Acute and transient psychotic disorders: an overview of studies in Asia

Acute and transient psychotic disorders (ATPD), introduced in the International Classification of Diseases (ICD-10) diagnostic system, have not received much attention in Asia. As the World Health Organization (WHO) is in the process of revising the ICD-10 and ICD-11 is expected to be published in the near future, it seems appropriate to review the status of ATPD in this region. A PubMed search using appropriate keywords was conducted to identify literature describing samples from Asian countries with the diagnosis of ATPD for evidence of ATPD as a distinct diagnostic group. A total of 103 papers were found, but only nine publications were specifically related to ATPD and the ICD-10 criteria. The total number of patients receiving a diagnosis of ATPD in these studies was 390. Immigrants appear prone to ATPD, especially foreign domestic workers. When compared to schizophrenia, ATPD as a group had a different family history, course and outcome. However, ATPD was diagnostically unstable over time. A range of 35.5% to 73.3% in Asian patients with baseline ATPD retained their diagnoses over 3-12 years. Most individuals with polymorphic subtypes of ATPD in India and Hong Kong were rediagnosed with bipolar disorder after 3-5 years. In Japan, 31.2% of polymorphic cases were diagnosed as schizophrenia after 12 years of follow-up. This review supports the ICD-10 concept of separating ATPD into its own group; however, polymorphic subtypes may need revision in ICD-11. Before firm suggestions are submitted to the WHO, further research and data review from other regions is necessary.