DIAGNOSTIC CONSISTENCY AND CHANGE IN A FOLLOW-UP STUDY OF 1215 PATIENTS

Diagnostic stability of schizophrenia: A systematic review

The objective is to systematically review previous literature on the diagnostic stability of schizophrenia, particularly to investigate prospective and retrospective consistency. We carried out a systematic literature search in PubMed and other minor sources from 1980 to July 2017. Specifically, prospective and retrospective consistency were examined. Thirty-nine studies were included, 5 focused on schizophrenia, 23 on psychotic episodes and 11 on psychiatric disorders in general. Samples sizes range from 60 to 10 058 subjects (total N = 39 965). The majority of studies (n = 26, 66.67%) were performed in Europe and North America and they had a prospective design (n = 27, 69.23%), with a median follow-up of 3 years. Prospective and retrospective consistency means were 84.29% and 67.15% respectively. Diagnostic change was also frequently measured (n = 12, mean 31.28%). The factors more commonly associated with diagnostic stability were: male sex, older age at the study inception, older age at onset, late stages of illness, family history of mental illness, poorer functioning and longer length of stay. Schizophrenia was found to have high diagnostic stability over time, although research on this topic is mainly focused in first psychotic episodes. More standardized methods are needed to further research diagnostic stability of schizophrenia over time and its determinants.

Decreasing rates of incident schizophrenia cases in psychiatric service: A review of the literature

A review of the literature shows that the admission rates of new cases of schizophrenia vary with a factor of two to five in North American studies as well as in European studies. Furthermore, the tendency has been decreasing for the last 40-50 years in Europe. Eighteen studies specifically analyzing the development over the last 20 years are reviewed. The studies preponderantly show significant decreases most probably due to the reduction of the number of available psychiatric beds alongside the decentralization of psychiatry, and to decreasing virulence of schizophrenia. Alternatively, a diagnostic delay of schizophrenia can hardly explain the decrease.

Stability of psychiatric diagnoses in New Zealand psychiatric hospitals

This study examines the stability over a five year follow-up of first admission psychiatric diagnoses assigned in New Zealand psychiatric hospitals in 1980 and 1981. Diagnostic stability is a measure of the degree to which psychiatric diagnoses remained unchanged at a later hospital admission. Reasonably high levels of stability were found for the initial diagnoses of substance abuse disorders (86% stable), anorexia nervosa (70%), schizophrenia (67%), and affective disorder (67%). Poor levels of stability were noted for the initial diagnoses of personality disorder (36%), other psychosis (excluding schizophrenia and affective psychosis) (22%), and other neurosis (excluding neurotic depression) (20%). The major trends in diagnostic change are described. Factors influencing diagnostic instability are also examined. For patients with an initial diagnosis of schizophrenia, a change in hospital is found to be the strongest factor causing diagnostic instability, with time between admissions and age at first admission also having a significant influence. The implications of these findings are discussed.

Walk-in clinic and diagnostic stability

One hundred and six consecutively seen psychiatric patients who had undergone detailed evaluation had their diagnosis compared with that arrived at in a walk-in evaluation one week to one month prior to the index evaluation. There was a diagnostic change in 21 cases and a change in drugs in 14. The pitfalls of this method for administering rapid efficient psychiatric care in countries with inadequate psychiatric manpower are highlighted.

How depressing life is--life-long morbidity risk for depressive disorder in the general population

We present estimates of lifetime risk and of cumulative risk up to each age for depressive disorder for the population of an inner city area (Camberwell, SE London). Estimates are based on an incidence study for the year 1976 which drew from the records of a case register. The estimates of lifetime risk obtained, 12% for men and 20% for women, are similar to those previously published in the literature. Inception risk by age and risks for in-patient treatment are also presented for men and women. The method of calculation is discussed and we show how to obtain an upper limit for the effect of the increased mortality associated with the disorder. We noted an apparent decline over the 'seventies' in inception rates for depression, and we consider the comparability of our statistics with risks calculated using complete psychiatric history data.

Some social and phenomenological characteristics of psychotic immigrants

Various studies have shown: (i) increased rates of psychoses in immigrants to Britain, and a particularly high rate of schizophrenia in the West Indian- and West African-born; and (ii) a greater proportion of atypical psychoses in immigrants. A retrospective study of psychotic inpatients from a London psychiatric unit demonstrated increased rates of schizophrenia in patients from the Caribbean and West Africa. These patients included a high proportion of those with paranoid and religious phenomenology, those with frequent changes of diagnosis, formal admissions, and married women. The West Indian-born had been in Britain for nearly 10 years before first seeing a psychiatrist and, if they had an illness with religious symptomatology, were likely to have been in hospital for only 3 weeks. Rates of schizophrenia without paranoid phenomenology were similar in each ethnic group. It is suggested that the increase in the diagnosis of schizophrenia in the West Indian-born, and possibly in the West African-born, may be due in part to the occurrence of acute psychotic reactions which are diagnosed as schizophrenia.

A mental health system in transition: profiles of change

These profiles of the changing Saskatchewan mental health system reveal that there have been increases in the number of admissions, readmissions, discharges, and outpatients in both the public and private sectors. Divergent patterns in the utilization of services in the public sector occur among the Indian and non-Indian populations. Over the past several decades there have been considerable changes in the types of psychiatric problems treated in the psychiatric care system. The social, demographic and admission characteristics of the people receiving treatment in the system have changed substantially. The data presented here imply that the status of mental illness is not solely a function of a physical or psychiatric condition but has elastic features capable of being expanded or restricted by the prevailing organizational structure which has evolved to handle the "problem" of mental illness. The advent of community psychiatry plus attendant changes in the health system has altered the nature of mental illness treated in the province. Consequently, concerns about ways of evaluating the effectiveness of current programs, of choosing between alternate service delivery systems, of establishing criteria for equitable resource allocation, and of understanding the forces for change need to be raised and explicitly dealt with.

Consistency in the diagnosis of the functional psychoses

A review of the case books of 868 patients who had been admitted into a psychiatric hospital from January 1, 1970, to December 31, 1973, was carried out for consistency in the pattern of diagnosis by the same or different psychiatrists. Of these, 16.5% had a revision in diagnosis. The pertinent literature was reviewed. The possible factors that contribute to the observed inconsistency in diagnosis in this and other investigations are discussed. It is concluded that the problems as reflected in the significant change in diagnosis in this study are multifactorial. It is suggested that these problems may be related to the unknown etiology of the functional psychoses and the absence of identifiable specific lesions.

Symptoms of depression in two communities

Histories of depression-related symptoms were obtained from 3845 randomly selected adult residents of Kansas City, Missouri, and Washington County, Maryland. Depressed persons were slightly more common in Kansas City than in Washington County but within the latter area no urban-rural differences were observed. More depressed persons were found among blacks than among whites. Slightly more white females than males were depressed; no significant differences were found between black females and males. After adjustment for the effects of other independent variables, the probability of having symptoms of depression was highest among persons who were young adults, unmarried, not employed outside the home, poorly paid, and not well educated.

Marital status and schizophrenia

The finding that married persons are more likely to be hospitalized schizophrenics is reviewed. Three interpretations of the finding are discussed: causation, selection, and differential utilization. A strategy to separate the three hypotheses is presented which uses data on rates of admission and duration of hospitalization and which concentrates on the widowed category. Data from the Maryland Psychiatric Case Register are used to test the hypotheses. Evidence of selection and differential utilization is found, but none in favor of the causation hypothesis. It is shown that selection operates less powerfully in rural areas.

The stability of psychiatric diagnosis

Numerous studies of the reliability of psychiatric diagnosis have been published in the last twenty years, but most have been based either on a comparison of the diagnoses made by two or more raters at a single joint interview, or separate interviews a few days apart (the observer agreement model), or on a comparison of the overall spectrum of diagnoses assigned to two comparable series of patients (the frequency agreement model). Comparisons between the diagnoses assigned to patients on successive admissions, or at other widely separated points in time (the consistency or stability model), have been carried out less often, in spite of the fact that the usefulness of our diagnostic categories is just as dependent on temporal stability as on reliability in an observer agreement situation.

The diagnostic distribution of treated psychiatric illness in Lebanon

The background, methodology, and general results of a comprehensive survey of treated psychiatric illness in Lebanon have been described in an earlier report (4). The investigation consisted of obtaining biographical and diagnostic data on all patients seen by psychiatrists in Lebanon over a six-month period (15 February 1964 to 15 August 1964) and was carried out with the collaboration of all three psychiatric hospitals in the country and twenty of the twenty-one psychiatrists practising within and outside these institutions.

Diagnostic change in a longitudinal study of psychiatric patients

This paper describes an investigation into the reasons for change in diagnosis in a group of 200 mental hospital patients who were admitted to hospital four times in two years. The cohort consists of the 44,047 patients in England and Wales who had their first admission in 1954, and 46,238 similarly admitted in 1955. The first two years of their progress has already been described in detail (Brooke, E. M., 1963), and further reports are in progress.