Stability of Diagnoses in Various Psychiatric Disorders: A Study of Long-Term Course

Abstract

The frequency of diagnostic shift was investigated in 267 patients diagnosed with various psychiatric disorders according to the 9th revision of the International Classification of Diseases (ICD-9). Forty-six patients fulfilled the diagnostic criteria for schizophrenic psychosis, 71 for affective psychosis, 66 for neurotic disorder, 24 for personality disorder, and 40 for psychogenic reaction. The remaining 20 patients were diagnosed with heterogenous disorders. The mean follow-up time was 12.5 years. Every episode of inpatient treatment was diagnosed cross-sectionally. Patients with an initial episode of schizophrenic psychosis showed by far the greatest stability (93%). A high stability was found in patients diagnosed with neurotic disorders (79%). Forty-two patients with an index diagnosis of affective psychosis suffered more than one type of episode during the course of disease. The lowest stability was noted in patients with a psychogenic reaction (10%). Eleven percent of patients with a final diagnosis of schizophrenia had an index diagnosis of psychogenic reaction. Our findings demonstrate that the course of disease should be considered in making the final diagnosis.

Stability of DSM-III-R Diagnoses: Study of a Case Register

“…Psychotic disorder and bipolar disorder were the most stable categories, whereas anxiety disorder and adjustment disorder were less stable. These results are comparable with previous studies [2,[6][7][8], in which psychotic conditions were the most stable, whereas 'neurotic' and affective diagnoses were more subject to change. Adjustment disorder was the weakest diagnostic group.…”

“…Kaelbling and Volpe [1] studied 934 patient records and found a stability of about 66% in the different diagnostic groups. Since then, other studies have been made on this topic, either from case registers [2][3][4], from medical records [1,5,6], or from patient interviews [7,8]. Overall, the diagnostic stability ranged from 60 to 80%.…”

“…The duration of the observation was variable, from 6 months [8] to more than 30 years [9]. Most of the studies described the category of psychosis or schizophrenic disorder, with a stability between 66 [1] and 93% [7]. A study by Chen et al [4] tried to identify factors associated with diagnostic changes in schizophrenia.…”

The Developmental Psychopathology of Personality Disorders

“…Vaglum, Friis, Karterud, Mehlum, & S. Vaglum, 1993;Vetter & Koller, 1993). Cross-sectional findings have similarly indicated that the prevalence of personality disorder traits declines with age among adolescents and adults (e.g., Kessler et al, 1994;Robins & Regier, 1991;Samuels et al, 2002).…”

Age and Remission of Personality Pathology in the Psychotic Disorders Compared to Mood and/or Anxiety Disorders

“…Fanous et al (2007) [19] examined the interaction between major depression and neuroticism based on a sample of male twins, and found that major depression may have a direct causal effect on neuroticism. Both literatures [20, 21] and clinical experiences suggest that the stability and the course of PSD and MAD were quite different. Therefore, we suppose that the trajectory of PD traits across age may differ from a typical trajectory in the presence of co-occurring Axis I disorders that share similar clinical characteristics.…”