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First-Episode Psychosis: Diagnostic Stability over One and Two Years

Haahr U.a · Friis S.b, c · Larsen T.K.f · Melle I.b · Johannessen J.O.f · Opjordsmoen S.b, c · Simonsen E.a · Rund B.R.d · Vaglum P.e · McGlashan T.g
aPsychiatric Research Unit, Zealand Region Psychiatry Roskilde, Roskilde, Denmark; bUllevaal University Hospital and Departments of cPsychiatry, dPsychology, and eBehavioral Sciences in Medicine, University of Oslo, Oslo, fStavanger University Hospital, Haugesund Hospital, Stavanger, Norway; gDepartment of Psychiatry, Yale University, New Haven, Conn., USA Psychopathology 2008;41:322–329 (DOI:10.1159/000146070)

Abstract

Background: Diagnostic stability is important for daily clinical work and planning of treatment. The aims of this study were to measure diagnostic stability in a clinical epidemiologic sample and to identify markers of change in diagnosis. Sampling and Methods: Diagnostic stability and change were measured in a sample of 301 patients with first-episode psychosis from four national health care sectors in Norway and Denmark at baseline, 1 and 2 years. Results: Diagnostic stabilities were high for schizophrenia and schizoaffective disorder (85–99%), low for schizophreniform disorder (16–19%), and intermediate for other diagnoses. Diagnostic change from schizophreniform to schizophrenia was frequent in year 1 (72%). Characteristics discriminating schizophreniform patients keeping their diagnosis (i.e. having recovered within 6 months with no relapse) from those developing schizophrenia at 1 year were female gender, better childhood premorbid functioning, shorter duration of untreated psychosis and more severe general psychotic symptoms, especially excitation. Conclusions: Findings provide validation for the DSM-IV categories within the schizophrenic spectrum. The limitations of the study were: the raters were not blind to baseline assessments; patients with longer duration of untreated psychosis were more likely to refuse participation; not all patients were assessed at 1- and 2-year follow-up, but the attrition was rather low.

 

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