Diagnostic Stability 18 Months After Treatment Initiation for First-Episode Psychosis
J Clin Psychiatry 2005;66(10):1239-1246
© Copyright 2015 Physicians Postgraduate Press, Inc.
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Objectives: (1) Assessment of diagnostic
stability of psychotic disorders or psychotic mood disorders from 6 weeks to 18 months after
initiation of treatment in a representative
first-episode psychosis (FEP) sample. (2) Comparison
between those patients who shifted from DSM-IV
schizophreniform disorder to schizophrenia or
schizoaffective disorder and those whose diagnosis
of schizophreniform disorder remained stable.
Method: The Early Psychosis Prevention
and Intervention Centre (EPPIC) in Australia
admitted 786 FEP patients from January 1998 to
December 2000. Data were collected from patients'
medical records (MRs) using a standardized
questionnaire. Seven hundred four MRs were
available, 36 of which were excluded owing to
nonpsychotic diagnoses or a psychotic disorder due to
a general medical condition. Of the remaining 668 patients, 176 (26.3%) were lost to
follow-up. Four hundred ninety-two subjects were
analyzed. Strategies to assure validity and reliability of
diagnoses were applied.
Results: The same diagnosis was made
at baseline (<= 6 weeks after admission into EPPIC) and 18 months for 69.9% of the patients.
Among the most consistent diagnoses were
schizophrenia (97.3%), schizoaffective disorder (94.1%),
and bipolar disorder (83.2%); the least stable, as
expected, was schizophreniform disorder (40.0%). In subjects with schizophreniform disorder
at baseline, the best predictors of a shift from schizophreniform disorder to schizophrenia
or schizoaffective disorder were a higher baseline Clinical Global Impressions-Severity of
Illness scale score and lower premorbid Global
Assessment of Functioning score, although the
variance accounted for was small (R2 = .07).
Conclusions: A longitudinally based
diagnostic process in FEP samples is needed,
especially in schizophreniform disorder and bipolar
disorder. However, a thorough initial assessment
of patient and family by a specialized team of
investigators regarding the kind and duration of
patient symptoms may lead to high diagnostic
stability, especially in schizophrenia and
schizoaffective disorder, even in a FEP sample with a
relatively short duration of untreated psychosis.