Diagnostic stability in a Dutch psychosis incidence cohort

Veen, Natalie D.; Selten, Jean‐Paul; Schols, Diede; Laan, Winfried; Hoek, Hans W.; Tweel, Ingeborg van der; Kahn, René S.

doi:10.1192/bjp.185.6.460

Cited by 65 publications

(56 citation statements)

References 17 publications

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“…10 Veen et al looked at diagnostic stability of psychotic disorders and found it to be as high as 91%. 11 Both these figures are considerably higher than in our study sample and consequently do not explain the changes that we have noticed.…”

Section: Discussioncontrasting

confidence: 50%

Changes in diagnoses before admission to a specialist medium secure unit

2012

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Aims and methodThere is evidence that changing diagnoses may be an important factor preceding homicide, but there is little literature on diagnostic antecedents to admission to specialist secure units after violent behaviour. Our aim was to establish the frequency of a history of changing diagnoses in patients in a UK specialist unit, and to explore the characteristics of these patients.ResultsIn total, 38 of 42 study participants had prior contact with psychiatric services. Just over 40% (16 of the 38) had had their diagnosis changed three or more times. All those who had major changes in their diagnosis had received a diagnosis of a psychotic illness at some point prior to the secure unit admission, but then had it withdrawn, only to be restored after prolonged assessment in the secure unit. Personality disorder and substance misuse comorbidity was common in this group; however, non-psychotic diagnoses were seen as more important than psychotic diagnoses by general services.Clinical implicationsChanges in diagnosis between first presentation to psychiatric services and admission to a medium-security unit were more common than would be expected from reports in the general literature. They are a testimony to the difficulties experienced by service providers in delivering a consistent service. This needs to be studied further.

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Section: Discussioncontrasting

confidence: 50%

Changes in diagnoses before admission to a specialist medium secure unit

2012

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“…Although, delusional disorder or psychosis NOS is sometimes included in schizophrenia spectrum psychosis (e.g., Franzek and Beckmann, 1998), a smaller proportion of patients in these categories maintain the same diagnosis at follow-up evaluations. Whereas, the schizophrenia spectrum diagnosis restricted to schizophrenia, schizophreniform and schizoaffective disorder has average rates of consistency of 90% (Schwartz et al, 2000;Veen et al, 2004), psychosis NOS is associated with approximately 45 to 50% consistency (Schwartz et al, 2000;Schimmelmann et al, 2005) and delusional disorder with more varying rates (e.g., about 67% in Schwartz et al, 2000;about 87% in Schimmelmann et al, 2005). We thus decided to exclude these two last categories from our group of patients with a first episode of schizophrenia spectrum psychosis (FEP-S).…”

Section: Participantsmentioning

confidence: 99%

P300 asymmetry and positive symptom severity: A study in the early stage of a first episode of psychosis

Renoult

Prévost

Brodeur

et al. 2007

Schizophrenia Research

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The amplitude of the P300 event-related potential (ERP) has been reported to be reduced over left compared to right temporal sites in schizophrenia patients. This left temporal P300 reduction has been associated with positive symptom severity and gray matter reduction in the left superior temporal gyrus. We investigated a group of patients with a first episode of schizophrenia spectrum psychosis and a group of normal controls to verify if P300 amplitude asymmetry already exists around the time of presentation for treatment. Relative to normal control subjects, no P300 asymmetry was found in patients. Nevertheless, P300 asymmetry was correlated with the severity of positive symptoms and worse global functioning (GAF), a good predictor of poor outcome.

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“…Studies elsewhere have mostly assessed longterm diagnostic stability over months or years 2,4,6,8,9,13 , and a majority have concentrated on a single diagnostic category such as schizophrenia, major depressive disorder or bipolar disorder. 1,3,5,11,[14][15][16][17][18][19][20][21][22][23][24][25][26] This present study set out to assess diagnostic stability in a resource-poor setting, and the findings indicate that the rate of short-term diagnostic stability is surprisingly low (72.8%) despite the fact that the assessments were often carried out within a few days of each other. The average time between admission and discharge at the MTRH was 35 days, meaning that the admission and discharge assessments were carried out just over one month apart on average.…”

Section: Discussionmentioning

confidence: 99%

“…Veen et al reported that schizophrenic disorders are likely to be under-diagnosed at first presentation compared to other diagnoses. 11 Most of the studies on diagnostic stability have been carried out in Western settings, and there is very little literature from Africa and other low-income regions on this topic. This study therefore set out to determine the diagnostic stability of various psychiatric diagnoses among re-admitted patients using prospective and retrospective consistency as measures of stability.…”

Section: Introductionmentioning

confidence: 99%

Short-term diagnostic stability among re-admitted psychiatric in-patients in Eldoret, Kenya

et al. 2012

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Objective: To determine the prospective and retrospective consistency of diagnoses among readmitted psychiatric in-patients at the Moi Teaching and Referral Hospital in Eldoret, Kenya. Method: Admission and discharge diagnoses among a consecutive sample of 114 psychiatric in-patients readmitted at the Moi Teaching and Referral Hospital between August and December 2009 were compared. Results:The commonest diagnoses at admission were schizophrenia spectrum disorders (47.4%) and bipolar spectrum disorders (30.7%). Overall diagnostic stability as measured by prospective consistency in this study was 72.8%.The most stable diagnostic category was Major Depressive Disorder (100% prospective and retrospective consistency), followed by Bipolar Disorders (91.4% prospective consistency, 69.6% retrospective consistency) and Substance-related disorders (87.5% prospective consistency, 50% retrospective consistency). Schizophrenia-spectrum disorders had a prospective consistency of 75.9% and a retrospective consistency of 87.2%. 'Other Psychotic Disorders' (acute psychotic episode and psychotic disorder not otherwise specified) had the lowest diagnostic stability, with both prospective and retrospective consistency being 0%. Conclusion: Mood disorders and substance-related disorders have the highest diagnostic stability among readmitted psychiatric inpatients in a low-income country.

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Diagnostic stability in a Dutch psychosis incidence cohort

Abstract: Schizophrenic disorders are underdiagnosed, rather than overdiagnosed, at first presentation.

Cited by 65 publications

References 17 publications

Changes in diagnoses before admission to a specialist medium secure unit

Changes in diagnoses before admission to a specialist medium secure unit

P300 asymmetry and positive symptom severity: A study in the early stage of a first episode of psychosis

Short-term diagnostic stability among re-admitted psychiatric in-patients in Eldoret, Kenya

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