Stability of Schizoaffective Disorder in Correlation with Duration of Follow-Up: Retrospective Analysis

Abstract

Background/Aims: Previous studies have indicated that the validity and reliability of schizoaffective disorder (SAD) diagnosis according to the DSM-IV criteria are insufficient, and that the stability of the diagnosis is poor. However, no study has examined exclusively the diagnostic stability of SAD. The aims of this study were to examine the longitudinal stability of the diagnosis of SAD and SAD subtypes among a large sample of patients, and to examine demographic and clinical variables as predictors of diagnostic stability. Methods: A retrospective chart review of 123 inpatients who were admitted to Geha Mental Health Center between the years 2000 and 2005, and who had been diagnosed with SAD at some stage of their illness. We compared the group of patients whose diagnosis of SAD had remained stable and the group of patients whose diagnosis had changed. Results: The diagnostic stability for SAD was 73.1%. Diagnostic transitions were mainly from and towards schizophrenia. We found an association between the SAD bipolar subtype and higher rates of diagnostic stability. The time that had elapsed since SAD diagnosis was made was significantly shorter in the group of patients with stable diagnosis than in the group of patients whose diagnosis had changed (p = 0.037). Conclusions: The diagnostic stability of SAD might be higher than previously reported. Patients who are diagnosed with SAD manic subtype have a higher tendency to retain their diagnosis than patients with other SAD subtypes. The diagnostic changes are derived from manifestations of new symptoms in the course of the disease. Clarification of the current diagnostic criteria in order to enable a more precise utilization of the SAD subtype diagnoses is warranted. Study Limitations: (a) The study design was retrospective and further prospective studies are needed to establish our findings; (b) there is a misusage of the SAD subtype definitions, thus conclusions regarding polarity of SAD and stability of diagnosis are limited, and (c) the population studied was comprised of inpatients, therefore generalization to the outpatient population should be done with caution.

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

“…We screened 4,415 articles, evaluated 327 articles at full‐text level, and included 31 studies in our quantitative analysis: 27 on the shift from SAD and 23 on the shift to SAD (Fig. ).…”

“…Scientific discussions about the value of diagnostic concepts benefit greatly from the inclusion of evidence from follow‐up studies – as has been emphasized by Robins and Guze and reiterated by Kendler . Studies analyzing not only the extent, but also the direction of diagnostic shift in SAD patients are discordant, with some showing more shift toward schizophrenia [e.g., ], and others showing more shift toward affective disorders [e.g., ], and most data on diagnostic shift in SAD patients can be found as a by‐product in studies analyzing schizophrenia, affective disorder, or psychoses. So far, there has been no systematic review and meta‐analysis on the extent and direction of diagnostic shift in SAD patients.…”

Evidence for Distinguishable Treatment Costs among Paranoid Schizophrenia and Schizoaffective Disorder

“…The extended inpatient period in the SAD group is not surprising for two reasons: First, there is a profound empirical evidence for a lower diagnostic stability of SAD when compared to SZ [ 20 – 23 ]. According to Chen and colleagues [ 20 ], the stability rate of SAD diagnosis was 18.6% seven years after the first admission.…”

“…According to Chen and colleagues [ 20 ], the stability rate of SAD diagnosis was 18.6% seven years after the first admission. In two recent longitudinal studies, the stability rate of SAD diagnosis varied between 36% [ 20 ] and 73.1% [ 23 ]. According to Brenner and colleagues, the main reason for a diagnostic shift are the poor validity and reliability of the SAD diagnosis and the longitudinal course of illness over the years [ 23 ].…”

“…In two recent longitudinal studies, the stability rate of SAD diagnosis varied between 36% [ 20 ] and 73.1% [ 23 ]. According to Brenner and colleagues, the main reason for a diagnostic shift are the poor validity and reliability of the SAD diagnosis and the longitudinal course of illness over the years [ 23 ]. Along these lines, reaching a reliable diagnosis of SAD appears to be a complex endeavor, that demands more time than diagnosing SZ.…”