The relation of ‘‘acute and transient psychotic disorder’’
(ICD-10 F23) to bipolar schizoaffective disorder
A. Marneros*, F. Pillmann, A. Haring, S. Balzuweit, R. Blo
¨
ink
Department of Psychiatry and Psychotherapy, Martin Luther University of Halle-Wittenberg, 06097 Halle, Germany
Received 25 July 2001; received in revised form 17 October 2001; accepted 12 November 2001
Abstract
The aim of this work is to investigate differences between acute and transient psychotic disorders (ATPD; F23 of ICD-10) and
bipolar schizoaffective disorders (BSAD). In a controlled prospective and longitudinal study, we compared all inpatients with
ATPD treated at Halle university hospital during a 5-year period with matched controls with BSAD. Sociobiographical data were
collected using a semi-structured interview. Follow-up investigations were performed at a mean of 2.2–3.3 years after the index
episode or 8.2–16.1 years after the first episode by means of standardized instruments. ATPD differs significantly from BSAD on
various relevant levels, such as gender (more female), age at onset (older), development of the full symptomatology (more rapid),
duration of the symptomatology (shorter), acuteness of onset (more acute), preceding stressful life-events (more frequent) and long-
term prognosis (better). It is concluded that ATPD and BSAD are different nosological entities. # 2002 Elsevier Science Ltd. All
rights reserved.
Keywords: Bipolar schizoaffective disorders; Acute and transient psychotic disorders; Classification; Outcome
1. Introduction
Schizoaffective disorders and acute and transient psy-
chotic disorders (ATPD) are both very special groups in
psychiatric nosology. These diagnoses and their alloca-
tion within the classification systems are connected with
some problems. The main question concerns their rela-
tion to the major group of psychotic disorders, namely
schizophrenia and mood disorders: Are they subgroups
of schizophrenia or affective disorders or are they sepa-
rate entities? This question provokes an ongoing dis-
cussion, which is more than 100 years old (see Marneros
and Angst, 2000; Marneros and Tsuang, 1986). The
category ATPD (ICD-10 F23) is an attempt to integrate
some national concepts such as ‘cycloid psychosis’ in
Germany, ‘bouffe
´
ede
´
lirante’ in France, ‘psychogenic
psychosis’ in Scandinavia, ‘atypical psychosis’ in Japan,
and ‘remitting schizophrenia’ in the USA (Perris, 1986;
Pichot, 1986; Marneros et al., 2000, 2002a,b; Pillmann
et al., 2002). However, these so-called ‘‘national con-
cepts’’ (and consequently, also ATPD) had a lot of dif-
ficulties when it came to distinguishing themselves from
schizoaffective disorders (Marneros and Tsuang, 1986).
The existing difficulties are understandable because the
ATPD, as defined in ICD-10, show some symptoms
which are also very common in schizoaffective dis-
orders, especially the rapid changing mood status or
even the bipolarity of affectivity in some patients with
ATPD (Marneros et al., 2000, 2001a,b; Pillmann et al.,
2002). This gives rise to the question whether there is
any relation between them and the bipolar schizoaffec-
tive disorder. Finding the answer to this question is the
intention of this study.
2. Methods
2.1. Recruitment
In the first phase of a prospective follow-up study, we
identified all consecutive cases fulfilling ICD-10 criteria
of ATPD (F23) treated as inpatients at the Department
of Psychiatry and Psychotherapy at Martin Luther
0022-3956/02/$ - see front matter # 2002 Elsevier Science Ltd. All rights reserved.
PII: S0022-3956(01)00058-9
Journal of Psychiatric Research 36 (2002) 165–171
www.elsevier.com/locate/jpsychires
* Corresponding author. Tel.: +49-345-557-3651; fax: +49-345-
557-3607.
E-mail address: andreas.marneros@medizin.uni-halle.de
(A. Marneros).