Symptom Assessment in Casenotes and the Clinical Diagnosis of Schizophrenia

Lutzhoft, Jan Holten; Skadhede, Søren; Fätkenheuer, B.; Häfner, Heinz; Löffler, W.; Riecher-Rössler, Anita; Maurer, Kurt

doi:10.1159/000284912

Cited by 7 publications

(5 citation statements)

References 16 publications

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“…However, in the present study, 50-77% of patients clinically diagnosed with other diagnoses than schizophrenia or schizophrenic psychoses obtained a DSM-III-R TRD of these disorders. These false-negative rates are of approximately the same magnitude as previously reported in studies from Finland and Denmark [36][37][38]40] , although higher than in a small Swedish study [41] . Altogether, these results indicate a convergence in the use of clinical schizophrenia diagnoses in the Scandinavian countries.…”

Section: Discussionsupporting

confidence: 84%

Characterization of Patients with Schizophrenia and Related Psychoses: Evaluation of Different Diagnostic Procedures

et al. 2006

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Background: We aimed at estimating the value of structured interviews, medical records and clinical diagnoses for assessing lifetime diagnosis of patients with schizophrenia. In addition, the validity of the Operational Criteria Checklist (OPCRIT) system was analysed. Sampling and Methods: Swedish patients (n = 73), diagnosed with schizophrenia and related disorders by their treating physician, were scrutinized. Independent research diagnoses according to the Diagnostic and Statistical Manual, ed. 3, revised (DSM-III-R) were obtained by (1) a structured interview; (2) the OPCRIT algorithm, based on record analysis only; (3) the OPCRIT algorithm, based on record and interview analysis, or (4) a separate traditional research diagnosis based on both record and interview analysis. In addition, clinical International Classification of Diseases (ICD) diagnoses, given by the treating physician, were obtained from the case notes. Concordance rates for the different psychosis diagnoses were calculated. Results: Diagnoses based on interviews only showed poor to fair agreement with the other research diagnoses, but patients diagnosed with schizophrenia or schizophrenic psychoses (i.e. schizophrenia, schizophreniform or schizoaffective disorder) at the interview almost always also obtained a corresponding research diagnosis based on record or combined sources. Diagnoses based on records only showed a good to excellent agreement with diagnoses based on records and interviews. Clinical ICD diagnoses generally displayed poor agreement with the research diagnoses, but 94% of patients ever given a clinical ICD diagnosis of schizophrenic psychosis received a corresponding traditional research diagnosis. OPCRIT diagnoses and independently assigned research diagnoses, based on the same information, displayed excellent concordance. Conclusions: Structured interviews performed with Swedish long-term-treated psychosis patients during non-hospitalization are a poor source for the evaluation of psychosis diagnoses, but a good screening instrument for the detection of DSM-III-R schizophrenia. In the investigated population, medical records are a valuable source for diagnostic assessment of psychoses and may serve as a stand-alone procedure in this patient category. Swedish clinical ICD diagnoses have a high positive predictive power identifying DSM-III-R diagnoses of schizophrenic psychoses, indicating validity of register-based research focusing on these diagnoses. The OPCRIT system is a valid tool for assessing DSM-III-R psychosis diagnoses. It should be emphasized that the present conclusions are based on the investigated Swedish psychosis population and cannot be generalized to populations composed of other patient groups or sampled in other settings, with other traditions regarding the use and availability of medical records.

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Section: Discussionsupporting

confidence: 84%

Characterization of Patients with Schizophrenia and Related Psychoses: Evaluation of Different Diagnostic Procedures

et al. 2006

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“…To explain the unexpected rest of that age difference in the pattern of schizophrenia onsets between the Danish and German females, we drew a randomized, stratified sample of 116 first-admission patients with a diagnosis of schizophrenia or related disorder from the Danish case register and obtained their case records from the hospitals where they had been treated. We did this in cooperation with our Danish colleagues and with the permission of the regional authorities [10, 11]. Using a case-note version of the IRAOS we determined for this sample 1) age at the onset of the first psychotic symptom and 2) age at fulfilling the diagnostic criteria for a schizophrenia diagnosis (i.e., the earliest point in time when the patients actually presented a sufficient number of symptoms qualifying them for the diagnosis according to the International Classification of Diseases, ICD-9).…”

Section: Materials Methods and Resultsmentioning

confidence: 99%

From Onset and Prodromal Stage to a Life-Long Course of Schizophrenia and Its Symptom Dimensions: How Sex, Age, and Other Risk Factors Influence Incidence and Course of Illness

Häfner

2019

Psychiatry Journal

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The core symptoms of psychosis—delusions, hallucinations, and thought disorders—are not unique to the disorder traditionally called schizophrenia. They occur at the early stages of various brain diseases, too. Psychosis seems to be a preformed pattern of response of the human brain. Most schizophrenia onsets are marked by a prodromal stage extending over several years and producing the maximum of social consequences. Schizophrenia incidence shows a steep increase culminating at age 15 to 25 years in males. In females it reaches a first peak at age 15 to 30 years and a second, flatter peak at menopausal age (44-49 years). Thereafter, incidence declines to a plateau at later ages. Unlike what the findings of most large-scale epidemiological studies applying an upper age limit of 45 to 55 years suggest, schizophrenia is a disorder of all ages. The lifetime risk seems to be the same for both sexes. The lower incidence in premenopausal women is accounted for by the downregulating effect of oestrogen on dopamine receptors. This hormonal protective effect is antagonised by the genetic effect of a high familial load. In the long-term illness course, right-censored to 11.2 years following first admission, the number of psychotic relapse episodes ranges from 0 to 29 with a mean of 3. The positive symptom dimension produces the highest number of relapses and the shortest duration of exacerbations with a mean length of two months. The depressive and negative symptom dimensions show exacerbations extending over nearly six months on average. Following the first illness episode symptom scores decline sharply, reaching a plateau five years after first admission. Negative symptoms come to a plateau after 2 to 3 years in females and after 5 years in males. Depression is the most frequent type of symptom in the long-term course. In the light of these results urgent treatment issues will be discussed.

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“…The sources of discordance are relatively simple to identify and principally involve information variance. A case record or abstract is a clinical tool, not a research database, as emphasised by Lützoft et al [24]. Features not recorded in the abstract or case notes are not necessarily absent.…”

Section: Discussionmentioning

confidence: 99%

“…A case record or abstract is a clinical tool, not a research database, as emphasised by Lützoft et al . [24]. Features not recorded in the abstract or case notes are not necessarily absent.…”

Section: Discussionmentioning

confidence: 99%