CLINICAL ASPECTS IN ACUTE AND TRANSIENT PSYCHOTIC

DISORDERS AND IN PARANOID SCHIZOPHRENIA -

COMPARATIVE STUDY
Abstract
Introduction: acute and transient psychotic disorders are diagnosed entities which are still in
process of crystallization.
Objectives: The analysis of clinical aspects in a group of subjects with acute and transient
psychotic disorders compared to a group of subjects with paranoid schizophrenia.
Material and Methods: Two groups of 41 subjects were selected, first one with acute and
transient psychotic disorders (AT!" and the second one with paranoid schizophrenia, in
which we analyzed the recurrence of psychotic and affecti#e symptoms in the admissions ,
during the first $ years after the onset .
Results: There are significant differences in the fre%uency of the other than running
commentary auditory hallucinations, #isual and tactile hallucinations, as well as delusions of
being followed, persecutory and sensiti#e relational delusions are fre%uently in the group with
paranoid schizophrenia.
Conclusions: The clinical symptoms re#ealed significant differences between the two entities.
Keywords: clinical, symptoms, psychosis
Introduction
Acute and transient psc!"tic dis"rders #ere$ %r"& t!e 'e(innin($ a (r"up "%
psc!"sis #!ic! is di%%icu)t t" enc)"se and descri'e$ 'ein( a !eter"(ene"us (r"up "% psc!"sis
de%ined under di%%erent na&es in di%%erent (e"(rap!ica) re(i"ns* Current)$ '"t! t!e ICD +,
-Internati"na) C)assi%icati"n "% Diseases. and DSM IV-TR -Dia(n"stic and Statistica) Manua)
"% Menta) Dis"rders. !a/e 'r"u(!t t!e& t"(et!er under t!e ter& 0acute psc!"tic dis"rders1$
acute and transient aspects 'ein( c!aracteristic in t!eir identit as psc!"sis* M"st e2istin(
studies "n t!ese psc!"ses$ #ere &ade "n t!eir re(i"na) /ersi"n -cc)"id psc!"sis$ reacti/e
psc!"sis$ 3'"u%%ee de)irante1$ atpica) psc!"sis$ etc*. and )ess "n current c)assi%icati"n
c"ncept #!ic! re/ea)s in ICD +, -+. "r DSM IV -4.*
T!ere'$ descripti/e data a/ai)a')e "n t!is c"ncept are et scarce* Since t!eir de%inin($
t!e #ere %"und t" 'e di%%erent %r"& t!e &ain tpica) psc!"ses -sc!i5"p!renia and peri"dic
a%%ecti/e dis"rders. a)t!"u(! t!eir s&pt"&at")"( inc)udes c"&&"n s&pt"&s*
T!eir rep"rtin( t" sc!i5"p!renia$ de%ined t!e& as psc!"ses #it! a 'etter "utc"&e*
It is si(ni%icant %"r su'6ects #it! t!ese psc!"ses t!at s"&e "% t!e& &a e/")/e "/er ti&e t"
di%%erent tpes "% psc!"sis* T!eir percenta(e /aries %r"& "ne stud t" an"t!er$ a !i(!
dia(n"stic sta'i)it "/er ti&e #as "'ser/ed especia)) in de/e)"pin( c"untries*-7.
MATERIAL AND METHOD
Our stud inc)uded 84 su'6ects #!" !ad t!eir %irst ad&issi"n in t!e Psc!iatric C)inic
"% Ti&is"ara 'et#een 4,,9 - 4,,8$ #!ic! #ere di/ided in t#" distinct (r"ups* :irst (r"up
inc)uded ;+ su'6ects dia(n"sed #it! acute and transient psc!"tic dis"rders -ATPD. t!at !a/e
n"t c!an(ed t!eir dia(n"sis durin( %"))"#-up and t!e sec"nd c"nsistin( "% t!e sa&e nu&'er
"% su'6ects dia(n"sed #it! paran"id sc!i5"p!renia*
1
Inclusion criteria c"nsisted "%<
- :"r '"t! su'6ects (r"ups$ t!e %irst ad&issi"n #it!in a psc!iatric depart&ent s!"u)d !a/e
'een in t!e Psc!iatric C)inic "% Ti&is"ara$ 'et#een 4,,9 = 4,,8*
- T!e a(e "% t!e su'6ects durin( t!eir %irst ad&issi"n s!"u)d !a/e 'een 'et#een t!e a(es "% +8
and >9 ears ")d*
- C)inica) dia(n"sis acc"rdin( t" ICD +, ?HO$ &ust 'e acute and transient psc!"tic
dis"rders %"r su'6ects "% t!e %irst (r"up and %"r t!"se in t!e sec"nd (r"up it &ust 'e
paran"id sc!i5"p!renia$ dia(n"ses #!ic! !ad t" 'e &aintained durin( t!e 9 ears "%
e/")uti"n@
- ?e !a/e an acti/e c"nsu)t in t!e &enta) !ea)t! centers "% Ti&is"ara and "utpatient
psc!iatric practice in Ti&is"ara@
- ?e !a/e /")untar participati"n$ #it!"ut an s"rt "% &"ti/ati"n %r"& researc!ers@
T!e su'6ects #it! a !ist"r "% a'usi/e use "% dru(s "r a)c"!") a'use$ #ere e2c)uded
%r"& t!e stud*
T!e esta')is!&ent "% t!e (r"upAs di&ensi"n 'e(an #it! t!e nu&'er "% su'6ects #it!
acute and transient psc!"tic dis"rder t!at &et t!e criteria &enti"ned a'"/e*
It #as rec"rded %"r eac! su'6ect t!e &anner t!at psc!"tic and a%%ecti/e %reBuenc "%
s&pt"&s$ #!ic! #ere rec"rded in t!e patients !"spita) ad&issi"ns$ c!an(ed durin( t!e
&enti"ned e/")uti"n* T!ere'$ %irst ranC Durt Sc!neiderAs s&pt"&s #ere rec"rded -!earin(
t!"u(!ts $ audit"r !a))ucinati"ns$ runnin( c"&&entar "r ta)C t" eac! "t!er a'"ut t!e patient
t" a t!ird pers"n $ t!e%t and t!"u(!t inserti"n$ di%%usi"n "% t!"u(! $ de)usi"na) percepti"ns "r
e2terna) in%)uence p!en"&ena . $ t!e %reBuenc "% tacti)e $ ")%act"r $ (ustat"r$ "t!er t!an
runnin( c"&&entar audit"r and /isua) !a))ucinati"ns and /ari"us tpes "% de)usi"ns
- 'i5arre$ er"t"&anic$ persecut"r$ sensiti/e re)ati"na)$ re)i(i"us E &stica)$ 6ea)"us$
!p"c!"ndriac $ &e(a)"&aniac$ depressi/e$ trance and p"ssessi"n$ de)usi"ns "% 'ein(
%"))"#ed. and t!e %reBuenc "% a%%ecti/e s&pt"&s - dst!&ic depressi"n E eup!"ria . "/er
ad&issi"ns durin( t!e in/esti(ated %i/e ears "% e/")uti"n*
Data #as "'tained %r"& patientAs c!arts ana)sis and a%ter discussi"ns #it! patients
and t!eir p!sicians* Data #as '"t! Buantitati/e and Bua)itati/e*
?e used a n"n-para&etric c"&paris"n test Mann- ?!itne* Descripti/e statistics #ere
ca)cu)ated -&eans$ %reBuencies$ percenta(es.*
RESULTS
T!e (r"up "% patients #it! acute and transient psc!"tic dis"rders inc)udes 44
#"&en -97*>F. and +G &en -;>*;F.$ and paran"id sc!i5"p!reniaAs (r"up inc)udes 47 #"&en
-9>*+F. and +8 &en -;7*GF.*
Re(ardin( s&pt"&s in t!e ana)5ed (r"ups$ paran"id sc!i5"p!renia su'6ects !ad
si(ni%icant) &"re epis"des "% i))ness #it! %irst ranC Durt Sc!neiderAs s&pt"&s durin( t!e
%i/e ears "% disease e/")uti"n$ t!an su'6ects #it! acute and transient psc!"tic dis"rders*
T!e a/era(e nu&'er "% epis"des is &"re t!an d"u')e %"r patients #it! sc!i5"p!renia -+*9
/ersus ,*>.* H &eans "% Mann-?!itne c"&paris"n test$ #e "'tain an "'/i"us statistica))
si(ni%icant di%%erence* -Z I 7*4+4$ p I *,,.*
2
Re(ardin( t!e a/era(e %reBuenc "% t!e !a))ucinati"n tpes #e !a/e a statistica))
si(ni%icant di%%erence re(ardin( t!e a/era(e nu&'er "% epis"des "% audit"r !a))ucinati"ns -Z
I 7*8J$ p I ,*,,,. and tacti)e !a))ucinati"ns -Z I 4*4J$ p I ,*,4. 'et#een t!e t#" (r"ups$ )ast
&enti"ned s&pt"&s #ere si(ni%icant) !i(!er "n su'6ects #it! paran"id sc!i5"p!renia*
In t!e ATPD (r"up$ ")%act"r and (ustat"r !a))ucinati"ns #ere &"re %reBuent per
epis"de$ c"&pared t" t!e "t!er (r"up$ 'ut t!e di%%erence #as n"t statistica)) si(ni%icant*
In '"t! (r"ups "t!er t!an runnin( c"&&entar audit"r !a))ucinati"ns pre/ai)ed ->,F "%
!a))ucinati"ns "n patients #it! sc!i5"p!renia and 9,F #it! ATPD. and /isua) !a))ucinati"ns*
?e a)s" "'ser/ed t!at persecut"r de)usi"ns$ sensiti/e-re)ati"na) and de)usi"ns "% 'ein(
%"))"#ed$ pre/ai)ed in t!e ana)5ed (r"ups*
T!e Mann-?!itne test re/ea)ed t!e e2istence "% a statistica)) si(ni%icant di%%erence
'et#een t!e nu&'er "% de)usi"na) epis"des #it! persecut"r de)usi"ns -Z I ;*97$ p I ,*,,.$
re)ati"na) sensiti/e de)usi"ns -Z I 4*89$ p I ,*,,4.$ and de)usi"ns "% 'ein( %"))"#ed$ -Z I
;*,9$ p I ,*,,. in a)) t!"se cases$ t!e nu&'er "% epis"des #as !i(!er at patients #it!
paran"id sc!i5"p!renia t!an at patients #it! ATPD* Er"t"&anic de)usi"n #as &"re
%reBuent) enc"untered at su'6ects #it! paran"id sc!i5"p!renia$ 'ut t!e di%%erence #as n"t
statistica)) si(ni%icant*
3
Comparison between the average number of diferent types of
hallucinations on both groups
1.8
0.09
0.29
0.56
0.05
0.56
0.15
0.02
0.32
0.07
0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 2
other that running commentary hallucinations
olfactory hallucinations
tactile hallucinations
visual hallucinations
gustatory hallucinations
Sx.ar. !"#$
Re(ardin( t!e presence "% a%%ecti/e s&pt"&s$ t!e di%%erence 'et#een t!e a/era(e
epis"des "% a%%ecti/e s&pt"&s -depressi"n E &ania . in '"t! (r"ups #ere n"t statistica))
si(ni%icant -Z I +*8G $ p I *,> . *
Depressi/e s&pt"&s #ere &"re c"&&"n at patients #it! paran"id sc!i5"p!renia and
&aniac s&pt"&s at patients #it! acute and transient psc!"tic dis"rder$ 'ut t!e di%%erences
#ere n"t statistica)) si(ni%icant* A)s"$ "/era))$ a%%ecti/e s&pt"&s are &"re %reBuent at
sc!i5"p!renic patients t!an at t!"se #it! ATPD$ 'ut t!is is due t" a !i(!er nu&'er "%
ad&issi"ns "n patients #it! sc!i5"p!renia*
Re)ated t" t!e nu&'er "% re)apses in t!e ana)5ed peri"d$ t!e a%%ecti/e s&pt"&s
#ere present "n an a/era(e "% 7;*G F "n patients ad&itted #it! paran"id sc!i5"p!renia and
;G*7 F "n patients ad&itted #it! ATPD $ #!ic! indicates a !i(!er rate "% a%%ecti/e s&pt"&s
"% ATPD patients t!an in t!"se #it! paran"id sc!i5"p!renia*
4
Discussions
A)t!"u(! t!e psc!"tic s&pt"&s #ere descri'ed as c"&&"n %"r t!e ana)5ed
entities$ di%%erences are e2pected t" 'e %"und in c)inica) p)an$ (i/en t!e %act t!at #e !a/e
di%%erent entities* S"&e aut!"rs su((est t!at$ in c)inica) p)an t!e "n) di%%erence 'et#een
sc!i5"p!renia and acute and transient psc!"tic dis"rders is &ade ' ne(ati/e s&pt"&s -; .
In t!is paper t!e ana)5ed s&pt"&s #ere deter&ined %r"& t!e 'e(innin($ #it! t!eir
rec"rdin( in !"spita) ad&issi"ns* ?e c"nsidered "n) t!e pr"ducti/e s&pt"&s and #e
"/er)""Ced t!e dis"r(ani5ed "r ne(ati/e "nes* It a)s" s!"u)d 'e n"ted t!at 6ust paran"id
sc!i5"p!renia cases #ere taCen in t!e sec"nd (r"up$ c"nsidered t" 'e t!e nearest c)inica))
%"r& "% acute and transient psc!"ses*
S"$ #e tried t" see #!at c)inica) di%%erences #e %ind "n) in ter&s "% pr"ducti/e and
a%%ecti/e s&pt"&s 'et#een t!e t#" entities*
A)s"$ t!e )iterature$ #!en ana)"( 'et#een t!e c)inica) presentati"ns "% t!e t#"
entities #ere &ade$ %irst ranC Durt Sc!neider Ks s&pt"&s$ a)t!"u(! &enti"ned as "ccurrin(
in '"t! psc!iatric c"nditi"ns$ !a/e 'een descri'ed as &"re c"&&"n in t!"se #it! paran"id
sc!i5"p!renia -9$ > .$ #!ic! is re/ea)ed in "ur stud* T!is %act is e2p)ained ' t!e c)inica)
de%initi"n "% paran"id sc!i5"p!renia$ #!ic! supp"se !i(! percenta(e "% t!eir presence$ #!i)e
in acute and transient psc!"sis$ t!eir presence is "n) de%inin( t!eir speci%ic %"r&s
- p")&"rp!ic psc!"tic dis"rder s&pt"&s "% sc!i5"p!renia - :47*+ and acute sc!i5"p!renia
-)iCe psc!"tic dis"rder - :47*4 .*
In '"t! (r"ups t!e &"st c"&&"n tpes "% !a))ucinati"ns #ere t!e "t!er t!an runnin(
c"&&entar audit"r !a))ucinati"ns$ /isua) and tacti)e !a))ucinati"ns$ #it! si(ni%icant
di%%erences 'et#een t!e t#" (r"ups "n) %"r t!e "t!er t!an runnin( c"&&entar audit"r
5
and tacti)e !a))ucinati"n$ &eanin( t!eir &"re %reBuent "ccurrence "n patients #it! paran"id
sc!i5"p!renia *
Re(ardin( t!e tpes "% de)usi"n$ t!e &"st c"&&"n %"r '"t! (r"ups #ere t!e sa&e
tpes "% de)usi"ns< persecut"r$ sensiti/e- re)ati"na)$ de)usi"n "% 'ein( %"))"#ed* Si(ni%icant
di%%erences 'et#een t!e t#" (r"ups re(ardin( t!e tpes "% de)usi"ns #ere a)) "% t!e a'"/e*
T!ese #ere &"re c"&&"n in t!e (r"up "% su'6ects #it! sc!i5"p!renia$ as #e)) as "t!er tpes
"% de)usi"na) t!e&es$ &enti"nin( t!at t!ere #ere n" si(ni%icant di%%erences 'et#een (r"ups*
O/era))$ "ur resu)ts &atc! #it! t!"se "% pre/i"us studies t!at %"))"#ed t!is
c)inica)) aspect* T!us$ Sa6it! et a) -4,,4. rep"rted "n ;9 su'6ects #it! acute p")&"rp!ic
psc!"tic dis"rder $ %"))"#ed durin( t!ree ears "% e/")uti"n $ t!at audit"r !a))ucinati"ns
- audit"r !a))ucinati"ns "t!er t!an t!e runnin( c"&&entar !a))ucinati"ns and t!e t!ird
pers"n . are t!e &"st c"&&"n !a))ucinati"ns * T!e &"st c"&&"n t!e&e #as t!e persecut"r
de)usi"n$ %irst ranC s&pt"&s 'ein( e2c)uded ' de%initi"n %r"& t!is (r"up* Audit"r
!a))ucinati"ns #ere present in G+*+ F "% su'6ects$ and persecut"r de)usi"ns in 84*4 F * -J.
In L"r(ensenA s retr"specti/e stud "n +J su'6ects #it! ATPD and ;7 su'6ects #it!
paran"id sc!i5"p!renia$ durin( 8 ears "% e/")uti"n$ t!e &ain t!e&e "% t!e %irst su'6ects #as
t!e de)usi"n "% re%erence$ and t" t!"se #it! paran"id sc!i5"p!renia #as t!e persecut"r
de)usi"n and t!e in%)uence de)usi"n -8 .* T!e in%)uence de)usi"n #as treated !ere separate)
and #as n"t inc)uded in Durt Sc!neiderMs %irst-ranC s&pt"&s$ as #e esta')is!ed in "ur stud*
T!e interestin( %act is t!at$ re(ardin( t!e su'6ects #it! acute and transient psc!"tic dis"rders$
t!e &"st c"&&"n tpe "% de)usi"n is represented ' t!e re%erence de)usi"n*
In t!e HASHAP stud$ &ade "n ;4 su'6ects #it! ATPD and t!e sa&e nu&'er "%
su'6ects #it! paran"id sc!i5"p!renia$ de)usi"ns #ere re)ati/e) eBua) re(ardin( %reBuenc $
e2cept %"r t!e de)usi"n "% in%)uence$ #!ic! #as &"re %reBuent in t!e (r"up #it!
sc!i5"p!renia* T!e !a))ucinati"ns %reBuenc #as si(ni%icant) !i(!er in t!"se #it! paran"id
sc!i5"p!renia* It a)s" re%ers t" a !i(! %irst ranC Durt Sc!neiderAs s&pt"&s %reBuenc in '"t!
(r"ups as #e)) as dst!&ic depressi"n* Maniac s&pt"&s #ere &"re c"&&"n in ATPD$
'ut t!e di%%erence #as n"t statistica)) si(ni%icant* T!e sa&e %act #as "'ser/ed in "ur stud
re(ardin( &aniac dst!&ia $ 'ut t!e depressi/e dst!&ia #as &"re %reBuent in patients
#it! paran"id sc!i5"p!renia *
A)t!"u(!$ t!e are )ess c"&&"n t!an in t!e (r"up #it! sc!i5"p!renia$ in t!e (r"up
#it! ATPD$ audit"r !a))ucinati"ns #ere t!e &"st c"&&"n tpe "% !a))ucinati"n$ %"))"#ed
' t!e /isua) and !aptic de)usi"ns * T!is is a)s" re/ea)ed in "ur stud * T!e &"st c"&&"n
tpes "% de)usi"ns $ #ere t!e re%erence and persecut"r de)usi"ns - su'6ects #it! ATPD .*-G .
Re(ardin( Durt Sc!neiderAs %irst ranC s&pt"&s$ #!i)e "ccurrin( in '"t!
psc!iatric c"nditi"ns$ t!e !a/e 'een descri'ed as 'ein( &"re c"&&"n in t!"se #it!
paran"id sc!i5"p!renia$ aspect a)s" re/ea)ed in "ur stud -9*> .
Conclusions

Re(ardin( psc!"tic and a%%ecti/e s&pt"&s$ #e %"und si(ni%icant c)inica)
di%%erences 'et#een t!e t#" (r"ups$ re(ardin( Durt Sc!neiderMs %irst-ranC s&pt"&s$ "t!er
t!an runnin( c"&&entar audit"r and tacti)e !a))ucinati"ns$ persecut"r de)usi"ns$ de)usi"n
"% 'ein( %"))"#ed and sensiti/e-re)ati"na)$ in ter&s "% t!eir c"&&"n "ccurrence "n patients
6
#it! paran"id sc!i5"p!renia* T!is !i(!)i(!ts a 'etter sta'i)it "n sc!i5"p!renics "/er ti&e
and an inc"nsistent e/")uti"n "n t!"se #it! acute and transient psc!"tic dis"rder*
Ni/en t!at sc!i5"p!renia is an entit t!at !a/e 'een e2tensi/e) studied$ "ur resu)ts
are n"t si(ni%icant %"r t!is* Instead t!e c"&e t" c"&p)ete t!e s" %ar e2istin( data$ %"r acute
and transient psc!"tic dis"rders$ #!ic! is an under("in( crsta))i5ati"n entit $ in t!e ne#
c)assi%icati"n %"r& *
:r"& t!e )atter c)inica) p"int "% /ie#$ %urt!er studies are needed t" address an
e2tensi/e s&pt"&at")"( and n"t 6ust t!eir de%inin( s&pt"&s *

Limitation

T!e initia) esta')is!in( "% s&pt"&s #!ic! #i)) 'e acc"unted$ e2c)udin( t!"se "%
dis"r(ani5ed "r ne(ati/e tpes$ as #e)) as t!e re)ati/e) s&a)) nu&'er "% su'6ects "% '"t!
(r"ups$ are t!e &ain )i&itati"ns "% t!e stud*
Bibliogra!"
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8