COMPARISON OF THE PROFILE OF PATIENTS WITH ACUTE AND TRANSIENT PYSCHOTIC DISORDER AND SCHIZOPHRENIA SEEN AT THE UNIVERSITY COLLEGE HOSPITAL, IBADAN, NIGERIA (2006-2010)

Abstract

Acute and transient psychotic disorders (ATPD) are disorders from schizophrenia. However very little research has been done on this disorder in low income countries where the magnitude is as much as ten times the incidence in the developed countries. A study that would identify characterize the sociodemographic and clinical differences between the two disorders would fill some of the gaps in knowledge about the disorders. To achieve the aforementioned objectives, a retrospective review of the records of patients with ATPD and schizophrenia was done. Sociodemographic and clinical data of all bew patients with an untreated first episode of ATPD seen at the University College Hospital Ibadan between the first of January 2006 and 31st of December 2010 were extracted using a pro forma. Information collected included age at first episode, sex, marital status at presentation, employment status, family history of mental illness and psychopathology at presentation. During the five year period, 2604 new patients aged between 18 and 63 years were seen at the Psychiatry clinic. There were 706 subjectswith schizophrenia and 208 subjects with ATPD representing 27.2% and 8.0% (Proportional morbidity rate) of all the cases seen respectively. Of these, 243 subjects with Schizophrenia and 124 subjects with ATPD met the inclusion criteria and were recruited into the study. Patients with ATPD 146.8% were more likely to present below the age of 25years compared to patients with schizophrenia (30%) (P<0.01). Excitement was more common in ATPD (17.2%) compared to schizophrenia (1.2%) (P<0.01), suspiciousness was more common in subjects with schizophrenia (20.2%) compared to ATPD (6.5%) (P<0.01). The presence of negative symptoms especially blunted affect (18.5% vs 4.0% P<0.01), emotional withdrawal (10.7% vs 0.8% P<0.01) passive social withdrawal (26.3% vs 3.2% P<0.01) were highly suggestive of schizophrenia rather than ATPD. Also the presence of anxienty (35.5% vs 22.6%, P<0.01) and uncooperativeness (14.5% vs 7.0% P=0.02) were significantly more likely to be ATPD than schizophrenia. Poor orientation (32.9% vs 18.5% P 0.01) were more common in Schizophrenia. Mean age of onset was similar between patients with Schizophrenia and ATPD (29.3 vs 29.5 years P-0.2). According to religion, presence of the symptoms of delusions, hallucinatory behaviour, conceptual disorganisation, gradiosity, hostility, somatic concern, tension, depression, active social withdrawal and poor impulse control. Differences which may be important in differentiating between the two included the observation that ATPD were more likely to present below 25 years compared to Schizophrenia, exictement as a symtom was more common in ATPD. The presence of anxiety and uncooperativeness were more suggestive of ATPD than schizophrenia. Suspiciousness was more common in Schizophrenia compared to ATPD. The presence of negative symptoms especially blunted affect, emotional withdrawal and passive social withdrawal was significantly more common in schizophrenia. Poor orientation, disturbance of volition, and preoccupation were more common in schizophrenia than ATPD.