At its December 2019 meeting, the American Psychiatric Association (APA) Board of Trustees approved "The American Psychiatric Association Practice Guideline for the Treatment of Patients with Schizophrenia." The full guideline is available at APA's Practice Guidelines website.

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OBJECTIVE Diagnostic shifts have been prospectively examined in the short-term, but the long-term stability of initial and follow-up diagnoses have rarely been evaluated. METHOD A cohort of 470 first-admission patients with psychotic disorders was systematically assessed at baseline, 6-month, 2-year, and 10-year follow-up. Longitudinal best-estimate consensus diagnoses were formulated after each assessment. RESULTS At baseline, the diagnostic distribution was: schizophrenia spectrum disorders 29.6%, bipolar disorder with psychotic features 21.1%, major depression with psychotic features 17.0%, substance-induced psychosis 2.4%, and other psychoses 27.9%. At year 10, the distribution changed to 49.8%, 24.0%, 11.1%, 7.0%, and 8.1%, respectively. Overall, 50.7% changed diagnoses at some point during the study. Most participants who were initially diagnosed with schizophrenia or bipolar disorder retained the diagnosis at year 10 (89.2% and 77.8%, respectively). However, 32.0% of participants (N=98) originally given a non-schizophrenia diagnosis gradually shifted into schizophrenia at year 10. The second biggest shift was to bipolar disorder (10.7% of those not given this diagnosis at baseline). Changes in the clinical picture explained many diagnostic shifts. In particular, poorer functioning and greater negative and psychotic symptoms predicted a subsequent shift to schizophrenia. Better functioning and lower negative and depressive symptoms predicted the shift to bipolar disorder. CONCLUSIONS First-admission patients run the risk of being misclassified at early stages in the illness course, including more than 2 years after first hospitalization. Diagnosis should be reassessed at all follow-up points.

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We performed a genome-wide association study of 6447 bipolar disorder (BD) cases and 12 639 controls from the International Cohort Collection for Bipolar Disorder (ICCBD). Meta-analysis was performed with prior results from the Psychiatric Genomics Consortium Bipolar Disorder Working Group for a combined sample of 13 902 cases and 19 279 controls. We identified eight genome-wide significant, associated regions, including a novel associated region on chromosome 10 (rs10884920; P=3.28 × 10−8) that includes the brain-enriched cytoskeleton protein adducin 3 (ADD3), a non-coding RNA, and a neuropeptide-specific aminopeptidase P (XPNPEP1). Our large sample size allowed us to test the heritability and genetic correlation of BD subtypes and investigate their genetic overlap with schizophrenia and major depressive disorder. We found a significant difference in heritability of the two most common forms of BD (BD I SNP-h2=0.35; BD II SNP-h2=0.25; P=0.02). The genetic correlation between BD I and BD II was 0.78, whereas the genetic correlation was 0.97 when BD cohorts containing both types were compared. In addition, we demonstrated a significantly greater load of polygenic risk alleles for schizophrenia and BD in patients with BD I compared with patients with BD II, and a greater load of schizophrenia risk alleles in patients with the bipolar type of schizoaffective disorder compared with patients with either BD I or BD II. These results point to a partial difference in the genetic architecture of BD subtypes as currently defined.