Diagnostic stability over one year in first-episode psychosis

Results of first-episode psychosis studies have shown that the diagnosis of schizophrenia is more stable across time than other diagnoses within the psychosis spectrum disorders. The objective of this study was to determine the diagnostic stability in a sample of first-episode patients and to determine the factors that predicted a diagnostic shift. Two hundred and twenty-eight individuals presenting for treatment with a first episode of non-affective psychosis were diagnosed at baseline and at one-year follow-up. Symptoms, functioning and cognition were also assessed. The overall consistency of diagnoses was 68% with an increase to 89% when schizophreniform was excluded. Schizophrenia was found to have the highest prospective consistency (95%), schizophreniform was less stable (36%) with shifts towards schizophrenia and other psychotic disorders were the least stable with a prospective consistency of 62%. Schizophrenia had the largest influx of cases at follow-up with a retrospective consistency of 63%. Schizophrenia can be reliably diagnosed at the initial assessment. There are clinical implications for dealing with the risk of shifting diagnosis for those who present with schizophrenia spectrum and other psychotic disorders.     

Acute polymorphic psychotic disorder: diagnostic stability over 3 years

OBJECTIVE: Acute polymorphic psychotic disorder without symptoms of schizophrenia (APPD) in ICD-10 is unique in many characteristics. This study aimed at investigating the diagnostic stability of APPD over 3 years. METHOD: Forty-five patients with first episode APPD were followed up and assessed at regular intervals over a period of 3 years. RESULTS: Thirty-two patients were females. Average age of the sample was 26.9 years. Thirty-three cases retained their index diagnosis of APPD, while 12 cases required diagnostic revision: 10 to bipolar affective disorder and the rest to unspecified non-organic psychosis. Shorter duration of illness (<1 month) and abrupt onset (<48 h) predicted a stable diagnosis of APPD. CONCLUSION: APPD is a relatively stable diagnosis and argues for a distinct diagnostic entity.     

First-episode psychosis: a comparative review of diagnostic evolution and predictive variables in adolescents versus adults.

OBJECTIVE: To review the diagnostic evolution and predictive variables of diagnosis and outcome in first-episode psychosis in adolescents (age 13-19 years) and adults. METHOD: Literature was reviewed through MEDLINE, Psycinfo, and PubMed, and supplemented by selected bibliographies. RESULTS: First-episode psychosis in the adolescent population has greater diagnostic instability than in adults. We identified trends in the predictive variables of diagnosis and outcome: 1) Premorbid adjustment (that is, personality) in adolescents and Global Assessment of Functioning (GAF) both before and after first-episode psychosis in adolescents and adults are the best predictors of diagnosis; 2) GAF (before and after) is the best predictor of outcome in both adolescents and adults. CONCLUSION: Adolescent-onset psychosis appears to be in continuity with adult-onset psychosis. The greater diagnostic instability in adolescents and the absence of significant data on predictive variables suggest a need for specialized and continuous care and research in the adolescent population.     

Diagnostic stability over 3 years in a total group of first-episode psychosis patients

First-episode psychosis (FEP) patients are often given diagnoses that later have to be changed. The aim of this study was to measure the diagnostic stability in a total group of FEP patients; 146 FEP patients were followed longitudinally and prospectively. Their revised baseline diagnoses were compared with their 3-year follow-up diagnoses. The schizophrenic spectrum disorders showed a high diagnostic stability as a group, but there was a great flow of patients between the different schizophrenic spectrum diagnoses. Also schizophrenia was a stable diagnosis. The affective psychosis group was homogenous without interaction of other psychosis groups. The other psychosis diagnoses, both regarded as a group and individually, turned out to be quite heterogeneous, with low stability values and a split course, often ending up in the schizophrenic spectrum. Fifty one per cent did not fulfil the criteria for DSM-IV axis 1 psychosis diagnosis at follow-up. In conclusion, our findings suggest that in the early phase of psychosis. Only three different diagnostic categories would be sufficient; "schizophrenic spectrum type", "affective psychosis," and for the rest "psychotic disorder NOS."     

First-episode psychosis: Part I. Editors' introduction.

Until recently, there has been a conspicuous lack of studies regarding the earliest phases of psychotic illness, with most research on schizophrenia and related disorders focusing on chronically ill patients. Currently, however, a number of investigators have turned their attention toward this topic, exploring the conceptual issues involved in defining the onset of psychosis, using case registers and population-based samples to do crucial epidemiologic studies on the course of schizophrenia, and developing mechanisms for identifying patients with first-episode psychosis and entering them into active research protocols. The issue of the Schizophrenia Bulletin is devoted to articles representing this full range of conceptual and empirical work on first-episode psychosis. The ultimate goal is for researchers working in this area to develop a network to enhance the sharing of concepts and data, with the eventual possibility of developing combined data bases and collaborative studies.     

The stability of temperament by child and mother reports over two years

The stability of temperament dimensions in children, adolescents, and young adults was examined over a 2-year period through the use of multiple informants and a measure of temperament, presumably applicable to informants of all ages. The study is based on 220 children from 91 families at high- and low-risk for major depression by virtue of the presence or absence of major depression in their parents. The Dimensions of Temperament Survey was completed independently by the child and by the parents about their child. Results showed a fair to moderate stability for child self-report of temperament and moderate to good stability for mother reports of child temperament. Discussion focuses on factors that may influence the stability of temperament ratings such as age, sex, mother's depression, socialization pressures, and expectations of temperament held by others.     

Intra-individual stability of CSF biomarkers for Alzheimer's disease over two years

This study examines the intra-individual stability of cerebrospinal fluid (CSF) biomarkers for Alzheimer's disease (AD) over 2 years in 83 patients with mild cognitive impairment (MCI) and 17 cognitively healthy control individuals. All participants underwent clinical and neuropsychological evaluation and lumbar puncture at baseline and after 2 years at a university hospital memory clinic. CSF was analyzed for total tau (T-tau), phospho-tau(181) (P-tau(181)) and amyloid-beta(1-42) (Abeta(1-42)). During the 2-year observational time, 12 MCI patients progressed to AD and 3 progressed to vascular dementia, while 68 remained stable. Baseline T-tau and P-tau(181) levels were elevated in the MCI-AD group as compared to the stable MCI patients and the control group (p<0.01), while baseline Abeta(1-42) levels were lower (p<0.001). Stable MCI patients were biochemically indistinguishable from controls. The biomarker levels at baseline and after 2 years showed Pearson R values between 0.81 and 0.91 (p<0.001) and coefficients of variation of 7.2 to 8.7%. In conclusion, intra-individual biomarker levels are remarkably stable over 2 years. Thus, even minor biochemical changes induced by treatment against AD should be detectable using these biomarkers, which bodes well for their usefulness as surrogate markers for drug efficacy in clinical trials.     

First-episode psychosis: psychopathology, quality of life, and functional outcome

The burgeoning interest in investigating the first episode of schizophrenia and related disorders provides an opportunity to examine how this approach has assisted our understanding of the heterogeneity of psychopathology of this disorder and the trajectories of its outcome. We present a review of relevant literature on categorical versus dimensional perspectives on psychopathology, with special reference to early signs, its relationship with other patient- and system-related characteristics, and the status and determinants of functional outcome and quality of life. The findings from longitudinal studies of the dimensional psychopathology of first-episode psychosis suggest continuity of some psychopathological dimensions from premorbid through prodromal to post-onset phases of psychosis and some aspects of longer-term course. Short-term functional outcome improves after treatment of the first episode, but longer-term outcome remains relatively poor for a substantial proportion of patients and is associated with preadolescent onset, poor premorbid adjustment, poor cognitive functioning, cerebral asymmetry, and negative symptoms during prodromal and post-onset phases. Poor quality of life is related to residual psychopathology, long delays in treatment, and poor premorbid adjustment. The potential effects of improved treatment and/or early intervention on functional outcome and quality of life have not been adequately examined, nor have the interrelationships between predictors and the underlying processes involved in determining variations in outcome. Studies of functional outcome still lack the rigor of operational definitions, choice of specific instruments for measurement, and use of large enough samples to generate meaningful results.     

Diagnostic stability four years after a first episode of psychosis

OBJECTIVE: The objective of this study was to determine the stability of a diagnosis of psychosis four years after the first-episode diagnosis. METHODS: The study was a prospective four-year follow-up study (1995 to 1999) of 147 patients with schizophrenia, affective disorder, and other psychoses who presented with a first episode of psychosis in an epidemiologic catchment area in Ireland. All diagnoses were made on the basis of the Structured Clinical Interview for DSM-IV. RESULTS: One quarter of the patients evidenced a change in diagnosis at follow-up. The most common change was to a diagnosis of schizophrenia. The positive predictive values of schizophrenia and bipolar affective disorder were 97 percent and 80 percent, respectively. Fewer years spent in education, lower levels of initial psychopathology, and presence of comorbid alcohol or substance abuse were associated with change in diagnosis at follow-up. CONCLUSIONS: Among the diagnoses studied, schizophrenia was the most stable diagnosis after four years. The greatest instability occurred in the categories of drug-induced psychosis and psychosis not otherwise specified.     

First-episode psychosis patients recruited into treatment via early detection teams versus ordinary pathways: course and health service use during 5 years

Aim: To compare the 5‐year course and outcome of first‐episode psychosis (FEP) patients recruited via active outreach detection teams (DTs) versus ordinary referral channels (not‐DT). Methods: Longitudinal comparison of two parallel consecutive samples on the Positive and Negative Syndrome Scale Score and the Global Assessment of Functioning Scale. Altogether, 203 FEP patients were identified, of whom 42 refused to participate. Included were 161 patients: 56 DT and 105 not‐DT. Results: After 2 years, the DT group developed more cases of schizophrenia with poorer prognostic features. However, the two groups did not differ significantly on outcome measures. More DT patients were treated as outpatients only and had fewer admissions and shorter total time as inpatients during the observation period. Conclusions: We have previously shown that detection teams recruited more chronic patients with poorer prognostic features, but fewer symptoms and better functioning at baseline. After 2 years, the DT patients functioned as well as the not‐DT patients. At 5 years, both groups have stabilized to the same plateau of low symptom severity.     

Baseline neuroendocrine function and diagnostic stability among patients with a nonmanic psychosis

Summary Psychotic patients underwent a dexamethasone suppression test (DST), careful diagnostic assessments at baseline and diagnostic reevaluations after 1 year. The predicted associations between baseline DST results and diagnosis were much clearer after prospective observation.     

First-episode non-affective psychosis in a total urban population: a 5-year follow-up

Background: The aim of this study is to investigate incidence rates, treatment, and outcome of a total in- and outpatient population of 71 patients (of 18–45 years of age) treated for a first-episode psychosis (DSM-IV) in three catchment areas in Stockholm. Methods: The study is based on the investigation of records and databases and on information by staff members and patients. Results: The incidence rate was 34.8 per 100,000 inhabitants (aged 18–45 years) and 16.5 per 100,000 inhabitants (total population). Sixty percent were diagnosed with schizophrenia syndromes. At 5-year follow-up, 73 % of the patients in the schizophrenia syndromes group versus 47 % of the non-schizophrenia group had a sick pension or were on long-term sick leave. Nine percent of the schizophrenia patients and 39 % of the non-schizophrenia psychosis patients were rated as not being in need of treatment. Non-compliance of medication was present in one-third of those patients prescribed neuroleptic medication. Seven percent had never received neuroleptic medication, all of whom were rated as ill at the 5-year follow-up. Conclusions: Incidence of treated first-episode psychosis is higher than has earlier been found, when exclusively outpatient treated individuals are also included. The social outcome is negative, even in the non-schizophrenia group. Non-compliance with medication and insufficient clinical follow-up may have worsened the results. Accepted: 23 March 2001     

First-episode psychosis, early intervention, and outcome: what have we learned?

OBJECTIVE: There has been increased interest in the potential of early intervention to positively influence outcome in first-episode psychosis (FEP) and, consequently, to influence mental health policy and practice. This study's objective was to examine the concept of early intervention and the evidence that currently exists to support such a shift in the delivery of care. METHOD: We examined the evidence for phase-specific treatment of FEP, looking for interventions that attempt to arrest the transition from a putative prodromal state to full psychosis, as well as for interventions that attempt to reduce delay in treatment. RESULTS: Some evidence supports specialized FEP interventions for short-term outcome in terms of symptom reduction, relapse rates, and greater adherence to and retention in treatment. As well, there is modest support for benefits to aspects of social and community functioning and satisfaction with life. Limited evidence supports a positive effect of community-wide case detection in terms of reduced delays in treatment and pharmacologic and psychological interventions in the prodromal phase. CONCLUSIONS: The field of early intervention in psychosis is young, with encouraging preliminary results, especially for improving outcome in established FEP. It requires further study, especially of longer-term outcome. Further studies need to examine the effects of a specialized approach on longer-term outcome and to explore cost-effective methods to reduce delays in treatment and provide interventions in the prodromal phase.