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Objective: ICD-10 acute and transient psychotic disorder (ATPD; F23) has one of its historical roots in the French concept of bouffée délirante. This study explores the empirical relationship of the two concepts. Method: During a 5-year period, all inpatients with ATPD were identified; the diagnosis of bouffée délirante was also determined. We systematically evaluated demographic and clinical features and carried out follow-up investigations at an average of 2.2 years after the index episode using standardized instruments. Results: Forty-two (4.1%) of 1036 patients treated for psychotic disorders or major affective episode fulfilled the ICD-10 criteria of ATPD. Of these, only 28.6% also fulfilled the criteria of bouffée délirante. Patients with bouffée délirante were significantly younger than the remaining ATPD patients. Outcome parameters were generally more favourable for patients diagnosed with bouffée délirante than for ATPD patients without a concurrent diagnosis of bouffée délirante, but the difference was statistically significant only for occupational status. Conclusions: There are indications that a diagnosis of bouffée délirante carries a somewhat better prognosis than ATPD in general. However, the low frequency of operationally diagnosed bouffée délirante suggests that the criteria might be too narrow. [ABSTRACT FROM AUTHOR]

Objective: This study explores psychopathological aspects of acute and transient psychotic disorders (ATPD), a diagnostic category introduced with ICD-10, to elucidate its relationship with schizophrenia and schizoaffective psychoses., Methods: We recruited all consecutive inpatients fulfilling the ICD-10 criteria of ATPD (F23) during a 5-year period as well as control groups with "positive" schizophrenia (PS) and bipolar schizoaffective disorder (BSAD) matched for gender and age at index episode. For the evaluation of psychopathological parameters during index episode a standardized symptom list was used. Prepsychotic (prodromal) symptoms were also assessed., Results: During the prepsychotic period few differences between the groups were detected. The most important difference between ATPD and the other two other psychotic disorders regarding phenomenology of the full-blown episodes was a higher frequency of "rapidly changing delusional topics", "rapidly changing mood" and anxiety in ATPD., Conclusion: ATPD show a characteristic psychopathological picture consistent with earlier concepts such as cycloid psychoses and bouffée délirante. Nevertheless, psychopathology alone is not enough to establish ATPD as an independent nosological entity.

Background: The purpose of the study was to evaluate the psychometric properties of the German version of the TEMPS-A questionnaire. Besides the reliability of the temperament scales, validity was the focus of interest. Therefore, the relationship between the TEMPS-A and the well-established personality questionnaire NEO-FFI, whose factors show theoretical overlap with temperaments, was investigated., Method: A total of 227 students aged between 20 and 42 years were asked to fill in both instruments. Reliability coefficients for the five temperament scales and correlations among the scales of both questionnaires were calculated, as well as multiple linear regression analysis with the five personality factors and gender as independent, and the five temperaments as dependent variables., Results: Reliability indices for the five temperament scales were satisfactory, with values ranging between 0.63 (depressive) and 0.76 (anxious). Women scored higher on depressive and anxious scales, whereas men had higher scores on hyperthymic temperament. Correlations within the temperament scales showed close relationships between depressive, anxious and cyclothymic temperaments; cyclothymic and irritable temperament were also related. The personality factors of the NEO-FFI predicted temperaments fairly well and explained between 41% and 58% of the variance; the main effects were exerted by neuroticism and extraversion, while the irritable temperament was primarily explained by low agreeableness., Limitation: The study sample was relatively small and selected., Conclusion: The TEMPS-A scale has sufficient reliability and good validity in a non-clinical sample. It opens new possibilities for clinical research at the interface of mental disorders, temperament and personality. Such research is in progress.

Objective: Little is known concerning the frequency of disability payments due to depressive and bipolar affective disorders in Germany., Method: 177 consecutive psychiatric in-patients were assessed with standardized interviews concerning diagnosis (SCID-I, DSM-IV) and illness history. To compare unipolar depressive and bipolar affective patients, a survival analysis was calculated., Results: 116 patients suffered from unipolar depression, 61 from bipolar affective disorder. Highly significantly, patients with bipolar affective disorders were granted disability payments more frequently and at an earlier age. Half of the bipolar affective patients received disability payments by the age of 46 years, half of the unipolar depressive patients by the age of 58 years., Conclusions: In this sample, bipolar affective patients received disability payments frequently and at an early age, which stresses that the prognosis of bipolar affective disorders is not as good as has been assumed for a long time. Early disability payments may lead to poverty and may obstruct access to social rehabilitation.

Although both DSM-IV and ICD-10 define schizoaffective mixed states, they have not received much attention-neither in the clinical nor in research context. We present preliminary results of a prospective study of bipolar affective (n = 100) and bipolar schizoaffective (n = 177) patients. 25% of the bipolar affective and 32% of the bipolar schizoaffective patients had at least one (schizo)mixed episode during the illness course. Nevertheless, (schizo)mixed episodes were rare-only 5.6% of all episodes. There was a trend that patients with (schizo)mixed episodes were more often women and exhibited more disability (reflected by higher rates of disability payments). Nevertheless, these differences failed to reach significance. Overall, schizo-mixed episodes are as frequent as "pure" affective mixed episodes. They might be linked to a less favourable course. Nevertheless, while their diagnostic criteria are problematic, they are systematically underdiagnosed.

Although a particularly vulnerable personality has been postulated by some authors as a pathogenetic factor in acute and transient psychotic disorders (ATPD) as introduced with ICD-10, little empirical work has been done on the subject. We therefore evaluated personality features and social interactions in a comparative study of patients with ATPD. We recruited all consecutive inpatients fulfilling the ICD-10 criteria of ATPD (F23) during a 5-year period, as well as control groups with "positive" schizophrenia (PS) and bipolar schizoaffective disorder (BSAD) matched for gender and age at index episode. For assessment of personality features and premorbid social contacts, we administered the NEO Five-Factor Inventory and a semi-structured interview. The assessment of the "Big Five" personality dimensions (neuroticism, extraversion, openness to experience, agreeableness, conscientiousness) with the NEO-FFI did not show any significant difference between ATPD patients and healthy controls. BSAD patients differed from mentally healthy controls on 2 of 5 subscales of the NEO-FFI (neuroticism, extraversion), but were otherwise indiscernible from ATPD patients and mentally healthy controls. In contrast, PS patients showed the most pronounced differences from the mentally healthy controls on the NEO-FFI, and had significantly less premorbid social interaction than the clinical controls. Within the limits of retrospective assessment, the present findings indicate that (1) patients with ATPD do not share the premorbid social impairment characteristic of schizophrenic patients and (2) the personality of patients with ATPD does not differ substantially from the general population.

The aim of the study was to investigate the frequency and characteristics of suicidal behavior in a cohort of patients with acute transient psychotic disorder (ATPD), diagnosed according to ICD-10 (F23). In a longitudinal study, 42 patients fulfilling the ICD-10 criteria of ATPD were investigated in comparison to matched control groups with 'positive schizophrenia' (PS) and bipolar schizoaffective disorder (BSAD). Suicidal behavior was studied in the index episode and during the long-term course, including a 5-year prospective follow-up. The prevalence of suicidal behavior during the entire course of illness in ATPD was 35.7% compared to 57.1% in BSAD and 40.5% in PS. The difference was not significant when the duration of the illness was taken into account. Suicidal behavior in ATPD was associated with the acute episode, while in PS, suicidal behavior mainly occurred during the longitudinal course. In logistic regression models, suicidal behavior was associated with a higher educational level and lower conscientiousness in the NEO Five-Factor Inventory for patients with PS, but not ATPD. Suicidal behavior in ATPD is frequent, in particular during the acute episode. It seems to be associated with the dramatic psychotic symptomatology during the acute episode.

Background: Temperament is an important factor in affective illness. There is some indication that mixed episodes result from an admixture of inverse temperamental factors (e.g. depressive and/or anxious) to a manic syndrome. To test this hypothesis, which has been first formulated by Akiskal [Clin. Neuropharmacol. 15 (Suppl. 1A) (1992) 632-633], we compared the temperament of non-acute bipolar affective patients with and without the history of a previous mixed episode., Methods: Patients who had been hospitalized for a bipolar disorder were re-assessed at least 6 months after their last in-patient treatment. Those who met the criteria for a partially remitted or full affective or psychotic episode at re-assessment were excluded from the study. Data concerning illness history, current psychopathology (SCID-I interview), depression (BDI), mania (Self-Report Manic Inventory) and temperament (TEMPS-A scale) were obtained. Patients with and without a history of previous mixed episodes were compared., Results: Of 49 eligible former patients, 22 subjects with and 23 subjects without a former mixed episode in bipolar affective disorder fulfilled the inclusion criteria. Subjects suffering from bipolar affective disorder exhibited significantly more depressive and anxious and less hyperthymic temperament, if they had experienced a mixed episode previously. Concerning cyclothymic and irritable temperament, bipolar affective patients with a former mixed episode presented non-significantly higher scores. Patients with a former mixed episode presented with higher depression scores than patients without such a history. No group differences were found concerning current mania scores., Limitations: (1). This is a preliminary report from an ongoing study. (2). Temperament had not been assessed premorbidly. (3). Although group comparisons revealed significant differences, these did not seem great enough to fully explain the emergence of a mixed episode., Conclusion: Our findings support the study's hypothesis that mixed episodes occur more often in subjects with an inverse temperament (e.g. depressive and anxious), although it cannot be ruled out that subsyndromal features of the bipolar illness had an effect on temperament assessment.

Acute and transient psychotic disorder (ATPD) is supposed to differ from schizophrenia, but little research has been done on the subject. In a prospective longitudinal case control study we compared all inpatients with ATPD (ICD-10 F23) treated at Halle University Hospital during a 5-year period with matched controls with "positive" schizophrenia (PS) and with mentally healthy controls. Followup investigations were performed at a mean of 2.2 years after the index episode or 8.2 years after the first episode. Female preponderance in ATPD was marked (78.6%). ATPD and PS patients were similar to each other (but different from healthy controls) in the prevalence of a "broken home" situation and a family history for mental disorders. Compared with PS patients, ATPD patients showed better premorbid social adaptation, and they more often displayed rapidly changing symptoms in the index episode and a negative life event preceding the episode. Despite comparable relapse rates, at followup ATPD patients showed better social adaptation, less psychological impairment, and better global functioning than PS patients. These data support the delineation of ATPD from schizophrenia.

32 formerly monosyndromatic enuretic patients who had been treated for this condition between 1980 and 1992 were compared with a matched control group from the general population in respect of sociobiography, psychopathological and dimensional factors (depressiveness, satisfaction with life, global functioning). Most of the former patients did not fulfil diagnostic criteria for an ICD-10 diagnosis at follow-up, although there was a 37% vs. 9% difference between former patients and controls in this respect--without a clear diagnostic pattern of such disorders. Furthermore, former patients had slightly higher depression scores and slightly lower global functioning than controls at follow-up. These results confirm that childhood enuresis has a low negative predictive value concerning the development of psychiatric disorders, although it may constitute a vulnerability factor.