Diagnostic Stability of Psychiatric Disorders in Re-Admitted Psychiatric Patients in Kerman, Iran

Abstract

Background:Several studies have evaluated the stability of psychiatric diagnosis follow in readmission of patients in psychiatric hospitals. However, there is little data concerning this matter from Iran. This study is designed to evaluate this diagnostic stability of the commonest psychiatric disorders in Iran.Objectives:The objective of this study was to determine the long-term diagnostic stability of the most prevalent psychiatric disorders among re-admitted patients at the Shahid Beheshti teaching hospital in Kerman, Iran.Patients and Methods:This study was based on 485 adult patients re-admitted at the Shahid Beheshti hospital between July and November 2012. All of the diagnoses were made according to DSM IV TR. Prospective and retrospective consistency and the ratio of patients who were obtained a diagnosis in at least 75%, 100% of the admissions were calculated.Results:The most frequent diagnoses at the first admission were bipolar disorder (48.5%) and Major depressive disorder (18.8%). The most stable diagnosis was bipolar disorder (71% prospective consistency, 69.4% retrospective consistency). Schizoaffective disorder had the greatest diagnostic instability (28.5% prospective consistency, 16.6% retrospective consistency).Conclusions:Among the cases evaluated, bipolar disorder had the most stability in diagnosis and the stability of schizoaffective disorder was poor.

Diagnostic stability and outcome after first episode psychosis

“…The authors suggested that some individuals managed to access healthcare very early in their disease course, and that the full extent of their symptoms may not yet have manifested at initial interview (Fraguas et al, 2008). Alavi et al (2014) reported a similar pattern of findings in a cohort of first episode psychosis individuals in Iran, and theorised that many who change to diagnoses of schizophrenia after a different initial diagnoses do so due to clinician behaviour; a diagnosis of schizophrenia carries a significant stigma burden, even amongst healthcare professionals (Henderson et al, 2014), and the authors proposed that clinicians are likely to wish to assign non-schizophrenia diagnoses until they are certain of the illness course, giving rise to apparent diagnostic instability.…”

“…Whilst clinician behaviour and fear of stigma may play a role in some studies this is not likely a factor in this cohort (or in the vast majority of other studies of diagnostic instability available in the literature) as diagnostic data used here is made by consensus of the research team and does not directly influence patient care. It is notable that some published studies reporting particularly high rates of diagnostic instability in first episode psychosis use clinical rather than research diagnoses (Alavi et al, 2014;Baca-Garcia et al, 2007).…”

Evaluation of the diagnostic continuity of unspecified mood disorder

“…Various studies found a diagnostic continuity for bipolar disorder between 49 and 93.5% (5,7,9,13,15) and for major depressive disorder of 44-84.8% (5,9,16,21,22). A study observing long-term change in the most common psychiatric diagnoses evaluated the diagnoses of 485 patients (13). At first consultation, the most frequent diagnoses were bipolar disorder (48.5%) and major depressive disorder (18.8%), (14).…”

“…The ICD-10 uses the term "unspecified mood disorder" (code 'F39') as a last resort in cases considered to be mood disorders where no other diagnosis can be applied (12). After a follow-up of 4 years, for schizophrenia and bipolar disorder according to ICD-10 and DSM-IV a diagnostic stability of 80-100% has been established (13)(14)(15)(16)(17). For mood disorders, a study following 10,016 outpatients found a retrospective diagnostic stability of 55.6% (9).…”