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The Journal of clinical psychiatry
Feb, 2011;72 (2): 183-93.

McLean-Harvard International First-Episode Project: two-year stability of ICD-10 diagnoses in 500 first-episode psychotic disorder patients.

Paola Salvatore, Ross J Baldessarini, Mauricio Tohen, Hari-Mandir K Khalsa, Jesus Perez Sanchez-Toledo, Carlos A Zarate, Eduard Vieta, Carlo Maggini
Author Information
  1. Paola Salvatore: Department of Psychiatry and Neuroscience Program, Harvard Medical School, Boston, Massachusetts, USA. psalvatore@mclean.harvard.edu
PMID: 20673546 DOI: 10.4088/JCP.09m05311yel

Abstract

OBJECTIVE: Because clinical and biologic research and optimal clinical practice require stability of diagnoses over time, we determined stability of ICD-10 psychotic disorder diagnoses and sought predictors of diagnostic instability.
METHOD: Patients from the McLean-Harvard International First-Episode Project, conducted from 1989 to 2003, who were hospitalized for first psychotic illnesses (N = 500) were diagnosed by ICD-10 criteria at baseline and 24 months, on the basis of extensive prospective assessments, to evaluate the longitudinal stability of specific categorical diagnoses and predictors of diagnostic change.
RESULTS: Diagnostic stability averaged 90.4%, ranking as follows: schizoaffective disorder (100.0%) > mania with psychosis (99.0%) > mixed affective episode (94.9%) > schizophrenia (94.6%) > delusional disorder (88.2%) > severe depressive episode with psychotic symptoms (85.2%) > acute psychosis with/without schizophrenia symptoms = unspecified psychosis (all 66.7%) >> acute schizophrenia-like psychosis (28.6%). Diagnoses changed by 24 months of follow-up to schizoaffective disorder (37.5%), bipolar disorder (25.0%), schizophrenia (16.7%), or unspecified nonorganic psychosis (8.3%), mainly through emerging affective features. By logistic regression, diagnostic change was associated with Schneiderian first-rank psychotic symptoms at intake > lack of premorbid substance use.
CONCLUSIONS: We found some psychotic disorder diagnoses to be more stable by ICD-10 than DSM-IV criteria in the same patients, with implications for revisions of both diagnostic systems.

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Grants

  1. MH-04844/NIMH NIH HHS
  2. R03 MH073049/NIMH NIH HHS
  3. MH-73049/NIMH NIH HHS
  4. ZIA MH002927/Intramural NIH HHS
  5. MH-47370/NIMH NIH HHS
  6. MH-10948/NIMH NIH HHS
  7. ZIA MH002927-01/Intramural NIH HHS

MeSH Term

Adolescent
Adult
Anxiety Disorders
Comorbidity
Diagnosis, Differential
Diagnostic and Statistical Manual of Mental Disorders
Female
Follow-Up Studies
Humans
International Classification of Diseases
Male
Middle Aged
Personality Disorders
Psychotic Disorders
Substance-Related Disorders
Young Adult
Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't

Word Cloud

Created with Highcharts 10.0.0disorder>psychoticstabilitydiagnosespsychosisICD-10diagnostic0%schizophreniasymptomsclinicalpredictorsMcLean-HarvardInternationalFirst-Episode=500criteria24monthschangeschizoaffectiveaffectiveepisode946%2%acuteunspecified7%patientsOBJECTIVE:biologicresearchoptimalpracticerequiretimedeterminedsoughtinstabilityMETHOD:PatientsProjectconducted19892003hospitalizedfirstillnessesNdiagnosedbaselinebasisextensiveprospectiveassessmentsevaluatelongitudinalspecificcategoricalRESULTS:Diagnosticaveraged904%rankingfollows:100mania99mixed9%delusional88severedepressive85with/without66>>schizophrenia-like28Diagnoseschangedfollow-up375%bipolar2516nonorganic83%mainlyemergingfeatureslogisticregressionassociatedSchneiderianfirst-rankintakelackpremorbidsubstanceuseCONCLUSIONS:foundstableDSM-IVimplicationsrevisionssystemsProject:two-yearfirst-episode

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