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Concurrent Diagnostic Validity of a Structured Psychiatric Interview
Abstract
• In order to estimate the concurrent validity of a structured psychiatric interview, we compared interview diagnoses obtained for 101 psychiatric inpatients to those recorded in the same patients' hospital charts. For most diagnoses considered, concordance was found to be high. For those in which concordance was low, we examined the reasons for the diagnostic discrepancy. Diagnostic errors that were judged to have occurred on the basis of the structured interview often seemed to have resulted from a lack of longitudinal clinical observation. However, more errors were judged to have occurred in the hospital charts, apparently because of physician oversight. We conclude that the concurrent validity of this structured interview is high and that such examinations might be useful not only for research but also for the routine initial evaluation of psychiatric patients.
The use of Structured Diagnostic Assessments (SDAs) is a solution for unreliability in psychiatry and the gold standard for diagnosis. However, except for studies between the 50 s and 70 s, reliability without the use of Non-SDAs (NSDA) is seldom tested, especially in non-Western, Educated, Industrialized, Rich, and Democratic (WEIRD) countries. We aim to measure reliability between examiners with NSDAs for psychiatric disorders. We compared diagnostic agreement after clinician change, in an outpatient academic setting. We used inter-rater Kappa measuring 8 diagnostic groups: Depression (DD: F32, F33), Anxiety Related Disorders (ARD: F40–F49, F50–F59), Personality Disorders (PD: F60–F69), Bipolar Disorder (BD: F30, F31, F34.0, F38.1), Organic Mental Disorders (Org: F00–F09), Neurodevelopment Disorders (ND: F70–F99) and Schizophrenia Spectrum Disorders (SSD: F20–F29). Cohen’s Kappa measured agreement between groups, and Baphkar’s test assessed if any diagnostic group have a higher tendency to change after a new diagnostic assessment. We analyzed 739 reevaluation pairs, from 99 subjects who attended IPUB’s outpatient clinic. Overall inter-rater Kappa was moderate, and none of the groups had a different tendency to change. NSDA evaluation was moderately reliable, but the lack of some prevalent hypothesis inside the pairs raised concerns about NSDA sensitivity to some diagnoses. Diagnostic momentum bias (that is, a tendency to keep the last diagnosis observed) may have inflated the observed agreement. This research was approved by IPUB’s ethical committee, registered under the CAAE33603220.1.0000.5263, and the UTN-U1111-1260–1212.
Diagnosing drug abuse and dependence is a task complicated by differences among people and the compounds used. Although acknowledging these multiple interactions, common behavior patterns and similarities in the development of a substance use disorder can be seen. These we refer to as stages in the abuse and dependence process. They need to be thoroughly understood by any clinician who seeks to do diagnostic interviewing.
The purpose of this chapter is to argue that the status of clinical psychology and psychotherapy is chaotic on many grounds. Many clinical psychologists and psychotherapists practice with little regard to theory as a guide to practice or to research as an evaluative link to interventions. Instead many clinical psychologists and psychotherapists base their interventions on the by-now-outdated 1on1, f2f, tb paradigm using intuitive and creative, nonreplicable improvisations that result in various Towers of Babel in evaluation, practice, research, and theory. In addition to reliability and validity, clinical psychologists and psychotherapists will need to follow a requirement of specificity, as shown in Fig. 2.1 of this volume.
Diagnosing drug abuse and dependence is a task complicated by differences among individuals and the compounds used. Although acknowledging these multiple interactions, common behavior patterns and similarities in the development of substance use disorders can be seen. We refer to these developmental phenomena as stages in the abuse and dependence process. They need to be thoroughly understood by any clinician who seeks to do diagnostic evaluations. These stages are discussed in detail in this section.
Structured psychological assessment (SPA) is considered as a deliberate, ordered means of collecting and organizing both subject self-report and professional ratings that allows a comparison of a particular individual to standards or guidelines (e.g., diagnostic criteria) and/or normative group data. SPA is a critical component to any formal psychological evaluation in that it is an informed, intentional process that involves the collection and integration of information from multiple methods or sources specific to the goals of a particular evaluation of an individual. We contend that, as in other areas of forensic and clinical evaluation, specific components or elements of psychological assessments—particularly, psychological testing and structured clinical ratings and interviews—should constitute a central component of any significant comprehensive evaluation of a sexual offender, particularly given limitations and issues in both self-report of sexual offenders and unstructured clinical judgment of evaluators. The purpose of this chapter is to characterize the nature and role of SPA measures in both clinical and forensic evaluations of sexual offenders and to identify the multidimensional personality tests, structured rating scales, and structured diagnostic interviews available to be utilized in such evaluations. In addition, a detailed discussion is offered of the particular application of the measures of SPA in providing information relevant to various issues of significance in the appraisal of sexual offenders. Such an approach regards “assessment” as an information-collection and decision-making process in which the evaluator formulates conclusions and opinions by iteratively considering and integrating various sources of information obtained via optimal, available structured means. SPA is particularly effective when results are considered in the context of available comprehensive records and other collateral sources of information regarding the individual under consideration. The use of SPA is virtually ubiquitous for all significant clinical and forensic evaluations generally and should represent the best standard of practice relating to all formal comprehensive psychosocial evaluations of sexual offenders by virtue of combining the possible and identified sexual offender’s self-report in relation to normative data, and structured professional judgment provides a unique substantive platform for understanding a particular sexual offender and offering unique and valuable information for decision-making about such offenders.
Previous studies of the association between inflammatory bowel disease and psychiatric illness have generated mixed results, and the findings have been hard to evaluate because of methodological problems in both ascertainment and evaluation of subjects. Most studies have allowed the introduction of selection bias by using patients referred for study, for treatment, or who were self selected, rather than by using a consecutive series. Precision of medical and psychiatric evaluation has often been faulty. Moreover, there have been few attempts to look at the relationship between ulcerative colitis or Crohn’s disease and psychiatric disorder other than a simple association. It is not known, for example, if Crohn’s or ulcerative colitis patients with a diagnosable psychiatric illness differ from others in terms of the severity or natural history of their gastrointestinal involvement. Finally, the suggestion that psychologically stressful life events may precipitate symptoms is complicated by methodological problems of such magnitude as to make the available studies uninterpretable. This report will discuss two areas; problems with methodology and the evidence (including our own) relating psychiatric illness to inflammatory bowel disease. The difficulty in using this information to support a psychiatric etiology for these diseases will also be stressed.
Although many psychiatrists believe that schizophrenia and manic depression are aetiologically distinct conditions, it is also held that both can be precipitated by parturition. That the same provoking event should affect them equally seems rather improbable. The association with the manic depressive diathesis is well founded on the work of Bratfos and Haug (1966) and Reich and Winokur (1970) who showed high puerperal breakdown rates in these patients, but there is no such evidence in schizophrenia. Is it possible that the apparent occurrence of puerperal schizophrenia is spurious, another consequence of the muddle over the diagnosis of schizophrenia? In theory this should be a simple epidemiolo- gical question to answer; all we need do is to define ‘puerperal psychosis’ and ‘schizophrenia’ and study a series of postpartum psychoses to see whether the form of the illness is schizophrenic.
Structured and semistructured interviews are methods of collecting data on psychiatric disorders according to specific diagnostic criteria. They are used primarily for research, but clinicians also find them helpful in clarifying psychiatric diagnoses. The interviews are particularly important because they are the means by which the data are systematically collected for much of modern psychiatric research. Moreover, the validity of research results in many instances depends on the effectiveness of these instruments.
Despite clinical reports of impaired memory functioning of depressed persons, the results of empirical studies in this area have been equivocal. The present study was designed to address a number of the methodological shortcomings of these earlier investigations, examining potential depressionassociated deficits in sensory and short-term memory processing in a single sample of subjects. Twenty depressed and 20 nondepressed subjects participated in two tasks, each examining one of these aspects of memory. The results of this study suggest that whereas sensory memory is intact in depressed individuals, short-term memory processing is impaired. More specifically, the depressed subjects experienced difficulty with the retention of material, likely owing to impaired rehearsal ability. The results of this study are discussed with respect to their implications for cognitive models of depression, and suggestions for future research in this area are offered.
The divisions concerning interviewing strategies that have persisted among clinicians with different frames of reference and between clinicians and social scientists rest largely on unexamined traditional assumptions about the necessary differences in their subjects and methods. Such divisions have been disadvantageous for the investigation of many kinds of research problems. Sufficient bases exist for a synthesis of psychodynamic and structured interviewing techniques and such a strategy can be applied to both patient and nonpatient populations. Such a synthesis offers the potential of yielding a more complete and unbiased understanding of both the objective dimension of the behavior and the subjective dimension of motivations and meaning associated with psychosocial problems.
Diagnostic information for psychiatric research often depends on both clinical interviews and medical records. Although discrepancies between these two sources are well known, there have been few studies into the degree and origins of inconsistencies.
We compared data from structured interviews and medical records on 1,970 Han Chinese women with recurrent DSM-IV major depression (MD). Correlations were high for age at onset of MD (0.93) and number of episodes (0.70), intermediate for family history (+0.62) and duration of longest episode (+0.43) and variable but generally more modest for individual depressive symptoms (mean kappa = 0.32). Four factors were identified for twelve symptoms from medical records and the same four factors emerged from analysis of structured interviews. Factor congruencies were high but the correlation of factors between interviews and records were modest (i.e. +0.2 to +0.4).
Structured interviews and medical records are highly concordant for age of onset, and the number and length of episodes, but agree more modestly for individual symptoms and symptom factors. The modesty of these correlations probably arises from multiple factors including i) inconsistency in the definition of the worst episode, ii) inaccuracies in self-report and iii) difficulties in coding medical records where symptoms were recorded solely for clinical purposes.
Researchers studying psychosocial problems have largely been divided between those focusing on behavioral and attitudinal dimensions, and those looking primarily at the motvations underlying the behavior. In the attempt to achieve a more comprehensive understanding of such problems, the authors have utilized a data collection strategy involving both psychodynamic and structured interviewing in order to uncover both behavioral and motivational dimensions. Drawing on material obtained in a study of chronic marijuana smoking among adults, the authors illustrate how the combined use of psychodynamic and structured interviews enhances the accuracy of the meanings and interpretations placed on the information which respondents provide to researchers, thereby leading to more valid conclusions about the topic under study.
A major innovation of the ICD-10 draft is provision of diagnostic guidelines. This is assumed to be appropriate for use in clinical situations. In Norway a similar approach was adopted when ICD-9 was introduced as the official classification system in 1987. This was done in order to avoid national diagnostic bias and increase diagnostic reliability. A comparison with the DSM-III criteria was included in the diagnostic guidelines. The effectiveness of this approach was investigated by comparing the chart ICD-9 diagnoses of 104 psychiatric in- and outpatients from 2 teaching hospitals with the diagnoses obtained by using case record rating forms (criterion diagnosis). According to the criterion diagnoses, the base rate of chart diagnoses of schizophrenia and manic-depressive psychosis was too low, and the base rate of reactive psychosis too high. Several chart diagnoses proved to have low reliability, particularly reactive psychosis, paranoid psychosis, depressive neurosis and personality disorders. The study suggests that the provision of extensive diagnostic guidelines does not necessarily alter previous diagnostic practice. Reasons for these findings and the implications for the ICD-10 diagnostic criteria and diagnostic guidelines are discussed.
A sample of 163 children and adolescents, consecutively admitted to a large, private psychiatric teaching hospital, was interviewed using the child version of the Diagnostic Interview Schedule for Children (DISC-C). Patients, ages 12 to 16, were interviewed during the first month of admission. Kappa coefficients were obtained from cross-tabulated frequencies of DISC and clinician diagnoses. Agreement between clinical and DISC diagnoses was generally poor across diagnostic categories. In general, when algorithms of a higher threshold were used, the percentage of patients in a particular diagnostic group was closer to the percentage diagnosed by the clinician. Discussion focuses on factors that may contribute to the discrepancy between number and type of diagnoses that the DISC yields compared to those made by the clinicians.
An interactive, computerized version of the Diagnostic Interview Schedule (DIS) was completed by 135 randomly selected psychiatric inpatients and evaluated by the patients and their psychiatrists. The results showed that the majority of the patients interacted well with the computer and that the treating psychiatrists found the computer reports generally accurate and helpful. Analysis of the agreement between the computer and the psychiatrists' diagnoses yielded mixed results depending on the method of analysis chosen. The thoroughness, consistency, and broad perspective of the computer interview combined with the insight, creativity, and experience of the well-trained clinician may ultimately provide a method of diagnosis that is superior to either used alone.
The relationship of the DSM‐III categories to the national diagnostic usage of ICD is of importance for communication between psychiatrists.
Here the theoretical relationship between the DSM‐III categories and the Norwegian use of ICD‐8 within the area of functional psychoses is discussed. An empirical investigation of these theoretical assumptions has been done on a hospital material diagnosed independently in the two classificatory systems. The empirical investigation gives support to the concordance of DSM‐III schizophreniform, Schizoaffective, and bipolar disorder and the Norwegian ICD‐8 Counterparts. The concordance is less for schizophrenic disorders and major depressoin. It is also found that the norwegian diagnoses of reactive psychoses spread over may DSM‐III diagnoses. In particular more of the reactive psychoses than predicted fall within the schizophrenic spectrum of DSM‐III.
We Gratefully acknowledge Bernice Rosman and Jonathan Schull for their helpful contributions to this project.
NIMH-DIS was translated into Chinese and modified to the Chinese version of DIS (DIS-CM). One hundred clinical patients and 187 community subjects were studied for diagnostic agreement between the DIS-CM and the psychiatrist's clinical diagnosis. In the community sample, DIS-CM overdiagnosed the cases of manic episode, phobic disorder, obsessive-compulsive disorder and alcoholic problem, while it underdiagnosed the cases of tobacco dependence in the community sample and manic episode in the clinical cases. Standard diagnostic criteria, method of symptom detection, and social desirability, were identified as the major factors contributing to the diagnostic disparity. Variables related to life situations, language habit and medical histories were also analysed to test the external validity of the DIS-CM in case identification. The results affirm that the DIS-CM is reliable as a psychiatric epidemiological tool.
The authors compared the diagnoses made for 50 patients in an emergency room with those made during a subsequent inpatient hospitalization. They found an acceptable level of reliability for broad diagnostic categories, such as psychosis, depression, and alcoholism. The authors believe such diagnostic reliability is sufficient for emergency assessment and triage. However, the diagnosis of more specific subtypes of mental illness, such as schizophrenia and bipolar disorder, were not made reliably in the emergency room. The authors point out the risk of diagnostic labeling, and suggest that the tendency to overlook nonalcoholic substance abuse deserves special attention.
Recently, there has been increased recognition of the importance of classification in the study of depression. Despite the popularity of the RDC and Feighner criteria to define groups for research, there have been few systematic evaluations and comparisons between these nosologies and DSM-III. These three classifications of depression were evaluated according to a series of criteria considered important for classifications in order to provide diagnosticians with a checklist for choosing between them. The research literature was reviewed to determine whether each classification satisfied these criteria. Overall, DSM-III fared best, largely because of structural improvements over earlier nosologies. A major problem with all three was within group heterogeneity and lack of cross-cultural generalizability. Situations in which each classification may be preferable are discussed.
The gastroenterologist is faced every day with patients who have a psychiatric illness as a primary significant diagnosis. This encounter occurs frequently because certain of the psychiatric illnesses can have gastrointestinal symptoms as a presenting complaints. Most important among these are depression and hysteria, which can present with anorexia, nausea, vomiting, a change in bowel habits, and abdominal pain. Table I lists the psychiatric disorders which can present with primary intestinal complaints. The psychiatric disorders which do not present with primary gastrointestinal complaints are also interesting, as they include some diagnoses considered to be associated with some intestinal disorders. Those psychiatric disorders not usually presenting with GI symptoms include schizophrenia, bipolar affective disorders (mania), phobic neurosis, obsessive compulsive neurosis, and personality disorders. Personality disorders are seen with functional GI disorders, but the association is often unrelated to the presenting complaints.
The focus of this study was on the patterns of appearance of alcoholism in the families of two groups: 90 male and female alcoholic inpatients and 30 control psychiatric inpatients. Results indicated that there was at least one first-degree- or one second-degree-relative family member who was diagnosed as alcoholic in 78% of the male alcoholic proband families and in 75% of the female alcoholic proband families. Prevalence of alcoholism for first- and second-degree relatives was similar. Thus, this pedigree study supports the genetic transmission hypothesis for alcoholism and suggests that "assortative mating" may have an effect on the transmission of alcoholism.
Fifty consecutive patients with ulcerative colitis were personally examined to determine the lifetime prevalence of specific psychiatric diagnoses. A personality assessment and a tabulation of recently occurring stressful events were done. A matched control sample with chronic nongastrointestinal medical illnesses was evaluated in the same way. The two groups were compared so as to quantify the relative association and impact of psychiatric disorder in ulcerative colitis. We found no greater frequency of diagnosable psychiatric disorder in ulcerative colitis patients than in the control population. Those with ulcerative colitis and a psychiatric illness did not appear to have more serious gastrointestinal involvement, nor did severity of the ulcerative colitis predict more frequent or more serious psychiatric disorder. Personality profiles were similar in probands and controls, and there was no correlation between the frequency of potentially stressful life events within the six months prior to interview and severity of ulcerative colitis at the time of interview. We did find slightly higher levels of obsessional symptomatology in ulcerative colitis cases, but this association appeared to be weak and unrelated to the severity of the gastrointestinal disorder. Despite the fact that more than a quarter of the ulcerative colitis patients had some diagnosable psychiatric illness, the occurrence of psychiatric disorder was rarely documented in the medical charts.
Synopsis
A new diagnostic instrument, The Diagnostic Interview Schedule, was evaluated for use by lay interviewers by comparing its DSM-III diagnoses when given by lay interviewers with results obtained through an independent interview by a psychiatrist using the same schedule, his clinical judgement after the interview, his clinical judgement after both the interview and a free question period, and with diagnoses on the medical chart.
In this study we assess the reliability of rating past psychiatric symptoms and lifetime diagnoses in a currently ill population using the SADS and RDC. Five raters from different centers interviewed 25 subjects in a short-interval test-retest design. Subjects had a wide diversity of affective and non-affective diagnoses and high levels of manifest psychopathology. Our results demonstrate that it is possible for raters from different research centers to reliably rate lifetime diagnoses and previous symptoms. Two important exceptions to the high reliability are the lifetime diagnoses of hypomania and the recurrent unipolar subtype of major depressive disorder, and we alert clinicians and researchers to be cautious when diagnosing these conditions. We conclude that the next step in measuring reliability should be a long-interval test-retest design with separate interviews conducted at the later assessment, one by the original rater and the other by a blind rater.
In a test-retest reliability study involving 25 psychiatric patients and 5 professional raters we demonstrate that research clinicians from collaborating institutions are able to achieve good reliability for most areas of the SADS and RDC when assessing psychiatrically ill patients under interview conditions that provide even less data than ideally obtained in the practice of clinical research. We expect greater reliability in the actual use of the SADS/RDC on most items and diagnoses since the SADS is intended to be used in conjunction with information obtained from relatives, friends, and treatment staff to confirm and clarify the judgements made by the raters on the patient interviews. Moreover, we are reassured that the diagnosis of schizo-affective disorders and schizophrenia is protected from the item unreliability found with specific delusions and hallucinations. Similarly, the difficulties in determining the episodic and chronic nature of the present episode does not substantially interfere with making an RDC diagnosis of the current condition. A complex diagnostic interview system such as the SADS and RDC requires multiple complementary techniques to determine reliability. We find that establishing explicit procedures for raters to discuss and categorize the reasons for their disagreements on individual items and diagnoses provides valuable data for understanding reliability problems. This has helped us to identify specific areas of the interview and criteria that require further clarification and more intensive rater training to improve ratings made by interviewers.
A series of 414 chronic pain patients referred to Are Hospital, Are, Sweden, for evaluation and rehabilitation were administered a structured diagnostic interview to detect alcohol and drug misuse and dependence according to DSM-III-R criteria. A total of 97 (23.4%) met criteria for active alcohol, analgesic, or sedative misuse or dependency; an additional 39 (9.4%) met criteria for a remission diagnosis. Current dependency was most common for analgesics (12.6%) followed by alcohol (9.7%) and sedatives (7.0%).
The present study investigated the concordance of clinical and research-based DSM-III-R diagnoses in community, public, and university hospital first-admission patients. In addition to demographic characteristics, information and criterion variance were assessed as explanations for the diagnostic disagreements.
As part of the Suffolk County (New York) Mental Health Project, 223 first-admission subjects with a psychotic disorder were interviewed with the Structured Clinical Interview for DSM-III-R, and consensus diagnosis was made by two project psychiatrists. Clinical diagnoses were abstracted from discharge summaries obtained subsequent to the research diagnoses, and reasons for disagreement between the two diagnoses were determined.
Moderate overall agreement between facility and research diagnoses was found, with highest agreement with the university facility, lowest with the public facilities, and intermediate agreement with the community facilities. Demographic variables were not significantly associated with diagnostic discordance. Apparent reasons for diagnostic disagreement included evidence of variability in information available to clinicians and research psychiatrists (N = 39 or 48% of cases with disagreement), as well as in clinical judgment in the application of DSM-III-R criteria (N = 42 or 52% of cases with disagreement).
Considerable differences between facility and research diagnoses remain, especially in the public and community sectors; these differences can be attributed to information and criterion variance. Longitudinal follow-up is necessary to establish the predictive validity of the initial clinical and research diagnoses. Future research should also address other possible reasons for these discrepancies.
Many patients treated for substance use disorders (SUDs) who become involved in 12-Step self-help groups have improved treatment outcomes. However, due to high rates of psychiatric comorbidity and major depressive disorder (MDD), among SUD patients in particular, concerns have been raised over whether these benefits extend to dual diagnosis patients. This study examined the influence of comorbid MDD among patients with SUDs on 12-Step self-help group involvement and its relation to treatment outcome.
A quasi-experimental, prospective, intact group design was used with assessments completed during treatment, and 1 and 2 years postdischarge.
A total of 2161 male patients recruited during in-patient SUD treatment, of whom 110 had a comorbid MDD diagnosis (SUD-MDD) and 2051 were without psychiatric comorbidity (SUD-only).
SUD-MDD patients were initially less socially involved in and derived progressively less benefit from 12-Step groups over time compared to the SUD-only group. However, substance use outcomes did not differ by diagnostic cohort. In contrast, despite using substantially more professional out-patient services, the SUD-MDD cohort continued to suffer significant levels of depression.
Treatment providers should allocate more resources to targeting depressive symptoms in SUD-MDD patients. Furthermore, SUD-MDD patients may not assimilate as readily into, nor benefit as much from, traditional 12-Step self-help groups such as Alcoholics Anonymous, as psychiatrically non-comorbid patients. Newer, dual-diagnosis-specific, self-help groups may be a better fit for these patients, but await further study.
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.
This study aimed to compare diagnoses obtained from routine psychiatric assessment in accident and emergency (A&E) settings with those from a standardized diagnostic interview.
Using Cohen's kappa, the agreement between diagnoses from routine psychiatric assessment and structured interview was calculated. Further statistical analysis was used to investigate differences between some of the main diagnostic subgroups.
The overall kappa value for all diagnoses was .47. Adjustment disorder, major depressive disorder and alcohol misuse/dependence were commonly identified, both at routine assessment and on structured interview. There was a disparity between the two diagnostic systems in the extent to which major depressive disorder and adjustment disorder were identified. Further analysis between these two groups was inconclusive as to the reasons for this difference.
There was moderate agreement between clinical and standardized diagnoses. Anxiety disorders were poorly identified at routine assessment. There is difficulty distinguishing between adjustment disorder and depressive episode in the A&E setting.
To examine the diagnostic stability and the functional outcome of patients with early-onset psychosis (EOP) over a 2-year follow-up period.
A total of 24 patients (18 males (75%) and 6 females (25%), mean age +/- SD: 15.7 +/- 1.6 years) with a first episode of EOP formed the sample. Psychotic symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). Social disability was measured with the Global Assessment of Functioning (GAF) disability scale. Diagnosis was assessed using the Kiddie-Sads-Present and Lifetime Version (K-SADS-PL), according to DSM-IV criteria. All diagnoses were re-assessed after 1 year and 2 years.
Schizophrenia had the highest prospective consistency (100% predictive value), while diagnostic stability was moderate for bipolar disorder (71.4%), and low for schizoaffective disorder (50%), schizophreniform and brief psychosis (50%), and psychosis not otherwise specified (NOS) (16.7%). The agreement between the baseline diagnoses and the 1-year follow-up diagnoses was 54.2%, whereas between the 1-year follow-up and the 2-year follow-up, it rose to 95.7%. Regardless of diagnosis, baseline negative symptoms were the only significant predictor of level of functioning at the 2-year follow-up (p = 0.010).
Our results highlight the primacy of the first-year follow-up diagnosis in predicting diagnostic stability of EOP.
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