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

219 Acute and transient psychotic disorderepisodes during the course, namely the manifestation of episodes belonging to othermajor disorders, is one of the most important arguments – although not the onlyone – against the assumption that ATPD, or its subgroup acute polymorphicpsychoses, is a separate nosological entity.The same findings (i.e., family, premorbid, course, outcome data and, especially,kind of episode) support the assumption that the brief polymorphic psychosesare also related to the affective spectrum.Methods of the HASBAPIn order to determine the relationship between ATPDs especially with regard to therelationship between the core groups of the acute polymorphic psychotic disordersand the bipolar affective and schizoaffective disorders, we combined them andcompared the findings of the HABILOS, described in chapter 1, with the previouslymentioned HASBAP. The HABILOS has been described elsewhere in this book,therefore, we only give a short description of the HASBAP in this chapter:The HASBAP combines three methodological approaches:(1) a prospective approach, studying a consecutively recruited inpatient samplewith a diagnosis of ATPD or brief psychotic disorder(2) a case-control design in which every patient of the original index cohort wasmatched for age and gender with two clinical groups and a non-clinicalcontrol group(3) a longitudinal approach for all three clinical groupsThe sample investigated in the HASBAP comprised all inpatients with ATPDtreated as inpatients at the Department of Psychiatry and Psychotherapy ofMartin–Luther University Halle-Wittenberg from 1993 to 1997. The hospital issituated in the city of Halle, Germany, and takes patients from the city, as well asfrom the surrounding communities, which comprise both rural and industrialareas. It can be said that Halle University Hospital serves a large municipal andsuburban area with a non-selective admission policy. Moreover, ATPD are acuteand usually dramatic psychotic states that – considering the German health caresystem – nearly always lead to inpatient treatment. The HASBAP sample can beregarded as representative of a clinical inpatient population with ATPD. Withsome restrictions, the findings of this study might also be regarded – because of theabove-mentioned reasons – as a reasonable approximation of ATPD in general,and not only for inpatients.The number of patients fulfilling the criteria of ATPD during this period amountedto 42 patients. For the present analysis, three patients were excluded because they hadshown affective or schizoaffective mixed states during earlier episodes, leaving a groupsize of 39 patients. The control groups comprised gender- and age-matched: