Eur Arch Psychiatry Clin Neurosci (2003) 253 : 209 –215 DOI 10.1007/s00406-003-0435-4 ■ Abstract Objective The aim of the present study was to investigate course and outcome of acute and transient psychotic disorders (ATPD). Method A sample of 73 first-hospitalized patients was evaluated after three to seven years in order to determine the frequency of re- lapses and to assess social adjustment. Result Forty-two percent experienced no relapse, 46 % experienced re- lapses without developing marked deficits in social ad- justment and 12 % had relapses associated with a severe social impairment. At discharge from first hospitaliza- tion the last group was distinguishable from the other two with respect to negative and depressive symptoms as well as the total score of the Strauss-Carpenter scale. Conclusion Only a minority of first-hospitalized pa- tients with ATPD develop a severe social impairment af- ter three to seven years. This subgroup, however, is not compatible with the concept of a “transient” psychotic disturbance, but rather with an early manifestation of a chronic schizophrenic disorder. ■ Key words acute and transient psychotic disorders · ICD-10 · diagnoses · validity · follow-up Introduction The category of acute and transient psychotic disorders (ATPD) was introduced in 1992 with the 10 th revision of the International Classification of Diseases (ICD-10) (WHO 1992). ATPD replaced the category of “other nonorganic psychoses” in ICD-9 (WHO 1977), which was derived from the Scandinavian concept of reactive psychoses (Strömgren 1987; Wimmer 1916). However, following a descriptive approach, ICD-10 has given only low priority to the presence of psychosocial stressors for the diagnosis of ATPD. Instead, the defining features of ATPD are an acute onset of psychotic symptoms within two weeks and a full recovery within one to three months. A depressive, manic or mixed affective episode has to be excluded. The presence of preceding stressors is not decisive, but if present may be coded additionally. Depending on the clinical picture the category of ATPD is divided into several subgroups: acute polymorphic psychotic disorder without and with symptoms of schiz- ophrenia (F23.0 and F23.1, respectively), acute schizo- phrenia-like psychotic disorders (F23.2), other acute predominantly delusional psychotic disorders (F23.3) and other or non-specific acute and transient psychotic disorders (F23.8 and F23.9, respectively). The polymor- phic subtypes, which are derived from the description of cycloid psychosis (Leonhard 1957; Perris 1974) and bouffee delirante (Mangan 1893; Pichot 1986), are char- acterized by rapidly changing symptoms, emotional tur- moil, ecstasy, overwhelming anxiety, marked irritability, perplexity or misidentification of people or places. In contrast to the traditional concepts of reactive psy- choses, cycloid psychoses and bouffee delirante, the cross-sectional delimitation of ATPD from schizophre- nia and delusional disorders in the ICD-10 results nei- ther from a specific clinical picture nor from the rela- tionship to precipitating stressors, but from the mode of onset and the duration of psychotic symptoms. ATPD is a common psychiatric diagnosis in Europe (Healy et al. 2001; Lange et al. 2002) as well as in devel- oping countries (Okasha et al. 1993). In recent years there has been an increasing interest in ATPD (Jor- genson et al. 1997; Marneros et al. 2002; Pillmann et al. 2001, 2002; Sajith et al. 2002). However, to date, little is known about the diagnostic validity of ATPD. Following the model of Robins and Guze (1970), diagnostic valid- ity can be examined with respect to the cross-sectional clinical picture, biological variables, family history as well as course and outcome, whereby the present study focuses on the last two topics. The historical predeces- ORIGINAL PAPER Markus Jäger · Marcus Hintermayr · Ronald Bottlender · Anton Strauss · Hans-Jürgen Möller Course and outcome of first-admitted patients with acute and transient psychotic disorders (ICD-10:F23) Focus on relapses and social adjustment Received: 10 June 2003 / Accepted: 11 June 2003 EAPCN 435 M. Jäger, M. D. () · M. Hintermayr · R. Bottlender · A. Strauss · H.-J. Möller Psychiatrische Klinik der Ludwig-Maximilians-Universität Nussbaumstr. 7 80336 Munich, Germany Tel.: +49-89/5160-2773 Fax: +49-89/5160-4749 E-Mail: markus.jaeger@psy.med.uni-muenchen.de