Skip to main content Accessibility help

Family psychiatric morbidity of acute and transient psychotic disorders and their relationship to schizophrenia and bipolar disorder

  • A. C. Castagnini (a1), T. M. Laursen (a2), P. B. Mortensen (a2) and A. Bertelsen (a1)



Although transient psychotic disorders are currently classified as a category separate from schizophrenia (SZ) and affective disorders, their distinctive features remain uncertain. This study examines the family psychiatric morbidity of the ICD-10 category of ‘acute and transient psychotic disorders’ (ATPDs), pointing out differences from SZ and bipolar disorder (BD).


From a cohort of 2.5 million persons, we identified all patients enrolled in the Danish Psychiatric Register who were ever admitted with ATPDs (n=2537), SZ (n = 10639) and BD disorder (n=5292) between 1996 and 2008. The relative risk (RR) of ATPDs, SZ and BD associated with psychiatric morbidity in first-degree relatives (FDRs) was calculated as the incidence rate ratio using Poisson regression.


The RR of ATPDs [1.93, 95% confidence interval (CI) 1.76–2.11] was higher if patients with ATPDs had at least one FDR admitted with any mental disorder than patients without family psychiatric antecedents. An additional risk arose if they had FDRs admitted not only with ATPDs (RR 1.60, 95% CI 1.33–1.92) but also with SZ (RR 2.06, 95% CI 1.70–2.50) and/or BD (RR 1.55, 95% CI 1.23–1.96). Despite some overlap, the risk of SZ (RR 2.80, 95% CI 2.58–3.04) and BD (RR 3.68, 95% CI 3.29–4.12) was markedly higher if patients with SZ and BD had FDRs admitted with the same condition.


These findings suggest that family psychiatric predisposition has a relatively modest impact on ATPDs and argue against a sharp differentiation of ATPDs from SZ and BD.


Corresponding author

*Address for correspondence: Dr A. C. Castagnini, Centre for Psychiatric Research, Aarhus University Hospital, Skovagervej 2, 8240 Risskov, Denmark. (Email:


Hide All
Aadamsoo, K, Saluveer, E, Küünarpuu, H, Vasar, V, Maron, E (2011). Diagnostic stability over 2 years in patients with acute and transient psychotic disorders. Nordic Journal of Psychiatry 65, 381388.
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV). American Psychiatric Association: Washington, DC.
Bruzzi, P, Green, SB, Byar, DP, Brinton, LA, Schairer, C (1985). Estimating the population attributable risk for multiple risk factors using case-control data. American Journal of Epidemiology 122, 904914.
Castagnini, A (2010). Wimmer's concept of psychogenic psychosis revised. History of Psychiatry 21, 5466.
Castagnini, A, Berrios, GE (2011). Acute transient psychoses and their differentiation from schizophrenia. Current Psychiatry Reviews 7, 248255.
Castagnini, A, Foldager, L, Bertelsen, A (2013). Long-term stability of acute and transient psychotic disorders. Australian and New Zealand Journal of Psychiatry 47, 5964.
Chang, WC, Pang, SLK, Chung, DWS, Chan, SSM (2009). Five-year stability of ICD-10 diagnoses among Chinese patients presented with first-episode psychosis in Hong-Kong. Schizophrenia Research 115, 351357.
Cooper, JE, Jablensky, A, Sartorius, N (1999). WHO collaborative studies on acute psychoses using the SCAAPS schedule. In Psychiatry: A World Perspective (ed. Stefanis, C.S., Rabavilas, A.D. and Soldatos, C.R.), vol. 1, pp. 185192. Excerpta Medica: Amsterdam.
Das, SK, Malhotra, S, Basu, D (1999). Family study of acute and transient psychotic disorders: comparison with schizophrenia. Social Psychiatry and Psychiatric Epidemiology 34, 328332.
Das, SK, Malhotra, S, Basu, D, Malhotra, R (2001). Testing the stress-vulnerability hypothesis in ICD-10-diagnosed acute and transient psychotic disorders. Acta Psychiatrica Scandinavica 104, 5658.
Gaebel, W (2012). Status of psychotic disorders in ICD-11. Schizophrenia Bulletin 38, 895898.
Gershon, ES, Alliey-Rodriguez, N, Liu, C (2011). After GWAS: searching for genetic risk for schizophrenia and bipolar disorder. American Journal of Psychiatry 168, 253256.
Gottesman, II, Laursen, TM, Bertelsen, A, Mortensen, PB (2010). Severe mental disorders in offspring with 2 psychiatrically ill parents. Archives of General Psychiatry 67, 252257.
Jäger, M, Bottlender, R, Strauss, A, Möller, HJ (2003). On the descriptive validity of ICD-10 schizophrenia: empirical analyses in the spectrum of non-affective functional psychoses. Psychopathology 36, 152159.
Jakobsen, KD, Frederiksen, JN, Hansen, T, Jansson, LB, Parnas, J, Werge, T (2005). Reliability of clinical ICD-10 schizophrenia diagnosis. Nordic Journal of Psychiatry 59, 209212.
Jørgensen, P, Bennedsen, B, Christensen, J, Hyllested, A (1997). Acute and transient psychotic disorder: a 1-year follow-up study. Acta Psychiatrica Scandinavica 96, 150154.
Kessing, LV (1998). A comparison of ICD-8 and ICD-10 diagnoses of affective disorder: a case register-based study from Denmark. European Psychiatry 13, 342345.
Kleist, K (1928). Über zykloide und epileptoide Psychosen und über die Frage der Degenerationspsychosen. Schweizer Archives für Neurologie und Psychiatrie 23, 337 (translation by G. Marshall. Cycloid, paranoid and epileptoid psychoses and the problem of degenerative psychoses. In: Themes and Variations in European Psychiatry (ed. R. S. Hirsh and M. Shepherd), pp. 297-331. Wright: Bristol, 1974.
Kraepelin, E (1896). Psychiatry [in German]. Barth: Leipzig.
Laird, N, Olivier, D (1981). Covariance analysis of censored survival data using log-linear analysis techniques. Journal of the American Statistical Association 76, 231240.
Langfeldt, G (1939). The Schizophreniform States. Munksgaard: Copenhagen.
Laursen, TM, Labouriau, R, Licht, RW, Bertelsen, A, Munk-Olsen, T, Mortensen, PB (2005). Family history of psychiatric illness as a risk factor for schizoaffective disorder: a Danish register-based cohort study. Archives of General Psychiatry 62, 841848.
Leonhard, K (1999). Classification of Endogenous Psychoses and their Differentiated Etiology (ed. Beckmann, H.). Springer: Wien.
Lichtenstein, P, Yip, BH, Björk, C, Pawitan, Y, Cannon, TD, Sullivan, PF, Hultman, CM (2009). Common genetic determinants of schizophrenia and bipolar disorder in Swedish families: a population-based study. Lancet 373, 234239.
Linden, SC, Harris, M, Whitaker, C, Healy, D (2009). Religion and psychosis: the effect of the Welsh religious revival in 1904–1905. Psychological Medicine 40, 13171323.
Magnan, V (1887). Leçon Cliniques sur les Maladies Mentales. Delahaye & Lecrosnier: Paris.
Mojtabai, R, Varma, VK, Susser, E (2000). Duration of remitting psychoses with acute onset. Implications for ICD-10. British Journal of Psychiatry 176, 576580.
Mors, O, Perto, PG, Mortensen, PB (2011). The Danish Psychiatric Central Research Register. Scandinavian Journal of Public Health 39 (Suppl. 7), 5457.
Nugent, KL, Paksarian, D, Mojtabai, R (2011). Nonaffective acute remitting psychoses: uncertainties on the way to DSM-V and ICD-11. Current Psychiatry Reports 13, 203210.
Owen, MJ, O'Donovan, MC, Thapar, A, Craddock, N (2011). Neurodevelopmental hypothesis of schizophrenia. British Journal of Psychiatry 198, 173175.
Perdersen, CB, Gotzsche, H, Moller, JO, Mortensen, PB (2006). The Danish Civil Registration System. A cohort of eight million persons. Danish Medical Bulletin 53, 441449.
Pillmann, F, Marneros, A (2005). Longitudinal follow-up in acute and transient psychotic disorders and schizophrenia. British Journal of Psychiatry 187, 286287.
Salvatore, P, Baldessarini, RJ, Tohen, M, Khalsa, HMK, Sanchez-Toledo, JP, Zarate, CA Jr., Vieta, E, Maggini, C (2011). McLean-Harvard International First-Episode Project: two-year stability of ICD-10 diagnoses in 500 first-episode psychotic disorder patients. Journal of Clinical Psychiatry 72, 183193.
Sartorius, N, Üstun, TB, Korten, A, Cooper, JE, van Drimmelen, J (1995). Progress toward achieving a common language in psychiatry, II: Results from the international field trials of the ICD-10 Diagnostic Criteria for Research for mental and behavioural disorders. American Journal of Psychiatry 152, 14271437.
Singh, SP, Burns, T, Amin, S, Jones, PB, Harrison, G (2004). Acute and transient psychotic disorders: precursors, epidemiology, course and outcome. British Journal of Psychiatry 185, 452459.
Susser, E, Wanderling, J (1994). Epidemiology of nonaffective acute remitting psychosis vs schizophrenia. Sex and sociocultural setting. Archives of General Psychiatry 51, 294301.
van Os, J, Kenis, G, Rutten, BPF (2010). The environment and schizophrenia. Nature 486, 203212.
WHO (1971). Classification of Diseases: Extended Danish-Latin version of the World Health Organization International Classification of Diseases, 8th revision, 1965. Danish National Board of Health: Copenhagen.
WHO (1992). The ICD-10 Classification of Mental and Behavioural Disorders. Clinical Descriptions and Diagnostic Guidelines. World Health Organization: Geneva.
Wimmer, A (1916). Psychogenic psychoses [in Danish]. In St Hans Hospital 1816–1915 Jubilaeums skrift, pp. 85216. Gad: Københaven (ed. and transl. J.Schioldann). Adelaide Academic Press: Adelaide, 2003.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed