Bipolar Disorders: Mixed States, Rapid-Cycling, and Atypical Forms

209 Acute and transient psychotic disorderTable 9.2 Subtypes of acute and transient psychotic disorder (World Health Organization,1992) according to ICD-10Acute polymorphic psychotic disorderwith symptoms of schizophrenia (F23.1)without symptoms of schizophrenia (F23.0)Acute schizophrenia-like psychotic disorder (F23.2)Other acute predominantly delusional psychotic disorders (F23.3)Other acute and transient psychotic disorder (F23.8)Unspecified acute and transient psychotic disorder (F23.9)Table 9.3 Acute polymorphic psychotic disorder without symptoms of schizophreniaA. The general criteria for acute and transient psychotic disorders (F23) must be metB. Symptoms change rapidly in both type and intensity from day to day or within thesame dayC. Any type of either hallucinations or delusions occurs, for at least several hours, at any timefrom the onset of the disorderD. Symptoms from at least two of the following categories occur at the same time:* Emotional turmoil, characterized by intense feelings of happiness or ecstasy, oroverwhelming anxiety or marked irritability* Perplexity, or misidentification of people or places* Increased or decreased motility, to a marked degreeE. If any of the symptoms listed for schizophrenia (F20.0–F20.3), criterion G(1) and (2), arepresent, they are present only for a minority of the time from the onset, i.e., criterion B ofF23.1 is not fulfilledF. The total duration of the disorder does not exceed 3 monthsAccording to the WHO, a full remission can be achieved within 2 or 3 months, butoften even after a few weeks or a few days. Nevertheless, some patients may developpersistent alterations. The present state of knowledge, however, does not allow fora definition of prognostic predictors.The HASBAP shows that the ATPDs are mostly independent from associatedacute stress. The factor ‘‘acute stress’’ does not have any defining, but also not anyprognostic, value in regard to the long-term prognosis of ATPD (Marneros andPillmann, 2004).It is essential to note that the WHO defines some subgroups of ATPD, Table 9.2.The most important group is that of the acute polymorphic psychotic disorder(Table 9.3). The majority of patients diagnosed as having ATPD fulfill the criteria