over a mean 4.2 years. Although these findings indicate that short-lived psychotic disorders have little predictive validity, significant differences among the ATPD subtypes support the revised ICD-11 ATPD category.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. World Health Organization (1992) The ICD-10 classification of mental and behavioural disorders, clinical descriptions and diagnostic guidelines. World Health Organization, Geneva

    Google Scholar 

  2. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (DSM-5), 5th edn. American Psychiatric Association, Washington, DC

    Book  Google Scholar 

  3. World Health Organization (2021) International classification of diseases 11th revision (ICD-11). https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/284410555. Accessed 8 July 2021

  4. Magnan V, Legrain M (1885) Les dégénérés: état mentale et syndromes épisodiques. Rueff, Paris

    Google Scholar 

  5. Kleist K (1928) Über zykloide und epileptoide Psychosen und über die Frage der Degenerationspsychosen. Schweiz Arch Neurol Psichiat 23:3–37

    Google Scholar 

  6. Leonhard K (2003) Aufteilung der endogenen Psychosen und ihre differenzierte Ätiologie, 8th edn. Thieme, Stuttgart

    Google Scholar 

  7. Castagnini A, Berrios GE (2009) Acute and transient psychotic disorders (ICD-10 F23): a review from a European perspective. Eur Arch Psychiatry Clin Neurosci 259:433–443

    Article  PubMed  Google Scholar 

  8. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders (DSM-IV), 4th edn. American Psychiatric Association, Washington, DC

    Google Scholar 

  9. Kendell RE (1989) Clinical validity. Psychol Med 19:45–55

    Article  CAS  PubMed  Google Scholar 

  10. Kendler KS (1980) The nosologic validity of paranoia (simple delusional disorder): a review. Arch Gen Psychiatry 37:699–706

    Article  CAS  PubMed  Google Scholar 

  11. Fusar-Poli P, Cappucciati M, Bonoldi I et al (2016) Prognosis of brief psychotic episodes: a meta-analysis. JAMA Psychiat 73:211–220

    Article  Google Scholar 

  12. Fusar-Poli P, Cappucciati M, Rutigliano G et al (2016) Diagnostic stability of ICD/DSM first episode psychosis diagnoses: meta-analysis. Schizophr Bull 42:1395–1406

    Article  PubMed  PubMed Central  Google Scholar 

  13. Jørgensen P, Bennedsen B, Christensen J, Hyllested A (1997) Acute and transient psychotic disorder: a 1-year follow-up study. Acta Psychiatr Scand 96:150–154

    Article  PubMed  Google Scholar 

  14. Pillmann F, Haring A, Balzuweit S, Marneros A (2002) A comparison of DSM-IV brief psychotic disorder with ‘positive’ schizophrenia and healthy controls. Compr Psychiatry 43:385–392

    Article  PubMed  Google Scholar 

  15. Salvatore P, Baldessarini RJ, Tohen M et al (2011) McLean-Harvard International First-Episode Project: two-year stability of ICD-10 diagnoses in 500 first-episode psychotic disorder patients. J Clin Psychiatry 72:183–193

    Article  PubMed  Google Scholar 

  16. Gaebel W, Zielasek J, Falkai P (2015) Psychotic disorders in ICD-11. Die Psichiatrie 12:71–76

    Article  Google Scholar 

  17. Castagnini AC, Fusar-Poli P (2017) Diagnostic validity of ICD-10 acute and transient psychotic disorders and DSM-5 brief psychotic disorder. Eur Psychiatry 45:104–113

    Article  CAS  PubMed  Google Scholar 

  18. Stein DJ, Szatmari P, Gaebel W et al (2020) Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies. BMC Med 18:21

    Article  PubMed  PubMed Central  Google Scholar 

  19. Castagnini AC, Foldager L, Berrios GE (2018) Acute polymorphic psychotic disorder: concepts, empirical findings and challenges for ICD-11. J Nerv Ment Dis 206:887–895

    Article  PubMed  Google Scholar 

  20. Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analysis of studies that evaluate health care interventions: explanation and elaboration. Ital J Public Health 6:354–391

    Google Scholar 

  21. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp

  22. Higgins JPT, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558

    Article  PubMed  Google Scholar 

  23. Cochran WG (1954) The combination of estimates from different experiments. Biometrics 10:101–129

    Article  Google Scholar 

  24. R Core Team (2020) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna. http://www.r-project.org/foundation/

  25. Viechtbauer W (2010) Conducting meta-analyses in R with the metafor package. J Stat Softw 36:1–48

    Article  Google Scholar 

  26. Okasha A, Eldawla A, Khalil A, Saad A (1993) Presentation of acute-psychosis in an Egyptian sample—a transcultural comparison. Compr Psychiatry 34:4–9

    Article  CAS  PubMed  Google Scholar 

  27. Sajith SG, Chandrasekaran R, Unni KES, Sahai A (2002) Acute polymorphic psychotic disorder: diagnostic stability over 3 years. Acta Psychiatr Scand 105:104–109

    Article  CAS  PubMed  Google Scholar 

  28. Marneros A, Pillmann F, Haring A, Balzuweit S, Bloink R (2003) Features of acute and transient psychotic disorders. Eur Arch Psychiatry Clin Neurosci 253:167–174

    Article  PubMed  Google Scholar 

  29. Singh SP, Burns T, Amin S, Jones PB, Harrison G (2004) Acute and transient psychotic disorders: precursors, epidemiology, course and outcome. Br J Psychiatry 185:452–459

    Article  PubMed  Google Scholar 

  30. Suda K, Hayashi N, Hiraga M (2005) Predicting features of later development of schizophrenia among patients with acute and transient psychotic disorder. Psychiatry Clin Neurosci 59:146–150

    Article  PubMed  Google Scholar 

  31. Aadamsoo K, Saluveer E, Kueuenarpuu H, Vasar V, Maron E (2011) Diagnostic stability over 2 years in patients with acute and transient psychotic disorders. Nord J Psychiatry 65:381–388

    Article  PubMed  Google Scholar 

  32. Castagnini A, Foldager L, Bertelsen A (2013) Long-term stability of acute and transient psychotic disorders. Aust N Z J Psychiatry 47:59–64

    Article  PubMed  Google Scholar 

  33. Castagnini AC, Munk-Jorgensen P, Bertelsen A (2016) Short-term course and outcome of acute and transient psychotic disorders: differences from other types of psychosis with acute onset. Int J Soc Psychiatry 62:51–56

    Article  PubMed  Google Scholar 

  34. Jäger M, Hintermayr M, Bottlender R, Strauss A, Möller HJ (2003) Course and outcome of first-admitted patients with acute and transient psychotic disorders (ICD-10: F23)—focus on relapses and social adjustment. Eur Arch Psychiatr Clin Neurosci 253:209–215

    Article  Google Scholar 

  35. Chang WC, Pang SLK, Chung DWS, Chan SSM (2009) Five-year stability of ICD-10 diagnoses among Chinese patients presented with first-episode psychosis in Hong Kong. Schizophr Res 115:351–357

    Article  PubMed  Google Scholar 

  36. Björkenstam E, Björkenstam C, Hjern A, Reutfors J, Bodén R (2013) A five year diagnostic follow-up of 1,840 patients after a first episode non-schizophrenia and non-affective psychosis. Schizophr Res 150:205–210

    Article  PubMed  Google Scholar 

  37. Queirazza F, Semple DM, Lawrie SM (2014) Transition to schizophrenia in acute and transient psychotic disorders. Br J Psychiatry 204:299–305

    Article  PubMed  Google Scholar 

  38. Rusaka M, Rancans E (2014) A prospective follow-up study of first-episode acute transient psychotic disorder in Latvia. Ann Gen Psychiatry 13:4

    Article  PubMed  PubMed Central  Google Scholar 

  39. Poon JYK, Leung CM (2017) Outcome of first-episode acute and transient psychotic disorder in Hong Kong Chinese: a 20-year retrospective follow-up study. Nord J Psychiatry 71:139–144

    Article  PubMed  Google Scholar 

  40. Wang HY, Guo WJ, Li XJ et al (2018) Higher required dosage of antipsychotics to relieve the symptoms of first-onset acute and transient psychotic disorder (ATPD) predicted the subsequent diagnostic transition to schizophrenia: a longitudinal study. Schizophr Res 193:461–462

    Article  PubMed  Google Scholar 

  41. Jørgensen P (1995) Comparative outcome of first admission patients with delusional beliefs. Eur Psychiatry 10:276–281

    Article  PubMed  Google Scholar 

  42. Amini H, Alaghband-rad J, Omid A et al (2005) Diagnostic stability in patients with first-episode psychosis. Australas Psychiatry 13:388–392

    Article  PubMed  Google Scholar 

  43. Abe T, Otsuka K, Kato S (2006) Long-term clinical course of patients with acute polymorphic psychotic disorder without symptoms of schizophrenia. Psychiatry Clin Neurosci 60:452–457

    Article  PubMed  Google Scholar 

  44. Thangadurai P (2006) Diagnostic stability and status of acute and transient psychotic disorders. Br J Psychiatry 188:293

    Article  CAS  PubMed  Google Scholar 

  45. Möller HJ, Jäger M, Riedel M et al (2011) The Munich 15-year follow-up study (MUFUSSAD) on first-hospitalized patients with schizophrenic or affective disorders: assessing courses, types and time stability of diagnostic classification. Eur Psychiatry 26:231–243

    Article  PubMed  Google Scholar 

  46. Narayanaswamy JC, Shanmugam VH, Raveendranathan D, Viswanath B, Muralidharan K (2012) Short-term diagnostic stability of acute psychosis: data from a tertiary care psychiatric center in South India. Indian J Psychol Med 34:176–178

    Article  PubMed  PubMed Central  Google Scholar 

  47. Castagnini A, Foldager L (2014) Epidemiology, course and outcome of acute polymorphic psychotic disorder: implications for ICD-11. Psychopathology 47:202–206

    Article  PubMed  Google Scholar 

  48. Rusaka M, Rancans E (2014) First-episode acute and transient psychotic disorder in Latvia: a 6-year follow-up study. Nord J Psychiatry 68:24–29

    Article  PubMed  Google Scholar 

  49. Heslin M, Lomas B, Lappin JM et al (2015) Diagnostic change 10 years after a first episode of psychosis. Psychol Med 45:2757–2769

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Rutigliano G, Merlino S, Minchino A et al (2018) Long-term outcomes of acute and transient psychotic disorders: the missed opportunity of preventive interventions. Eur Psychiatry 46:126–133

    Article  Google Scholar 

  51. López-Díaz Á, Fernández-González JL, Lara I, Ruiz-Veguilla M (2020) Predictors of diagnostic stability in acute and transient psychotic disorders: validation of previous findings and implications for ICD-11. Eur Arch Psychiatry Clin Neurosci 270:291–299

    Article  PubMed  Google Scholar 

  52. Pillmann F, Marneros A (2005) Longitudinal follow-up in acute and transient psychotic disorders and schizophrenia. Br J Psychiatry 187:286–287

    Article  PubMed  Google Scholar 

  53. Marneros A, Pillmann F, Haring A, Balzuweit S, Blöink R (2002) The relation of ‘acute and transient psychotic disorder’ (ICD-10 F23) to bipolar schizoaffective disorder. J Psychiatr Res 36:165–171

    Article  CAS  PubMed  Google Scholar 

  54. Pillmann F, Wustmann T, Marneros A (2012) Acute and transient psychotic disorders versus persistent delusional disorders: a comparative longitudinal study. Psychiatry Clin Neurosci 66:44–52

    Article  PubMed  Google Scholar 

  55. Chaudhuri BP, Bhagabati D, Medhi D (2000) Risperidone versus haloperidol in acute and transient psychotic disorder. Indian J Psychiatry 42:280–290

    CAS  PubMed  PubMed Central  Google Scholar 

  56. Khanna A, Lal N, Dalal PK, Khalid A, Trivedi JK (1997) Treatment of acute and transient psychotic disorders with low and high doses of oral haloperidol. Indian J Psychiatry 39:136–142

    CAS  PubMed  PubMed Central  Google Scholar 

  57. Agarwal V, Sitholey P (2006) A preliminary open trial of olanzapine in paediatric acute and transient psychotic disorders. Indian J Psychiatry 48:43–46

    Article  PubMed  PubMed Central  Google Scholar 

  58. Marcelli D, Rose-Rehinardt H, Fahs H, Kasolter-Péré MA (2002) Episode psychotique aigu de l’adolescent et du jeune adulte: questions diagnostiques, thérapeutiques et éthiques. Ann Méd Psychol 160:368–395

    Google Scholar 

  59. Holm J, Brus O, Båve U et al (2017) Improvement of cycloid psychosis following electroconvulsive therapy. Nord J Psychiatry 71:405–410

    Article  PubMed  Google Scholar 

  60. Castagnini A, Foldager L, Bertelsen A (2013) Excess mortality of acute and transient psychotic disorders: comparison with bipolar affective disorder and schizophrenia. Acta Psychiatr Scand 128:370–375

    Article  CAS  PubMed  Google Scholar 

  61. Pillmann F, Balzuweit S, Haring A, Bloink R, Marneros A (2003) Suicidal behavior in acute and transient psychotic disorders. Psychiatry Res 117:199–209

    Article  PubMed  Google Scholar 

  62. Schwartz JE, Fennig S, Tanenberg-Karant M et al (2000) Congruence of diagnoses 2 years after a first-admission diagnosis of psychosis. Arch Gen Psychiatry 57:593–600

    Article  CAS  PubMed  Google Scholar 

  63. Schimmelmann BG, Conus P, Edwards J, McGorry PD, Lambert M (2005) Diagnostic stability 18 months after treatment initiation for first-episode psychosis. J Clin Psychiatry 66:1239–1246

    Article  PubMed  Google Scholar 

  64. Rahm C, Cullberg J (2007) Diagnostic stability over 3 years in a total group of first-episode psychosis patients. Nord J Psychiatry 61:189–193

    Article  PubMed  Google Scholar 

  65. Subramaniam M, Pek E, Verma S, Chan YH, Chong SA (2007) Diagnostic stability 2 years after treatment initiation in the Early Psychosis Intervention Programme in Singapore. Aust NZ J Psychiatry 41:495–500

    Article  Google Scholar 

  66. Haahr U, Friis S, Larsen TK et al (2008) First-episode psychosis: diagnostic stability over one and two years. Psychopathology 41:322–329

    Article  PubMed  Google Scholar 

  67. Salvatore P, Baldessarini RJ, Tohen M et al (2009) McLean-Harvard International First-Episode Project: two-year stability of DSM-IV diagnoses in 500 first-episode psychotic disorder patients. J Clin Psychiatry 70:458–466

    Article  PubMed  Google Scholar 

  68. Kingston T, Scully PJ, Browne DJ et al (2013) Diagnostic trajectory, interplay and convergence divergence across all. Psychol Med 43:2523–2533

    Article  CAS  PubMed  Google Scholar 

  69. El Hamaoui Y, Yaalaoui S, Moussaoui D, Battas O (2003) Etude de suivi sur deux ans de patients présentant un accès psychotique aigu: modalités évolutives et prognostic. L’Encéphale 29:425–429

    Google Scholar 

  70. Rufino A, Uchida RR, Vilela JAA et al (2005) Stability of the diagnosis of first-episode psychosis made in an emergency setting. Gen Hosp Psychiatry 27:189–193

    Article  PubMed  Google Scholar 

  71. Pedros A, Marti J, Gutierrez G, Tenias JM, Ruescas S (2009) Two-year diagnostic stability and prognosis in acute psychotic episodes. Actas Esp Psiquiatria 37:245–251

    CAS  Google Scholar 

  72. Kapfhammer HP, Reininghaus EZ, Fitz W, Lange P (2014) Clinical course of illness in women with early onset puerperal psychosis: a 12-year follow-up study. J Clin Psychiatry 75:1096–1104

    Article  PubMed  Google Scholar 

  73. Pillmann F, Haring A, Balzuweit S, Bloink R, Marneros A (2002) A comparison of DSM-IV brief psychotic disorder with ‘positive’ schizophrenia and healthy controls. Compr Psychiatry 43:385–392

    Article  PubMed  Google Scholar 

  74. First MB, Gaebel W, Maj M et al (2021) An organization- and category-level comparison of diagnostic requirements for mental disorders in ICD-11 and DSM-5. World Psychiatry 20:34–51

    Article  PubMed  PubMed Central  Google Scholar 

  75. Mojtabai R, Varma V, Susser E (2000) Duration of remitting psychoses with acute onset—implications for ICD-10. Br J Psychiatry 176:576–580

    Article  CAS  PubMed  Google Scholar 

  76. Castagnini A, Berrios GE (2019) Approach to refine ICD-11 acute and transient psychotic disorder (polymorphic psychotic disorder). Schizophr Res 212:239–240

    Article  PubMed  Google Scholar 

  77. Reed GM, Sharan P, Rebello TJ et al (2018) The ICD-11 developmental field trials study of reliability of diagnoses of high-burden mental disorders: results among adult patients in mental health settings of 13 centres. World Psychiatry 17:174–186

    Article  PubMed  PubMed Central  Google Scholar 

  78. International Early Psychosis Association (IEPA) Writing Group (2005) International clinical practical guidelines for early psychosis. Br J Psychiatry 187(suppl. 48):120–124

    Article  Google Scholar 

  79. Byrne P (2007) Managing the acute psychosis. BMJ 334:286–292

    Article  Google Scholar 

  80. Castagnini AC, Laursen TM, Mortensen PB, Bertelsen A (2013) Family psychiatric morbidity of acute and transient psychotic disorders and their relationship to schizophrenia and bipolar disorder. Psychol Med 43:2369–2375

    Article  CAS  PubMed  Google Scholar 

  81. Kanazawa T, Ikeda M, Glatt SJ et al (2013) Genome-wide association study of atypical psychosis. Am J Med Genet Part B-Neuropsychiatr Genet 162:679–686

    Article  CAS  Google Scholar 

  82. Okayama T, Hashiguchi Y, Kikuyama H, Yoneda H, Kanazawa T (2018) Next generation sequencing analysis of multiplex families with atypical psychosis. Trans Psychiatry 8:221

    Article  Google Scholar 

  83. Fusar-Poli P, Cappucciati M, De Micheli A et al (2017) Diagnostic and prognostic significance of brief limited intermittent psychotic symptoms (BLIPS) in subjects at ultra high risk. Schizophr Bull 43:48–56

    Article  PubMed  Google Scholar 

  84. Marchira CR, Supriyanto I, Subandi MA, Good BJ (2016) The association between duration of untreated psychosis in first psychotic episode patients and help seeking behaviors in Jogjakarta, Indonesia. Int J Cult Ment Health 9:120–126

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Child Neuropsychiatry, University of Modena and Reggio Emilia, Modena, Italy

    Augusto Castagnini

  2. Health Research Unit, Department of Animal Science, Aarhus University, Tjele, Denmark

    Leslie Foldager

  3. Bioinformatics Research Centre, Aarhus University, Aarhus, Denmark

    Leslie Foldager

  4. Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy

    Ernesto Caffo

  5. Department of Psychiatry and Robinson College, University of Cambridge, Cambridge, UK

    German E. Berrios

Authors
  1. Augusto Castagnini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leslie Foldager
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ernesto Caffo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. German E. Berrios
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Augusto Castagnini.

Ethics declarations

Conflict of interest

None.

Supplementary Information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Castagnini, A., Foldager, L., Caffo, E. et al. The predictive validity and outcome of ICD-10 and DSM-5 short-lived psychotic disorders: a review and meta-analysis. Eur Arch Psychiatry Clin Neurosci 272, 1157–1168 (2022). https://doi.org/10.1007/s00406-021-01356-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00406-021-01356-7

Keywords

Search

Navigation