Diagnostic shift in patients diagnosed with schizoaffective disorder: a systematic review and meta‐analysis of rediagnosis studies

Santelmann, Hanno; Franklin, Jeremy; Bußhoff, Jana; Baethge, Christopher

doi:10.1111/bdi.12388

Cited by 19 publications

(15 citation statements)

References 62 publications

(69 reference statements)

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“…The hazard ratio for psychotic depression to progress to SAD was exceptionally high, 10.6 (CI 95% 4.0-28.4). This finding may reflect the previously reported frequent shift from psychotic depression to SAD, 20 although the wide confidence interval indicates uncertainty in the actual size of the risk.…”

Section: Predictors For Diagnostic Conversionmentioning

confidence: 71%

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Diagnostic conversion from unipolar depression to bipolar disorder, schizophrenia, or schizoaffective disorder: A nationwide prospective 15‐year register study on 43 495 inpatients

et al. 2020

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Objective To examine temporal patterns and predictors for diagnostic conversion from unipolar depression (UD) to bipolar disorder (BD), schizophrenia, and schizoaffective disorder (SAD). Methods A prospective nationwide register‐based cohort (n = 43 495) of all first psychiatric hospitalizations due to UD during 1996‐2011 was followed up to 15 years. We used cumulative incidence function (CIF) analyses and the Fine‐Gray subdistribution model to define the cumulative incidence of the conversions and subdistribution hazard ratios (SHRs) for predictors. Results The overall 15‐year cumulative incidence of conversion was 11.1% (95% CI 10.7‐11.6): 7.4% (95% CI 7.0‐7.8) for BD, 2.5% (95% CI 2.3‐2.7) for schizophrenia, and 1.3% (95% CI 1.1‐1.4) for SAD. The highest crude incidence rate emerged during the first year. Psychotic depression predicted higher conversion risk to BD (SHR = 2.0, 95% CI 1.5‐2.7), schizophrenia (SHR = 5.3, 95% CI 3.3‐8.7), and SAD (SHR = 10.6, 95% CI 4.0‐28.4) than mild depression. Female sex, greater overall disturbance, and comorbid personality disorder predicted conversion to BD, whereas young age and male sex to psychotic disorders. Conclusions Among patients with first hospitalization due to UD, approximately one in nine converts to another major psychiatric disorder during 15 years, with the highest risk occurring within the first year. Patients with psychotic depression are particularly vulnerable for conversion to other major psychiatric disorders. Conversion to psychotic disorders occurs earlier than to BD. Males are at higher risk for progression to psychotic disorders, whereas females, patients with recurrent depressive episodes, severe disturbance of overall functioning, and personality disorder are at higher risk for converting to BD.

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Section: Predictors For Diagnostic Conversionmentioning

confidence: 71%

“…Depressive symptoms and UD frequently precede both schizophrenia 11,18,19 and schizoaffective disorder (SAD), 20 and ultra-highrisk (UHR) patients often seek treatment due to depressed mood. UD per se appears to predict conversion to psychosis in UHR patients.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic conversion from unipolar depression to bipolar disorder, schizophrenia, or schizoaffective disorder: A nationwide prospective 15‐year register study on 43 495 inpatients

et al. 2020

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“…The temporal stability of schizoaffective disorder, however, is markedly lower than that of its most important differential diagnoses, schizophrenia and affective disorders. Averaging the results of more than two dozen studies on the longitudinal course of SAD, we found that, at reassessment after on average 2 years, a solid third of patients with an initial diagnosis of SAD had switched to other diagnoses—mainly to schizophrenia (19%) and affective disorders (14%) 2 . It adds to the impression that, among those who received a diagnosis of SAD at reassessment, fully 55% had not been so diagnosed at baseline.…”

Section: Proxies For Validity: Temporal Stability and Position Relatimentioning

confidence: 60%

How reasonable is it to uphold the diagnostic concept of schizoaffective disorder?

Baethge

2020

Bipolar Disorders

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“…The nosological validity of SZA as a separate diagnosis is questioned and the diagnostic reliability is low (Jäger et al, 2010;Santelmann et al, 2015). Diagnostic shift over time is common (Fusar-Poli et al, 2016;Santelmann et al, 2016). SZA may reflect the co-occurrence of SZ and a mood disorder (Abrams et al, 2008), whereas others suggest a dimensional approach with SZA on a continuum between SZ and bipolar disorder (Keshavan et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

Auditory brainstem response (ABR) profiling in schizoaffective disorder

Baghdassarian

Lewander

2020

Acta Neuropsychiatr.

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AbstractObjective:The aim of the study was to assess whether the auditory brainstem response (ABR) profiling test for schizophrenia (SZ) would recognise schizoaffective disorder (SZA) patients as SZ or not.Method:Male and female SZA patients (n = 16) from the psychosis unit at Uppsala University Hospital were investigated. Coded sets of randomised ABR recordings intermingled with patients with SZ, adult attention-deficit hyperactivity disorder (ADHD) and healthy controls were analysed by an independent party blinded to clinical diagnoses.Results:The ABR profiling test for SZ was positive in 5/16 patients (31%) and negative in 11/16 patients (69%) with SZA. A surprising finding was that 4/16 (25%) SZA patients were positive for the ABR profiling test for ADHD.Conclusion:With the ABR profiling test, a minority of patients with SZA tested positive for SZ. In contrast, a majority (85%) of patients with SZ in a previous study tested positive. These preliminary results leave us ignorant whether SZA should be regarded as a SZ-like disorder or a psychotic mood disorder and add to the questions regarding the validity of this diagnostic entity. However, the ABR profiling method is still in its infancy and its exploration in a range of psychiatric disorders is warranted.

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Diagnostic shift in patients diagnosed with schizoaffective disorder: a systematic review and meta‐analysis of rediagnosis studies

Cited by 19 publications

References 62 publications

Diagnostic conversion from unipolar depression to bipolar disorder, schizophrenia, or schizoaffective disorder: A nationwide prospective 15‐year register study on 43 495 inpatients

Diagnostic conversion from unipolar depression to bipolar disorder, schizophrenia, or schizoaffective disorder: A nationwide prospective 15‐year register study on 43 495 inpatients

How reasonable is it to uphold the diagnostic concept of schizoaffective disorder?

Auditory brainstem response (ABR) profiling in schizoaffective disorder

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