DSM-IV 단기정신병적장애와 ICD-10 급성일과성정신병적장애의 임상적 유사점과 차이점

Similarities and Differences between DSM-IV Brief Psychotic Disorder and ICD-10 Acute and Transient Psychotic Disorder

Time is the most important factor in defining the diagnostic concepts of DSM-IV brief psychotic disorder (BPD) and ICD-10 acute and transient psychotic disorder (ATPD). Time factor is more complicated in ICD-10 ATPD than in DSM-IV BPD because he first time factor in ICD-10 ATPD concerns the development of symptoms (acute onset within 2 weeks), and the second factor, the duration of an episode, depends on the subtypes of ICD-10 ATPD. For instance, the duration of an episode in acute polymorphic psychotic disorder (APPD) with symptoms of schizophrenia must not exceed I month, while APPD without symptoms of schizophrenia may occur forup to three months. Despite the differences with respect to time factor in DSM-IV BPD and ICD-10 ATPD, it is not necessary to consider them as separate diagnostic entitie because they are identical in almost all of the essential clinical parameters. The strict criterion of episode duration in DSM-IV BPD should therefore be reconsidered. The APPD within ICD-10 ATPD subtypes, which is very similar to both cycloid psychosis and bouff´ee d´elirante, has a significant diagnostic concordance with DSM-IV BPD, and can be distinguished more clearly from schizophrenia and bipolar schizoaffective disorder. In contrast, ASPD not only has similarities to schizophrenia but also to bipolar schizoaffective disorder. This means that ASPD could function as a bridge between one end of the psychotic continuum occupied by schizophrenia and the opposite end occupied by major affective disorder. Taking this into consideration, ICD-10 ATPD could be much more homogeneous if APPD was not combined with ASPD. On the other hand, the symptomatologic polymorphism carries the most relevant distinguishing power in differentiating the subtypes of ICD-10 ATPD, so the distinction of APPD with and without symptoms of schizophrenia is not needed.