Five-year diagnostic stability among adolescents in an inpatient psychiatric unit

Blázquez, Alicia; Ortiz, Ana G.; Castro‐Fornieles, Josefina; Morer, Àstrid; Baeza, Inmaculada; Martínez, Esteve; Lázaro, Luisa

doi:10.1016/j.comppsych.2018.11.011

Cited by 10 publications

(8 citation statements)

References 30 publications

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“…A small number of studies have investigated diagnostic stability in clinical child and adolescent populations [ 19 - 23 ]. These studies indicate that psychotic disorders typically have highest temporal stability, followed by internalising disorders, externalising disorders and personality disorders [ 20 , 22 , 23 ]. Overall, temporal reliability of diagnosis in clinical practice tends to be low.…”

Section: Introductionmentioning

confidence: 99%

“…These studies confirm diagnostic adjustments are common in clinical practice. However, the literature on diagnostic reliability in clinical contexts shows numerous limitations, with the few studies that exist relying on small ( n < 100) samples [ 20 , 22 , 24 ], recruiting participants from a single clinical (usually inpatient) setting [ 20 - 23 ], and/or exclusively focusing on one diagnostic class [ 19 , 24 - 26 ]. Finally, individual studies define and measure stability in different ways, usually in terms of prospective concordance, retrospective concordance or kappa coefficients.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic trajectories in child and adolescent mental health services: exploring the prevalence and patterns of diagnostic adjustments in an electronic mental health case register

O’Connor

Downs

Shetty

et al. 2019

Eur Child Adolesc Psychiatry

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Community-based epidemiological studies show transitions between psychiatric disorders are common during child development. However, little research has explored the prevalence or patterns of the diagnostic adjustments that occur in child and adolescent mental health services (CAMHS). Understanding diagnostic trajectories is necessary to inform theory development in developmental psychopathology and clinical judgements regarding risk and prognosis. In this study, data from CAMHS clinical records were extracted from a British mental health case register (N = 12,543). Analysis calculated the proportion of children whose clinical records showed a longitudinal diagnostic adjustment (i.e. addition of a subsequent diagnosis of a different diagnostic class, at > 30 days' distance from their first diagnosis). Regression analyses investigated typical diagnostic sequences and their relationships with socio-demographic variables, service use and standardised measures of mental health. Analysis found that 19.3% of CAMHS attendees had undergone a longitudinal diagnostic adjustment. Ethnicity, diagnostic class and symptom profiles significantly influenced the likelihood of a diagnostic adjustment. Affective and anxiety/ stress-related disorders longitudinally predicted each other, as did hyperkinetic and conduct disorders, and hyperkinetic and pervasive developmental disorders. Results suggest that approximately one in five young service users have their original psychiatric diagnosis revised or supplemented during their time in CAMHS. By revealing the most common diagnostic sequences, this study enables policy makers to anticipate future service needs and clinicians to make informed projections about their patients' likely trajectories. Further research is required to understand how young people experience diagnostic adjustments and their psychological and pragmatic implications.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diagnostic trajectories in child and adolescent mental health services: exploring the prevalence and patterns of diagnostic adjustments in an electronic mental health case register

O’Connor

Downs

Shetty

et al. 2019

Eur Child Adolesc Psychiatry

View full text Add to dashboard Cite

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“…One focus for criticism of prevailing systems of psychiatric diagnosis is diagnostic categories' poor temporal and inter-rater reliability (Freedman et al, 2013). Epidemiological and clinical studies show this problem is particularly acute in childhood diagnoses (Blázquez et al, 2019;Copeland et al, 2013;Costello et al, 2003;Ford et al, 2017;O'Connor, Downs, et al, 2019;Pettit et al, 2005). The low reliability of many childhood diagnoses means that during engagement with child and adolescent mental health services, a diagnosis once received can be lost, replaced or supplemented by a different diagnostic classification (O'Connor, Downs, et al, 2019).…”

mentioning

confidence: 99%

Lived Experiences of Diagnostic Shifts in Child and Adolescent Mental Health Contexts: a Qualitative Interview Study with Young People and Parents

O’Connor

McNicholas

2020

J Abnorm Child Psychol

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Funding: The research was funded by the European Union's Horizon 2020 research and innovation programme under grant agreement 702970.Claire Mac Bride. The authors would like to thank all who helped publicise the participant recruitment adverts and the families who volunteered their time to participate in the study. Ethics: The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. All procedures involving human subjects were approved by University College Dublin's Human Research Ethics Committee, ref LS-17-105-OConnor-McNicholas. Lived experiences of diagnostic shifts in child and adolescent mental health contexts: A qualitative interview study with young people and parentsPsychiatric diagnoses are important resources in helping young people and families make sense of emotional or behavioural difficulties. However, the poor reliability of diagnoses in childhood means many young service-users experience their diagnosis being removed, revised or supplemented over time. No previous research has investigated how young service-users experience, understand or respond to alteration of their original diagnosis. The current study adopted a qualitative approach to explore the lived experience of diagnostic shifts in child and adolescent mental health contexts. Narrative interviews were conducted with families living in Ireland, who had direct experience of diagnostic shifts. Participants included 21 parents (19 female) and 14 young people (8 female, mean age=14). Thematic analysis explored the range of interpretations and implications of diagnostic shifts in families' lives, identifying three themes that underpinned participants' narratives. Diverse Trajectories & Experiences outlined the variety of contexts for diagnostic shifts, ways they were communicated to parents and young people, and their clinical consequences. A Process of Readjustment captured processes of emotional and conceptual adaptation in the aftermath of a diagnostic shift. Finally, Social Repositioning explored how diagnostic shifts could prompt changes to interpersonal relations, social identity and stigma experiences. The study shows that diagnostic shifts carry significant emotional, social and practical repercussions. While diagnostic shifts may threaten the therapeutic relationship and service-user understanding, they also offer opportunities to enhance young people's self-concept, social relationships and therapeutic engagement.Clinician awareness of the socio-emotional implications of diagnostic shifts is vital to inform sensitive communication and support strategies.

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“…We suggest a different approach that shows a good convergent validity of the GTS-QOL-French with the WHOQOL-BREF. The WHOQOL-BREF was used in a first study of the HRQoL of adults with GTS [8] and subsequently in a study of adolescents [50]. The 'Physical /ADL' subscale of the GTS-QOL-French groups together four items relating to involuntary movements, pain or physical injury due to tics, vocal tics and the impact on ADL and leisure activities.…”

Section: Plos Onementioning

confidence: 99%

Cross-cultural adaptation and psychometric evaluation of the French version of the Gilles de la Tourette Syndrome Quality of Life Scale (GTS-QOL)

et al. 2020

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Introduction The Gilles de la Tourette Syndrome–Quality of Life Scale (GTS-QOL) is a self-rated disease-specific questionnaire to assess health-related quality of life of subjects with GTS. Our aim was to perform the cross-cultural adaptation of the GTS-QOL into French and to assess its psychometric properties. Methods The GTS-QOL was cross-culturally adapted by conducting forward and backward translations, following international guidelines. The psychometric properties of the GTS-QOL-French were assessed in 109 participants aged 16 years and above with regard to factor structure, internal consistency, reliability and convergent validity with the MOVES (Motor tic, Obsessions and compulsions, Vocal tic Evaluation Survey) and the WHOQOL-BREF (World Health Organization Quality of Life Brief). Results Exploratory factor analysis of the GTS-QOL-French resulted in a 6-factor solution and did not replicate the original structure in four subscales. The results showed good acceptability (missing values per subscale ranging from 0% to 0.9%), good internal consistency (Cronbach’s alpha ranging from 0.68 to 0.94) and good test–retest reliability (intraclass correlation coefficients ranging from 0.70 to 0.81). Convergent validity with the MOVES and WHOQOL-BREF scales showed high correlations. Discussion Our study provides evidence of the good psychometric properties of the GTS-QOL-French. The cross-cultural adaptation and validation of this specific instrument will make it possible to assess health-related quality of life in French-speaking subjects with GTS. The GTS-QOL-French could be recommended for use in future research.

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Five-year diagnostic stability among adolescents in an inpatient psychiatric unit

Cited by 10 publications

References 30 publications

Diagnostic trajectories in child and adolescent mental health services: exploring the prevalence and patterns of diagnostic adjustments in an electronic mental health case register

Diagnostic trajectories in child and adolescent mental health services: exploring the prevalence and patterns of diagnostic adjustments in an electronic mental health case register

Lived Experiences of Diagnostic Shifts in Child and Adolescent Mental Health Contexts: a Qualitative Interview Study with Young People and Parents

Cross-cultural adaptation and psychometric evaluation of the French version of the Gilles de la Tourette Syndrome Quality of Life Scale (GTS-QOL)

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