Clinical features and outcomes in Acute Transient Psychotic disorder: A retrospective analysis

INTRODUCTION: ATPD being an uncommon diagnosis has not been extensively explored by standardized epidemiological studies with prevalence rate for ATPD ranging from 3.9 to 12.5 per 100,000 people. It has been seen that the diagnoses of more than half of the individuals initially diagnosed with ATPD are eventually revised to schizophrenia or affective disorders. Hence the current study was undertaken with the objectives to explore the socio-demographic and clinical characteristics of ATPD and examine the diagnostic stability and longitudinal revisions in the diagnosis of ATPD. METHODOLOGY: The study design was retrospective and observational. The data was collected from the psychiatry OPD records of tertiary health care center in rural India between 2000-2010. After application of inclusion and exclusion criteria, total of 120 patients were studied for sociodemographic data, psychiatric symptoms, mental status examination findings, diagnosis on the first visit and subsequent revisions in the diagnosis based on clinical progress of the patients. SPSS 21 was used for the statistical analysis. RESULT: The patients included in the study consisted of equal number of males and females with larger portion being married. Half of the patients lived in rural area and rest in semi-urban area. Delusion was the most common symptom for first episode psychosis patients. Antecedent psychosocial stressors were found in 44.2% cases 44.2% patients improved within 3 months and didn’t return for follow up. 51% were later diagnosed with chronic mental illnesses (schizophrenia and related disorders including schizoaffective disorder; or bipolar affective disorder). The mean duration in years for the diagnosis of schizophrenia and related disorders (3.84±3.5 years) was lesser than that for bipolar disorder (4.04±3.84 years), however the difference was not found to be statistically significant on comparing the means (P=1.7). CONCLUSION: ATPD was shown to primarily impact young individuals, had a wide range of symptoms, and was roughly half of the time preceded by stressors. While treating patients diagnosed with ATPD, clinicians should be aware of the high risk of diagnostic revision, which is a key practical implication of the current study. To better understand the socio-demographic and clinical factors of diagnostic stability in ATPD, longitudinal follow-up studies are needed.