UGC Salud Mental, Hospital Universitario Virgen Macarena, Seville, Spain.
UGC Salud Mental, Hospital San Juan de la Cruz, Úbeda, Spain.
Eur Arch Psychiatry Clin Neurosci. 2020 Apr;270(3):291-299. doi: 10.1007/s00406-019-01014-z. Epub 2019 May 6.
Acute and transient psychotic disorders (ATPD) have moderate prospective diagnostic stability. Female gender, older age at onset, good premorbid adjustment, abrupt onset, shifting polymorphic symptomatology and absence of schizophrenic features have been found to be predictive factors of diagnostic stability in ATPDs. Nevertheless, most of these findings need to be replicated. The purpose of this study was to evaluate the diagnostic stability of patients with ATPD, and to determine whether previously accepted predictors of diagnostic stability for ATPD could be externally validated in our cohort. To that end, a prospective 2-year observational study was conducted on patients with first-episode ATPD. Multivariate analysis was performed to determine factors associated with ATPD diagnostic stability at the end of the follow-up period. The following prior knowledge variables were analyzed: female gender, older age at onset, good premorbid adjustment, abrupt onset, shifting polymorphic symptomatology and absence of schizophrenic features. Sixty-eight patients with first-episode ATPD completed the follow-up, of whom 55.9% (n = 38) retained their diagnosis of ATPD at the end of the study. Multivariate analysis revealed that diagnostic stability was independently significantly associated with the presence of shifting polymorphic symptomatology (OR = 7.42, 95% CI 1.65-33.30; p = 0.009) and the absence of schizophrenic features (OR = 6.37, 95% CI 1.47-27.54; p = 0.013) at the onset of the psychotic disorder. Our findings provide empirical support for the ICD-11 proposal restricting the new ATPD category to the acute polymorphic disorder without schizophrenia symptoms.
急性和短暂性精神病性障碍 (ATPD) 具有中等程度的前瞻性诊断稳定性。研究发现，女性性别、发病年龄较大、病前适应良好、急性发作、多变的多态症状以及缺乏精神分裂症特征，这些因素均为 ATPD 诊断稳定性的预测因素。然而，这些发现大多需要进行复制。本研究旨在评估 ATPD 患者的诊断稳定性，并确定之前被认为是 ATPD 诊断稳定性预测因素的因素是否可以在我们的队列中得到外部验证。为此，对首次发作的 ATPD 患者进行了为期 2 年的前瞻性观察研究。进行多变量分析以确定与随访期末 ATPD 诊断稳定性相关的因素。分析了以下先前知识变量：女性性别、发病年龄较大、病前适应良好、急性发作、多变的多态症状以及缺乏精神分裂症特征。68 例首次发作的 ATPD 患者完成了随访，其中 55.9%（n=38）在研究结束时保留了 ATPD 的诊断。多变量分析显示，诊断稳定性与发病时存在多变的多态症状（OR=7.42，95%CI 1.65-33.30；p=0.009）和缺乏精神分裂症特征（OR=6.37，95%CI 1.47-27.54；p=0.013）独立显著相关。我们的研究结果为 ICD-11 将新的 ATPD 类别限制为无精神分裂症症状的急性多态障碍的提议提供了经验支持。
