Diagnostic Stability in Patients with First-Episode Psychosis

Abstract

Affective psychoses and schizophrenia, in line with previous findings, remained stable. Diagnoses of brief psychoses were highly stable as well; this could reflect a non-relapsing course of acute brief psychoses, especially in developing countries.

McLean-Harvard International First-Episode Project

“…These studies 25,28 averaged with our findings (Table 2) indicated that ICD-10 schizophrenia was a particularly stable initial diagnosis (92.2±9.2%), mania with psychotic symptoms similarly stable (90.8±8.4%), delusional disorder and severe depressive episode with psychotic features less stable (75.4±21.2%), ATPD moderately unstable (63.7±32.6%), and the pool of unspecified acute psychoses even less stable (40.1±24.1% of cases remaining stable for at least one year). Compared with our findings of 100% longitudinal diagnostic stability among initial ICD-10 schizoaffective cases (Table 2), one comparable study found that only 20% of cases initially considered schizoaffective (2.9%) remained so at 36 months, 25 and the other did not identify any subject as schizoaffective at baseline or at 12-months.…”

“…38 Accordingly, ICD-10 diagnoses of ATPD, particularly the APPD subtypes, may be somewhat more stable, and potentially more reliable and valid constructs than DSM-IV schizophreniform and brief psychotic disorder. Several studies 21,25,39,41,43,44 investigated the incidence, characteristics, and diagnostic stability of ICD-10 acute, transient psychoses, alone or within the broad range of first-episode functional psychoses, generally finding low to moderate overall stability rates (34.4%–57.9%), though relatively high positive predictive power was found among such diagnoses in developing countries (64.4%–73.3%), 28,40,42 particularly for the APPD subtypes. 40 …”

“…26,31,32,35,38 Several studies specifically considered longitudinal stability of individual, ICD-10 acute psychotic-disorder diagnoses, 39–44 schizophrenia, 45,46 mania or severe depression with psychotic features, 47–49 but only two 25,28 considered diagnostic stability over time in a broad range of functional psychoses, and neither explored factors predicting stability. 25,28 …”

“…47–49 However, we found only two studies that investigated diagnostic stability over time in the broad range of ICD-10 functional psychoses, and neither explored factors predicting diagnostic change or stability over time. 25,28 …”

McLean-Harvard International First-Episode Project

“…In contrast to schizophreniform disorder, DSM-IV brief psychotic disorder was a moderately stable category since only 38.9% later changed, usually to BPD or psychosis-NOS. Unlike schizophreniform disorder, brief psychoses often are relatively acute and time-limited, may be episodic but rarely follow a chronic course, and often appear in relatively well-functioning women 11,12,15,17,18,24,26,37. Brief psychosis,4 as well as “acute and transient psychoses” of ICD-10,5 may be more valid constructs than schizophreniform disorder, and appears to be associated with a more episodic-favorable course.…”