Abstract
Psychiatric diagnosis is often treated as a stable construct both clinically and in research; however, some evidence suggests that diagnostic change may be common, which may impact research validity and clinical care. In the present study we examined diagnostic stability in individuals with psychosis over time. Participants with a diagnosis of any psychotic disorder (n = 142) were assessed at two timepoints using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders. We found a 25.4% diagnostic change rate across the total sample. People with an initial diagnosis of psychosis not otherwise specified and schizophreniform disorder had the highest rates of change, followed by those with schizophrenia and schizoaffective disorder; people with bipolar disorder had the lowest change rate. Most participants with an unstable initial diagnosis of schizophrenia, schizophreniform disorder, bipolar disorder, or psychosis not otherwise specified converted to a final diagnosis of schizoaffective disorder. Participants with an unstable initial diagnosis of schizoaffective disorder most frequently converted to a diagnosis of schizophrenia. Our findings suggest that diagnostic change is relatively common, occurring in approximately a quarter of patients. People with an initial diagnosis of schizophrenia-spectrum disorder were more likely to have a diagnostic change, suggesting a natural stability of some diagnoses more so than others.
Highlights
Both in research and clinical settings psychiatric diagnosis is often considered a stable construct
Some evidence suggests that diagnostic change may be common, especially in psychotic disorders such as bipolar disorder (BP), brief psychotic disorder, major depressive disorder with psychotic features (MDD), psychosis not otherwise specified (Psych NOS), schizoaffective disorder (SZA), schizophrenia (SZ), and schizophreniform disorder (SZform)
Participants with an unstable initial diagnosis of SZA were most likely to convert to a final diagnosis of SZ (75.0%)
Summary
Both in research and clinical settings psychiatric diagnosis is often considered a stable construct. Substantial debate regarding the utility of categorical vs dimensional classification in psychotic disorders continues across the psychosis spectrum and in disorders such as SZA in particular [1,2,3,4,5,6]. The Kraepelinian dichotomy draws a sharp boundary between BP and SZ; diagnoses that share characteristics of both disorders may be conceptualized as categorically separate disorders or may be considered to fall along a continuum in which someone may move toward one end or the other reflecting shifting symptom profiles [2, 3]. Clear evidence of the superiority of categorical vs dimensional classification systems has not been demonstrated [7], and pre-defined categorization of diagnoses is commonly used in both clinical and research settings.
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