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disability payments were granted at a mean age of 50.2 years in 1999. According to
the official statistics, the age when disability payments were granted for affective,
schizophrenic, and other psychotic disorders, was 7.2 years (males) and 14.2 years
(females) earlier than the mean age of 50.2 years. Therefore, schizoaffective
patients and affective patients having mixed episodes were younger when their
disability payments were granted than the controls (Fig. 8.9).


Conclusions
In spite of existing definitions and criteria for mixed schizoaffective episodes in
both ICD-10 and DSM-IV, very little work on the topic has been carried out. The
main reason is the uncertainty of how to define schizoaffective disorders and a
still-ongoing evolution of their concepts. Perhaps another difficulty is the exact
estimation of a very complicated symptomatology with schizophrenic, depressive,
and manic components during a schizoaffective mixed episode. Nevertheless, the
findings, both from the Cologne study and from the HABILOS, show that at a rate
of more than 30%, the frequency of schizoaffective mixed episodes is high and
equivalent to that in pure affective disorders.

Schizophrenia spectrum




)
um
(bi




pe se
Bip lar




e s ur
ctr
po
ola spe




siv ar co
r c ctru
ou




pr pol
rse m)




(de Uni
es




Adjustable homeostasis of affectivity

Fig. 8.10 The affective continuum.
203 Schizoaffective mixed states


There are many similarities between schizoaffective and affective mixed epi-
sodes, but also relevant differences: for example, there are no gender differences in
patients having schizoaffective mixed episodes “ perhaps a result of the impact of
the schizo-element. The age at onset is lower, the duration of schizoaffective mixed
episodes can be longer, and the patients having schizoaffective mixed episodes
exhibited more inability to work at a younger age.
These results support the assumption that not only are schizoaffective mixed
episodes frequent, but they also represent the most severe form of bipolar disorder
standing on the top of a continuum “ as we previously pointed out (Marneros,
1999, 2000), and as is illustrated in Figure 8.10.


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9


Acute and transient psychotic disorder:
an atypical bipolar disorder?
¨
Andreas Marneros, Frank Pillmann, Stephan Rottig,
¨
Andrea Wenzel, and Raffaela Bloink
Martin-Luther University Halle-Wittenberg, Halle, Germany




Introduction
Karl Kleist, the main creator of the concept of ˜˜cycloid psychoses,™™ wrote in 1928
that many of the cases allocated by Kraepelin into the group of ˜˜mixed states™™
would better be described as ˜˜cycloid psychoses.™™ In Kleist™s opinion, cycloid
psychoses are bipolar disorders, but do not belong to the category of manic-
depressive insanity (Kleist, 1928, 1953). Cycloid psychoses are the essential com-
ponent of what the World Health Organization (WHO, 1992) defined as ˜˜acute
and transient psychotic disorder (ATPD)™™ (ICD-10 F23). We investigated the
ATPD by carrying out the Halle Study on Brief and Acute Psychotic Disorder
(HASBAP), which is a longitudinal comparative study (Marneros et al., 2000,
2002; Pillmann et al., 2001; 2002a, b; Marneros and Pillmann, 2004). The HASBAP
compares patients with acute and transient psychotic disorders with patients
diagnosed as having schizophrenia or bipolar schizoaffective disorder, as well as
with a mentally healthy control group. In a further step, we now combine the
findings of HASBAP with the findings of the Halle Bipolarity Longitudinal Study
(HABILOS), already presented in Chapter 1. In this chapter, we longitudinally
compare patients diagnosed as having ATPD from the HASBAP with patients
diagnosed as having affective or schizoaffective mixed states belonging to the
HABILOS group.



Definitions of acute and transient psychotic disorders
As ATPD (ICD-10 F23), the WHO defines psychotic states having an acute or
abrupt onset, usually a good prognosis, and typical symptoms. They may or may
not be associated with acute stress (Table 9.1).

Cambridge University Press, 2005.
#
208 A. Marneros et al.



Table 9.1 ˜˜Acute and transient psychotic disorders™™ according to ICD-10 (F23: World Health
Organization, 1992)

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