ATPD

Question 1

Historical names

Answer 1

France: Bouffee Delirante

Germany:
Motility Psychosis
Cycloid Psychosis
Reactive Psychosis

Scandinavia:
Psychogenic psychosis[8–11]
Schizophreniform Psychosis

America:
Remitting Schizophrenia
Good Prognosis Schizophrenia
Hysterical Psychosis[16]
Acute Schizoaffective Psychosis

Japan: Atypical Psychosis[18]

Africa:
Acute Primitive Psychosis[19]
Acute Paranoid Psychosis[20]
Transient Psychosis[21]

India:
Acute Psychoses of Uncertain Origin

Hysterical Psychosis

Acute Psychosis without Antecedent Stress

Acute Schizophrenic Episode

Question 2

Common features of these historical entities were:

Answer 2

– acute or sudden onset

– unstable, variable, fluid and florid symptomatology

– volatile polymorphic content

– anxiety

– fear or prominent affective symptoms

– association with a clear precipitant

– good premorbid adjustment

– rapid and complete recovery

Question 3

3 studies observing ATP

Answer 3

1. IPSS
2. Determinanats of Outcomes of severe mental health disorders (DOSMeD)
3. CAP

Question 4

IPSS findings

Answer 4

26% schiz had good outcome and o Lu one episode

Prognosis in developing countries better

Question 5

DOSMeD

Answer 5

1. There were a group of patients who had non-affective psychosis and which remitted completely. These were called as non-affective, acute, remitting psychosis (NARP). Incidence of such NARP cases was 10 times higher in the developing countries in the DOSMeD data
2. Developing countries - benign course on 2 yr follow up

Question 6

CAP (CAP (Cross-cultural study of Acute Psychosis) ) - offshoot of DOSMeD

Answer 6

1. 41 % showed symptoms of schiz, 20% affective, 35 other psychosis
   2.40% - stress close to onset
   3.2/3 rd remained well at 1 yr follow up with no relapse
2. Outcome in patients of acute psychosis with schizophrenic symptom was similar to those with only affective symptoms.

Question 7

RELATIONSHIP OF ATPS WITH SCHIZOPHRENIA AND AFFECTIVE DISORDERS

Answer 7

Some disorders neither schiz nor MDP

overlap etiology Inc genetics of schiz and MDP , different course

Family genetic studies of atp

affective disorder and ATP in the first degree relatives of 40 schizophrenic and 40 ATP patients, it was found that family history of ATP was three times greater and that of schizophrenia was four times lower in the FDRs of ATP as compared to the FDRs of schizophrenic subjects.[65] Further in this study, history of schizophrenia was seen in FDRs of those ATP patients who had schizophrenic symptoms. Family history of affective disorder was similar in FDRs of ATP and schizophrenic probands in this study. These findings gave evidence that ATP is genetically distinct from MDP and that there is genetic overlap between ATP and schizophrenia and schizophrenic symptoms.

Descriptive studies failed to provide a clear separation of psychoses into well-defined clusters by classical symptoms approach.
There was definite evidence in favour of shared genetic liability between the two disorders, i.e., schizophrenia and MDP.

Question 8

ATP: VALIDATION STUDIES NAMES

Answer 8

1. Chandigarh Acute Psychosis Study:
2. ICMR ACUTE PSYCHOSIS STUDY
3. Further analysis of DOSMeD data
4. Chandigarh ATP course and outcome studies

Question 9

Chandigarh Acute Psychosis Study:

Answer 9

acute onset psychosis, defined by specific criteria were studied[69] and the findings at the Chandigarh centre revealed that only 60% cases of acute psychosis fitted the criteria for diagnosis of schizophrenia and MDP as per ICD-9 (version used then) and catego. The remaining 40% cases were of non-schizophrenia, non-affective psychosis and could be considered as “ACUTE PSYCHOSES”. These acute psychoses cases had greater frequency of stress (28/42) and undifferentiated symptoms

Question 10

ICMR ACUTE PSYCHOSIS STUDY

Answer 10

Bikaner, Goad, Patiala, Vellore)

323 cases of acute psychosis

It was found that 35% of cases were categorized as Schizophrenics, 25% as MDP and 40% as non-organic psychosis as per ICD-9; and 52% of cases of acute psychosis could not be categorized into any of the catego diagnosis.

Question 11

Further analysis of DOSMeD data

Answer 11

1. Acute psychosis more in female and developing countries
2. NARP episode duration In 20 % less than 28 weeks
3. Recovery maintained at follow up upto 12 yrs
4. Considering the duration of episode; acute remitting psychosis had a modal distribution of 2-4 months[76] which is larger than 1-3 months given in ICD-10 for ATP.

Question 12

W

Answer 12

In a short-term (5 years) follow-up study of ICD-10 ATP cases, it was found that majority (75%) had good outcome in the form of complete recovery and no residual symptoms. Female gender, presence of stress at onset and absence of schizophrenic symptoms predicted good outcome.

At 1-year follow-up, diagnostic change was seen from ATP to schizophrenia in 15% and from ATP to affective disorder in 28% cases.

Question 13

Recurrent in ATP

Answer 13

35 to 45%

Question 14

Antecedent factors in ATP

Answer 14

1. Female
2. LSES
   3 rural population
3. Stress preceding the onset was seen in about 60% of ATP patients and stress was more common among female subjects and was associated with better outcome
4. Types of psychosocial stress experienced by males and females in ATP were different
5. There was history of childbirth within 3 months prior to onset among female
6. History of non-specific, short-lasting fever without any associated clinical or lab finding, preceding the onset of ATP was found more frequently among ATP patients as compared to acute onset schizophrenia and affective disorders cases.
7. Seasonal pattern was examined for onset of ATP patients and it was found that onset of ATP had a summer peak as compared to schizophrenia patients

Question 15

HYPOTHESIS ABOUT THE NATURE OF ATP

Answer 15

Research findings summarized as

1.ATP is a descriptively valid entity on the basis of onset, duration, course and outcome.

2. ATP presents with cross-sectionally prominent psychotic, affective, confusional symptoms.
3. Diagnostic criteria particularly duration of episode given in ICD-10 is short and needs to be changed to 6 months at least.
4. There is suggestive evidence of genetic distinctiveness of ATP.
5. Schizophrenia symptoms in ATP and in schizophrenia appear to have shared genetic liability.
6. Environmental factors such as fever, childbirth, seasonality, low SES, stress, rural living, seem to be involved in triggering ATP.
7. Course and outcome of ATP is different from that of schizophrenia or of affective disorder.
8. Except for recurrent course, there seems to be minimal overlap of ATP with affective disorder.

Question 16

Environmental factors in schiz .

Answer 16

, urban living has been reported to be an environmental risk for schizophrenia[92,93] and urban risk is cumulative through childhood from birth to 15 years.

In schizophrenia, sensitive periods for neurodevelopmental injury are considered to be:

Foetal stage - 3 years: During this stage, important neuroanatomical cortical changes (neuronal proliferation, migration, pruning) take place. Schizophrenia may result from early CNS insult occurring during second trimester and between 1 and 2 years of age.
7-12 years: During this age, myelination is completed.
Late puberty: When (a) 40% of neuronal synapses are eliminated, (b) Maturation of temporal and pre-frontal areas occurs and (c) Massive changes in neurotransmitters and body hormones occur.

Question 17

Research on ATP supports the notion that there is:

Answer 17

Genetic distinctiveness of ATP. Although the findings point towards genetic distinctiveness of ATP, it is hypothesized that ATP may be an environmentally induced psychotic condition superimposed upon an underlying vulnerability to psychosis. What type of psychosis the patient is likely to develop, could be related to:
The timings of brain insult, e.g., early-life insult may lead more often to schizophrenia and later-life insult may lead to ATP.
The severity of brain insult where ATP may be associated with less severe insult.

Question 18

There may be a common genetic liability to psychosis and further distinction between schizophrenia, MDP and ATP could lie on two dimensions:

Answer 18

Symptoms dimensions, where symptoms of schizophrenia → schizoaffective psychosis → ATP affective psychosis with psychotic symptoms → affective psychosis without psychotic symptoms lie on a continuum.
Course dimension, which may vary from chronic deteriorating → recurrent with varying levels of recovery → single episode with full recovery.

Question 19

Icd 11 crit atpd

Answer 19

1.Acute onset of psychotic symptoms: delusions, hallucinations, disorganized thinking, or experiences of influence, passivity or control, that emerge without a prodrome, progressing from a non-psychotic state to a clearly psychotic state within 2 weeks. Psychomotor disturbances may also be present, including catatonia.

2. Symptoms change rapidly, both in nature and intensity. Such changes may occur from day to day, or even within a single day.
3. Absence of negative symptoms during the psychotic episode.
4. The duration of the symptoms does not exceed 3 months, and most commonly lasts from a few days to 1 month.

First or multiple episodes
Currently symptomatic, partial remission, complete remission or unspecified

Question 20

ICd 10 crit

Answer 20

A heterogeneous group of disorders characterized by

the acute onset of psychotic symptoms such as delusions, hallucinations, and perceptual disturbances, and by the severe disruption of ordinary behaviour.

Acute onset - two weeks or less.

no evidence of organic causation.

Perplexity and puzzlement are often present but disorientation for time, place and person is not persistent or severe enough to justify a diagnosis of organically caused delirium

Complete recovery usually occurs within a few months, often within a few weeks or even days.

The disorder may or may not be associated with acute stress, defined as usually stressful events preceding the onset by one to two weeks.

Subcategories

0 Acute polymorphic psychotic disorder without symptoms of schizophrenia

F23.1 Acute polymorphic psychotic disorder with symptoms of schizophrenia

F23.2 Acute schizophrenia-like psychotic disorder

F23.3 Other acute predominantly delusional psychotic disorders