Diagnostic Stability in Patients with First-Episode Psychosis

2005 ◽  
Vol 13 (4) ◽  
pp. 388-392 ◽  
Author(s):  
Homayoun Amini ◽  
Javad Alaghband-Rad ◽  
Abbas Omid ◽  
Vandad Sharifi ◽  
Rozita Davari-Ashtiani ◽  
...  
Keyword(s):  
Psychotic Disorders ◽  
International Classification Of Diseases ◽  
First Episode Psychosis ◽  
Classification Systems ◽  
First Episode ◽  
Episode Psychosis ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Dsm Iv

Objective: To examine the short-term stability of Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) and International Classification of Diseases (10th revision; ICD-10) diagnoses in a group of patients with first-episode psychosis. Method: Sixty patients with first-episode psychosis admitted consecutively to Roozbeh Hospital, Tehran, were sampled; their illnesses could not be attributed to any medical or substance-induced conditions. Patients were assessed at the time of discharge from the hospital, and at 3, 6and 12 month intervals following admission. Ateach visit, two psychiatrists made consensusDSM-IV and ICD10 diagnoses, based on all available information. Stability was discerned as the consistency between diagnoses at the time of discharge and at 12 month follow up. Results: Forty-eight patients completed follow up. Affective psychotic disorders and schizophrenia in both classification systems were highly stable. In addition, all patients with DSM-IV brief psychotic disorder and ICD-10 acute and transient psychotic disorders remained the same at follow up. Conclusions: Affective psychoses and schizophrenia, in line with previous findings, remained stable. Diagnoses of brief psychoses were highly stable as well; this could reflect a non-relapsing course ofacute brief psychoses, especially in developing countries.

The Inter-Rater and Test-Retest Reliabilities of Prodromal Symptoms in First-Episode Psychosis

1996 ◽  
Vol 30 (4) ◽  
pp. 498-504 ◽  
Author(s):  
Henry J. Jackson ◽  
Patrick D. McGorry ◽  
Susan Harrigan ◽  
Jenepher Dakis ◽  
Lisa Henry ◽  
...  
Keyword(s):  
Field Trial ◽  
American Psychiatric Association ◽  
Psychotic Disorders ◽  
First Episode Psychosis ◽  
World Health ◽  
First Episode ◽  
Prodromal Symptoms ◽  
Episode Psychosis ◽  
Dsm Iv ◽  
Health Organization

Objective: As part of the DSM-IV field trial for psychotic disorders, the authors endeavoured to determine the reliability of the DSM-IV prodromal features for schizophrenia in a first-episode sample. Method: Fifty first-episode psychotic patients were assessed using a semi-structured instrument to determine the presence/absence of nine prodromal symptoms. Inter-rater reliability data were calculated for 25 of the patients, and test-retest data were calculated for the remaining 25 patients. Results: Levels of reliability were poor. Conclusions: The results lend some support to American Psychiatric Association and World Health Organization decisions to omit specific criteria for prodromal features from their respective nosologies.

Relapse After First-Episode Psychosis: A 3-Year Follow-Up

2017 ◽  
Vol 41 (S1) ◽  
pp. S276-S276
Author(s):  
E. Pereira ◽  
M. Mota Oliveira ◽  
R. Guedes ◽  
M.J. Peixoto ◽  
I. Ferraz ◽  
...  
Keyword(s):  
Psychotic Disorders ◽  
Statistical Significance ◽  
First Episode Psychosis ◽  
Response To Treatment ◽  
First Episode ◽  
Final Sample ◽  
Episode Psychosis ◽  
Competing Interest ◽  
Relapse Rates

IntroductionRelapse after first-episode psychosis (FEP) is a frequent problem, which can lead to patients’ poorer functioning and response to treatment. Its prevention is one of the most important and challenging targets in the treatment of psychotic disorders.ObjectivesTo characterize and evaluate relapse rates after FEP, during the course of 3 years, of a group of patients admitted at a psychiatry department.MethodsA retrospective observational study was conducted. Patients with a FEP between ages 18 to 40, admitted at the Clinic of Psychiatry and Mental Health at São João Hospital Centre between January 1, 2007 and September 30, 2013. Only patients with, at least, 3 years of follow-up at the clinic were included.ResultsFinal sample of 58 patients, 39 of which were male (mean age = 26.4 years). Forty patients were excluded by not completing the 3 years follow-up at our department. The cumulative relapse rates were 32.8% at 12 months, 53.4% at 24 months and 63.8% at 36 months. Patients with at least one relapse were younger (25.78 years vs. 27.52 years) and had shorter periods of first hospitalization (19.25 days vs. 23.52 days). These data did not reach statistical significance. Non-adherence to prescribed medication was described in 73.0% (n = 27) of patients at the time of relapse. Eight of them (21.6%) presented with cannabis use.ConclusionsAlthough no statistical significance was reached, our findings are consistent with other studies. A future study with a bigger sample would be important in achieving statistical significant results.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A systematic review of longitudinal outcome studies of first-episode psychosis

2006 ◽  
Vol 36 (10) ◽  
pp. 1349-1362 ◽  
Author(s):  
N. M. MENEZES ◽  
T. ARENOVICH ◽  
R. B. ZIPURSKY
Keyword(s):  
Psychotic Disorders ◽  
First Episode Psychosis ◽  
First Episode ◽  
Future Research ◽  
Significant Heterogeneity ◽  
Chronic Patients ◽  
Psychosocial Therapy ◽  
Longitudinal Outcome ◽  
Episode Psychosis

Background. Existing outcome literature has had an over-representation of chronic patients and suggested a progressive course and poor outcome for schizophrenia. The current study aimed to recombine data of samples from longitudinal studies of first-episode psychosis (FEP) to describe outcome and its predictors.Method. A literature search (1966–2003) was conducted for prospective studies examining outcome in first-episode non-affective psychosis using the following key words: early, first, incident, episode, admission, contact, psychosis, schizophrenia, psychotic disorders, course, outcome, follow-up, longitudinal, cohort. These were pooled and analyzed using descriptive and regression analyses.Results. Thirty-seven studies met the inclusion criteria, representing 4100 patients with a mean follow-up of 35·1±6·0 months. Studies varied in the categories of outcome used, the most common being ‘good’ (54% of studies) and ‘poor’ (34% of studies), variably defined. In studies reporting these categories, good outcomes were reported in 42·2% (3·5%) and poor outcomes in 27·1% (2·8%) of cases. Predictors associated with better outcome domains were: combination of pharmacotherapy and psychosocial therapy, lack of epidemiologic representativeness of the sample, and a developing country of origin. Use of typical neuroleptics was associated with worse outcome. Stratification analyses suggested that populations with schizophrenia only, and those with prospective design, were associated with worse outcome domains.Conclusions. Outcome from FEP may be more favorable than previously reported, and treatment and methodological variables may be important contributors to outcome. Significant heterogeneity in definitions and methodology limited the comparison and pooling of data. A multi-dimensional, globally used definition of outcome is required for future research.

scholarly journals Acute and transient psychotic disorders: precursors, epidemiology, course and outcome

2004 ◽  
Vol 185 (6) ◽  
pp. 452-459 ◽  
Author(s):  
Swaran P. Singh ◽  
Tom Burns ◽  
Shazad Amin ◽  
Peter B. Jones ◽  
Glynn Harrison
Keyword(s):  
Psychotic Disorders ◽  
First Episode Psychosis ◽  
Acute Onset ◽  
Favourable Outcome ◽  
First Episode ◽  
Affective Psychosis ◽  
Episode Psychosis ◽  
Icd 10 ◽  
Premorbid Functioning ◽  
Better Than

BackgroundICD–10 has introduced the diagnostic group acute and transient psychotic disorders (ATPDs; F23). Aims To validate the nosological distinctiveness of ICD–10 ATPDs by following up an inception cohort with first-episode psychosis. Method All patients with first-episode psychosis identified in Nottingham between 1992 and 1994 and diagnosed using ICD–10 criteria were reassessed 3 years later. ATPD outcomes were compared with schizophrenia and affective psychosis. Multivariate analyses were conducted to determine whether acute onset and early remission predicted favourable 3-year outcome in first-episode psychosis. Results Of 168 cases of first-episode psychosis, 32 (19%) received an intake diagnosis of ATPD. The diagnosis of ATPD was stable in women over 3 years, but not in men. Outcomes in ATPD were better than in schizophrenia and similar to affective psychosis. In non-affective psychoses, favourable outcomes were a function of gender and premorbid functioning rather than acute onset and early remission. Conclusions The ICD–10 criteria for ATPDs identify a diagnostically unstable group of disorders. Acute onset and early remission do not independently predict favourable outcome over 3 years in first-episode psychosis.

Change in cannabis use, clinical symptoms and social functioning among patients with first-episode psychosis: a 5-year follow-up study of patients in the OPUS trial

2013 ◽  
Vol 44 (1) ◽  
pp. 117-126 ◽  
Author(s):  
L. Clausen ◽  
C. R. Hjorthøj ◽  
A. Thorup ◽  
P. Jeppesen ◽  
L. Petersen ◽  
...  
Keyword(s):  
Antipsychotic Medication ◽  
Negative Symptoms ◽  
Psychotic Disorders ◽  
Clinical Symptoms ◽  
First Episode Psychosis ◽  
Cannabis Use ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Episode Psychosis

BackgroundSeveral studies indicate that cannabis use among patients with psychotic disorders is associated with worse outcome, but only a few studies have controlled for baseline condition and medication.MethodAt 5-year follow-up, interviews were carried out with 314 first-episode psychosis patients included in the OPUS trial. The patients included were in the age range of 18 to 45 years old and 59% were male. Cannabis use was extracted from the Schedule for Clinical Assessment in Neuropsychiatry. At follow-up, the patients were divided into different groups according to the variable cannabis use: abstainers, stoppers, starters and continuers. Psychotic, negative and disorganized dimensions (ranging from zero to five) were calculated for each of the four groups based on the Schedule for the Assessment of Positive and Negative Symptoms in Schizophrenia.ResultsCannabis users were younger (24.6 years v. 27.4 years, p < 0.001) and had a lower level of education. At the 5-year follow-up, users of cannabis had higher scores on the psychotic dimension [difference 0.97, 95% confidence interval (CI) 0.41–1.53, p = 0.001] and lower levels of the Global Assessment of Functioning (difference 8.26, 95% CI 2.13–14.39, p = 0.01). Those who stopped using cannabis between entry and 5-year follow-up had a significantly lower level of psychotic symptoms at 5-year follow-up even after controlling for baseline level of psychotic symptoms and for insufficient antipsychotic medication (adjusted difference in psychotic dimension –1.04, 95% CI –1.77 to –0.31, p = 0.006).ConclusionsContinuous cannabis use was associated with higher levels of psychotic symptoms after 5 years, and this association was only partly explained by insufficient antipsychotic medication.

scholarly journals S228. SOCIAL AND OCCUPATIONAL FUNCTIONING AND SATISFACTION WITH CARE IN FINNISH FIRST-EPISODE PSYCHOSIS PATIENTS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S125-S125
Author(s):  
Paula Barrientos ◽  
Jaana Suvisaari ◽  
Tuula Kieseppä
Keyword(s):  
Patient Satisfaction ◽  
Psychotic Disorders ◽  
First Episode Psychosis ◽  
Diagnostic Interview ◽  
First Episode ◽  
Satisfaction With Care ◽  
Episode Psychosis ◽  
Psychiatric Staff

Abstract Background Patient satisfaction with care (PSC) is a valuable predictor in both quality of life and treatment outcomes with psychiatric patients. First episode psychosis (FEP) patients are a diverse group of usually young adults. Determining the factors behind PSC in FEP patients could be an important tool in planning better care programs and predictive tools for the outcome of FEP. Many FEP patients are still on the cusp of their adult lives. Achieving better treatment adherence by higher PSC could help many people back to their studies or work lives and enhance their quality of life and social and occupational functioning. Determining background factors and associations with better PSC would help tailoring treatment options for FEP patients. Methods The Helsinki Early Psychosis Study recruited FEP patients (aged 18 to 40 years old) who were having their first treatment of psychosis in the catchment area of the Helsinki University Hospital and the psychiatric services of Helsinki City in the time period from December 2010 to June 2016. The diagnoses of psychotic disorders were later verified using the Structured Diagnostic Interview for DSM-IV, Research Version, as well as a review of all medical records. Substance-induced psychotic disorders and psychotic disorders due to a general medical condition were excluded. Baseline assessment was conducted as soon as the patient had entered treatment and was able to give informed consent according to the treating personnel. Follow ups were conducted at 2 months after baseline. Data was gathered on symptoms, sociodemographic factors, functioning, overall health, aspects of treatment and medication. Duration of untreated psychosis was determined as accurately as possible with the help of patient records and diagnostic interview. Patient satisfaction was evaluated by PSQ (Patient satisfaction questionnaire) developed by Swedish researchers for their early intervention program for first episode psychosis patients. The questionnaire contains ten questions about different aspects of the patients’ care and was part of the 2-month follow-up protocol. Results 97 patients were recruited in the study. Out of those patients, 72 patients participated in the 2-month follow up and 51 filled out the PSC questionnaire. The results of the PSQ were translated into a dichotomist scale of “satisfied” (very or rather satisfied) or “not satisfied” (neither satisfied nor dissatisfied; rather or very dissatisfied). Interestingly, DUP was not associated with higher or lower satisfaction with care unlike in other studies. Conversely, higher SOFAS score at the 2-month follow up was associated with better treatment satisfaction. Especially patients who felt they had been able to influence their care, who felt that the sessions with the psychiatric staff been helpful, and who were satisfied with the concern and understanding the psychiatric staff had shown had significantly higher SOFAS than those who were not satisfied with these aspects of care, whereas e.g. attitudes regarding medication were not significantly associated with SOFAS. A summary score of the PSQ correlated positively with the 2 month SOFAS scores (Spearman rho 0.40, p=0.007). Discussion Unlike in many other studies, longer DUP was not associated with poorer PSC. Instead, satisfaction with qualitative aspects of treatment contact and being able to influence treatment decisions were associated with better functioning. This suggest that the staff-patient relationship and empowering patients in treatment decisions are important in the treatment of FEP.

Diagnostic trajectory, interplay and convergence/divergence across all 12 DSM-IV psychotic diagnoses: 6-year follow-up of the Cavan-Monaghan First Episode Psychosis Study (CAMFEPS)

2013 ◽  
Vol 43 (12) ◽  
pp. 2523-2533 ◽  
Author(s):  
T. Kingston ◽  
P. J. Scully ◽  
D. J. Browne ◽  
P. A. Baldwin ◽  
A. Kinsella ◽  
...  
Keyword(s):  
Psychotic Disorder ◽  
A Priori ◽  
Individual Case ◽  
First Episode Psychosis ◽  
First Episode ◽  
Psychotic Illness ◽  
Episode Psychosis ◽  
Dsm Iv

BackgroundThe boundaries of psychotic illness and the extent to which operational diagnostic categories are distinct in the long term remain poorly understood. Clarification of these issues requires prospective evaluation of diagnostic trajectory, interplay and convergence/divergence across psychotic illness, without a priori diagnostic or other restrictions.MethodThe Cavan-Monaghan First Episode Psychosis Study (CAMFEPS), conducted using methods to attain the closest approximation to epidemiological completeness, incepts all 12 DSM-IV psychotic diagnoses. In this study we applied methodologies to achieve diagnostic reassessments on follow-up, at a mean of 6.4 years after first presentation, for 196 (97%) of the first 202 cases, with quantification of prospective and retrospective consistency.ResultsOver 6 years, the 12 initial psychotic diagnoses were characterized by numerous transitions but only limited convergence towards a smaller number of more stable diagnostic nodes. In particular, for initial brief psychotic disorder (BrP), in 85% of cases this was the harbinger of long-term evolution to serious psychotic illness of diagnostic diversity; for initial major depressive disorder with psychotic features (MDDP), in 18% of cases this was associated with mortality of diverse causality; and for initial psychotic disorder not otherwise specified (PNOS), 31% of cases continued to defy DSM-IV criteria.ConclusionsCAMFEPS methodology revealed, on an individual case basis, a diversity of stabilities in, and transitions between, all 12 DSM-IV psychotic diagnoses over 6 years; thus, psychotic illness showed longitudinal disrespect to current nosology and may be better accommodated by a dimensional model. In particular, a first episode of BrP or MDDP may benefit from more vigorous, sustained interventions.

What’s Happened to Paraphrenia? The Modernity of Emil Kraepelin’s Thinking

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
L. Pelizza ◽  
F. Bonazzi
Keyword(s):  
Psychotic Disorders ◽  
Diagnostic Category ◽  
International Classification Of Diseases ◽  
Delusional Disorder ◽  
Systematic Research ◽  
Diagnostic And Statistical Manual ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Dsm Iv

Paraphrenia is a psychotic disorder described by Kraepelin in 1913. He formulated this concept to define a group of patients who exhibited symptoms characteristic of dementia praecox (marked delusions with or without hallucinations), but with minimal disturbances of emotion and volition, and much less personality deterioration. after the publication of Mayer"s prognostic research in 1921 (which studied the outcomes of 78 paraphrenic patients reported by Kraepelin), the view to differentiate paraphrenia from schizophrenia was considered to be unfounded in Germany. Paraphrenia is now diagnosed relatively infrequently and is not listed in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) or International Classification of Diseases (ICD-10). However, it appears that some psychiatrists recognize the illness but label it "atypical psychosis", "schizoaffective disorder," or "delusional disorder" for lack of a better diagnostic category.Virtually no systematic research on paraphrenia has been conducted in the past 60 years. We describe a 30-year-old man affected by sistematic paraphrenia, according to the neo-Kraepelinian description of paraphrenia proposed by Ravindran et al. in 1999 (description compatible with the formats of DSM-IV and ICD-10). Using a questionnaire adapted from this description, our case of paraphrenia were distinguished from those of schizophrenia and delusional disorder. in conclusion, It is possible to define and recognize paraphrenia, because it is a viable diagnostic entity. as in the days of Kraepelin, the problems concerning paraphrenia cannot be neglected when considering the classification of psychotic disorders.

scholarly journals Validity of nosological classification

1999 ◽  
Vol 1 (3) ◽  
pp. 185-190
Keyword(s):  
International Classification Of Diseases ◽  
Point Of View ◽  
Classification Systems ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Medical Classification ◽  
Dsm Iv

The term "nosological classification" is often used in connection with medical classification systems, and the tendency is to equate it with "diagnosis" and "validity." However, particularly in the case of psychiatry this is far from always being the case. From a scientific point of view, the two most up-to-date classification systems in use today - the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), and the International Classification of Diseases, 10th Revision (ICD-10) - may be considered as the theoretical basis of current psychiatric nosology. In this paper we show that the instrumentally generated DSM-IV or ICD-10 diagnoses of schizophrenia have relatively low validity in comparison with clinician expert diagnoses. If medical classification is to be realistic, simple to use, and reliable, nosological systems must be based not only on established facts, but also on theoretical assumptions regarding the nature of disease.

scholarly journals Diagnostic change 10 years after a first episode of psychosis

2015 ◽  
Vol 45 (13) ◽  
pp. 2757-2769 ◽  
Author(s):  
M. Heslin ◽  
B. Lomas ◽  
J. M. Lappin ◽  
K. Donoghue ◽  
U. Reininghaus ◽  
...  
Keyword(s):  
Population Based ◽  
First Episode ◽  
Drug Induced ◽  
Episode Psychosis ◽  
Icd 10 ◽  
Dsm Iv ◽  
Drug Induced Psychosis ◽  
Using Data ◽  
Psychotic Bipolar Disorder

BackgroundA lack of an aetiologically based nosology classification has contributed to instability in psychiatric diagnoses over time. This study aimed to examine the diagnostic stability of psychosis diagnoses using data from an incidence sample of psychosis cases, followed up after 10 years and to examine those baseline variables which were associated with diagnostic change.MethodData were examined from the ÆSOP and ÆSOP-10 studies, an incidence and follow-up study, respectively, of a population-based cohort of first-episode psychosis cases from two sites. Diagnosis was assigned using ICD-10 and DSM-IV-TR. Diagnostic change was examined using prospective and retrospective consistency. Baseline variables associated with change were examined using logistic regression and likelihood ratio tests.ResultsSlightly more (59.6%) cases had the same baseline and lifetime ICD-10 diagnosis compared with DSM-IV-TR (55.3%), but prospective and retrospective consistency was similar. Schizophrenia, psychotic bipolar disorder and drug-induced psychosis were more prospectively consistent than other diagnoses. A substantial number of cases with other diagnoses at baseline (ICD-10, n = 61; DSM-IV-TR, n = 76) were classified as having schizophrenia at 10 years. Many variables were associated with change to schizophrenia but few with overall change in diagnosis.ConclusionsDiagnoses other than schizophrenia should to be regarded as potentially provisional.

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