Stability of schizophrenia diagnosis in a 10-year longitudinal study on first episode of non-affective psychosis: Conclusions from the PAFIP cohort.
Suárez-Pinilla P; Department of Psychiatry, University Hospital Marqués de Valdecilla, IDIVAL, Santander, Spain.; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
Suárez-Pinilla M; Department of Neurodegenerative Disease, Institute of Neurology, University College of London, London, UK.
Setién-Suero E; Department of Psychiatry, University Hospital Marqués de Valdecilla, IDIVAL, Santander, Spain.; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
Ortiz-García de la Foz V; Department of Psychiatry, University Hospital Marqués de Valdecilla, IDIVAL, Santander, Spain.; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
Mayoral-Van Son J; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.; Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocío - IBiS, Sevilla, Spain.
Vázquez-Bourgon J; Department of Psychiatry, University Hospital Marqués de Valdecilla, IDIVAL, Santander, Spain.; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
Gómez-Revuelta M; Department of Psychiatry, University Hospital Marqués de Valdecilla, IDIVAL, Santander, Spain.
Juncal-Ruíz M; Department of Psychiatry, IDIVAL, School of Medicine, Sierrallana Hospital, University of Cantabria, Torrelavega, Spain.
Ayesa-Arriola R; Department of Psychiatry, University Hospital Marqués de Valdecilla, IDIVAL, Santander, Spain.; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
Crespo-Facorro B; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.; Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocío - IBiS, Sevilla, Spain.
Acta psychiatrica Scandinavica [Acta Psychiatr Scand] 2021 Oct; Vol. 144 (4), pp. 342-357. Date of Electronic Publication: 2021 Jul 21.
Typ publikacji :
Imprint Name(s) :
Publication: Malden, MA : Wiley-Blackwell
Original Publication: Copenhagen : Munksgaard International Publishers
MeSH Terms :
Child ; Humans ; Longitudinal Studies ; Male ; Prospective Studies ; Retrospective Studies
American Psychiatric Association. DSM-5 Diagnostic Classification. In: Diagnostic and Statistical Manual of Mental Disorders. Arlington, VA: American Psychiatric Association; 2013.
Van Os J, Rutten BPF, Poulton R. Gene-environment interactions in schizophrenia: review of epidemiological findings and future directions. Schizophr Bull. 2008;34:1066-1082.
Maria Pelayo-Teran J, Suarez-Pinilla P, Chadi N, Crespo-Facorro B. Gene-environment interactions underlying the effect of cannabis in first episode psychosis. Curr Pharm Des. 2012;18:5024-5035.
Green AI, Canuso CM, Brenner MJ, Wojcik JD. Detection and management of comorbidity in patients with schizophrenia. Psychiatr Clin North Am. 2003;26:115-139.
Slotema CW, Blom JD, Niemantsverdriet MBA, Deen M, Sommer IEC. Comorbid diagnosis of psychotic disorders in borderline personality disorder: prevalence and influence on outcome. Front Psychiatry. 2018;9:14.
Keshavan MS, Kaneko Y. Secondary psychoses: an update. World Psychiatry. 2013;12:4-15.
Vrbova K, Prasko J, Holubova M, et al. Self-stigma and schizophrenia: a cross-sectional study. Neuropsychiatr Dis Treat. 2016;12:3011-3020.
Ayesa-Arriola R, Manuel Rodríguez-Sánchez J, Pérez-Iglesias R, et al. The relevance of cognitive, clinical and premorbid variables in predicting functional outcome for individuals with first-episode psychosis: a 3 year longitudinal study. Psychiatry Res. 2013;209:302-308.
McGorry PD. Early intervention in psychosis: obvious, effective, overdue. J Nerv Ment Dis. 2015;203:310-318.
Bird V, Premkumar P, Kendall T, Whittington C, Mitchell J, Kuipers E. Early intervention services, cognitive-behavioural therapy and family intervention in early psychosis: systematic review. Br J Psychiatry. 2010;197:350-356.
Schimmelmann BG, Conus P, Edwards J, McGorry PD, Lambert M. Diagnostic stability 18 months after treatment initiation for first-episode psychosis. J Clin Psychiatry. 2005;66:1239-1246.
Kahn RS, Sommer IE, Murray RM, et al. Schizophrenia. Nat Rev Dis Prim. 2015;1:1-23.
McGorry PD. Early clinical phenotypes, clinical staging, and strategic biomarker research: building blocks for personalized psychiatry. Biol Psychiatry. 2013;74:394-395.
Klaerke LR, Baandrup L, Fagerlund B, et al. Diagnostic stability and long-term symptomatic and functional outcomes in first-episode antipsychotic-naïve patients with schizophrenia. Eur Psychiatry. 2019;62:130-137.
Mason P, Harrison G, Croudace T, Glazebrook C, Medley I. The predictive validity of a diagnosis of schizophrenia. A report from the International Study of Schizophrenia (ISoS) coordinated by the World Health Organization and the department of psychiatry, University of Nottingham. Br J Psychiatry. 1997;170:321-327.
Kessing LV. People diagnosed with schizophrenia retain the diagnosis long term: commentary. Evid. Based. Ment. Health. 2005;8:68.
Veen ND, Selten J-P, Schols D, et al. Diagnostic stability in a Dutch psychosis incidence cohort. Br J Psychiatry. 2004;185:460-464.
Addington J, Chaves A, Addington D. Diagnostic stability over one year in first-episode psychosis. Schizophr Res. 2006;86:71-75.
Haahr U, Friis S, Larsen TK, et al. First-episode psychosis: diagnostic stability over one and two years. Psychopathology. 2008;41:322-329.
Schwartz JE, Fennig S, Tanenberg-Karant M, et al. Congruence of diagnoses 2 years after a first-admission diagnosis of psychosis. Arch Gen Psychiatry. 2000;57:593-600.
Subramaniam M, Pek E, Verma S, Chong SA, Chan YH. Diagnostic stability 2 years after treatment initiation in the Early Psychosis Intervention Programme in Singapore. Aust N Z J Psychiatry. 2007;41:495-500.
Amin S, Singh SP, Brewin J, Jones PB, Medley I, Harrison G. Diagnostic stability of first-episode psychosis. Comparison of ICD-10 and DSM-III-R systems. Br J Psychiatry. 1999;175:537-543.
Heslin M, Lomas B, Lappin JM, et al. Diagnostic change 10 years after a first episode of psychosis. Psychol Med. 2015;45:2757-2769.
Bromet EJ, Naz B, Fochtmann LJ, Carlson GA, Tanenberg-Karant M. Long-term diagnostic stability and outcome in recent first-episode cohort studies of schizophrenia. Schizophr Bull. 2005;31:639-649.
Gale-Grant O, Dazzan P, Lappin JM, et al. Diagnostic stability and outcome after first episode psychosis. J Ment Heal. 2021;30:104-112.
Fusar-Poli P, Cappucciati M, Rutigliano G, et al. Diagnostic stability of ICD/DSM first episode psychosis diagnoses: meta-analysis. Schizophr Bull. 2016;42:1395-1406.
Pelayo-Terán JM, Pérez-Iglesias R, Ramírez-Bonilla MariLuz, et al. Epidemiological factors associated with treated incidence of first-episode non-affective psychosis in Cantabria: insights from the clinical programme on early phases of psychosis. Early Interv Psychiatry. 2008;2:178-187.
Crespo-Facorro B, Pelayo-Terán JM, Pérez-Iglesias R, et al. Predictors of acute treatment response in patients with a first episode of non-affective psychosis: sociodemographics, premorbid and clinical variables. J Psychiatr Res. 2007;41:659-666.
Ayesa-Arriola R, Ortíz-García de la Foz V, Martínez-García O, et al. Dissecting the functional outcomes of first episode schizophrenia spectrum disorders: a 10-year follow-up study in the PAFIP cohort. Psychol Med. 2021;51:264-277.
First MB, Gibbon M, Spitzer R, Williams J. User’s guide for the structured clinical interview for DSM-IV axis I Disorders - Research version. Washington, D.C.: American Psychiatric Press; 1996.
First MB, Gibbon M. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II). In: Hilsenroth MJ, Segal DL, eds. Comprehensive handbook of psychological assessment, Vol. 2. Personality assessment, . John Wiley & Sons Inc; 2004:134-143.
Canoon-Spoor H, Potkin S, Wyatt R. Measurement of premorbid adjustment in chronic schizophrenia. Schizophr Bull. 1982;8:470-484.
Andreassen N. Scale for the Assessment of Negative Symptoms (SANS). Iowa City: University of Iowa; 1983.
Andreassen N. Scale for the Assessment of Positive Symptoms (SAPS). Iowa City: University of Iowa; 1983.
Flemenbaum A, Zimmermann RL. Inter and intra rater reliability of the brief psychiatric rating scale. Psychol Rep. 1973;32:783-792.
Addington D, Addington J, Maticka-Tyndale E. Assessing depression in schizophrenia: The Calgary depression scale. In: British Journal of Psychiatry. Br J Psychiatry Suppl, 1993;22:39-44.
Young RC, Biggs JT, Ziegler VE, Meyer DA. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry. 1978;133:429-435.
Guy W. The clinical global impression scale. In: ECDEU Assessment Manual for Psychopharmacology-Revised. Rockville: National Institute of Mental Health, 1976:218-222.
Andreasen NC, Carpenter WT, Kane JM, Lasser RA, Marder SR, Weinberger DR. Remission in schizophrenia: proposed criteria and rationale for consensus. Am J Psychiatry. 2005;162:441-449.
Caseiro O, Pérez-Iglesias R, Mata I, et al. Predicting relapse after a first episode of non-affective psychosis: a three-year follow-up study. J Psychiatr Res. 2012;46:1099-1105.
Mayoral-van Son J, de la Foz V-G, Martinez-Garcia O, et al. Clinical outcome after antipsychotic treatment discontinuation in functionally recovered first-episode nonaffective psychosis individuals: a 3-year naturalistic follow-up study. J Clin Psychiatry. 2016;77:492-500.
Pelayo-Terán JM, Gajardo Galán VG, de la Ortiz-García de la Foz V, et al. Rates and predictors of relapse in first-episode non-affective psychosis: a 3-year longitudinal study in a specialized intervention program (PAFIP). Eur Arch Psychiatry Clin Neurosci. 2017;267:315-323.
Youden WJ. Index for rating diagnostic tests. Cancer. 1950;3:32-35.
Bergh S, Hjorthøj C, Sørensen HJ, et al. Predictors and longitudinal course of cognitive functioning in schizophrenia spectrum disorders, 10 years after baseline: The OPUS study. Schizophr Res. 2016;175:57-63.
Chang WC, Yee Man Tang J, Lai Ming Hui C, et al. The relationship of early premorbid adjustment with negative symptoms and cognitive functions in first-episode schizophrenia: a prospective three-year follow-up study. Psychiatry Res. 2013;209 3:353-360.
Arciniegas DB. Psychosis. Contin. Lifelong Learn. Neurol. 2015;21:715-736.
Cuesta MJ, Basterra V, Sanchez-Torres A, Peralta V. Controversies surrounding the diagnosis of schizophrenia and other psychoses. Expert Rev Neurother. 2009;9:1475-1486.
Waters F, Fernyhough C. Hallucinations: a systematic review of points of similarity and difference across diagnostic classes. Schizophr Bull. 2017;43:32-43.
Gras A, Amad A, Thomas P, Jardri R. Hallucinations et trouble de personnalité borderline : une revue de littérature. Encephale. 2014;40:431-438.
Buckley PF, Miller BJ, Lehrer DS, Castle DJ. Psychiatric comorbidities and schizophrenia. Schizophr Bull. 2009;35:383-402.
Van Os J, Kenis G, Rutten BPF. The environment and schizophrenia. Nature. 2010;468:203-212.
Henderson C, Noblett JO, Parke H, et al. Mental health-related stigma in health care and mental health-care settings. Lancet Psychiatry. 2014;1:467-482.
Marshall M, Lewis S, Lockwood A, Drake R, Jones P, Croudace T. Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Arch Gen Psychiatry. 2005;62:975-983.
Murru A, Carpiniello B. Duration of untreated illness as a key to early intervention in schizophrenia: a review. Neurosci Lett. 2018;669:59-67.
Moriarty PJ, Lieber D, Bennett A, et al. Gender differences in poor outcome patients with lifelong schizophrenia. Schizophr Bull. 2001;27:103-113.
Mojtabai R, Bromet EJ, Harvey PD, Carlson GA, Craig TJ, Fennig S. Neuropsychological differences between first-admission schizophrenia and psychotic affective disorders. Am J Psychiatry. 2000;157:1453-1460.
Contributed Indexing :
Keywords: cohort*; diagnosis*; first-episode psychosis*; follow-up*; schizophrenia*
Entry Date(s) :
Date Created: 20210706 Date Completed: 20210922 Latest Revision: 20210922
Update Code :
Objective: To evaluate the 10-year stability of schizophrenia diagnosis in a cohort of first-episode psychosis (FEP) patients and the factors associated with it.
Methods: Changes in diagnosis of 209 FEP patients were described during 10 years of follow-up. Related factors with maintenance or change of schizophrenia diagnosis were evaluated in prospective and retrospective approaches through binary logistic regressions, ROC and survival curves.
Results: Out of the 209 patients, 126 were diagnosed of schizophrenia 6 months after their inclusion in the clinical program. Prospective analyses showed that eight of those 126 schizophrenia patients had changed to a different diagnosis after 10 years, and predictors of change were better childhood premorbid adjustment, less severity of clinical global impression at baseline, and diagnosis of comorbid personality disorder during follow-up. Retrospectively, out of the 154 patients with schizophrenia in the 10-year assessment, 36 had a different diagnosis at baseline, and those factors related to a different prior diagnosis than schizophrenia were better socioeconomic status and shorter duration of untreated psychosis (DUP). A survival analysis on the timing of schizophrenia diagnosis showed that male gender and longer DUP were predictors of earlier definite diagnosis.
Conclusions: Diagnostic stability of schizophrenia in our FEP sample is high, especially prospective stability, and the group of patients with diagnostic change corresponded to a milder psychopathological profile before and at the onset of disease. Moreover, we observed a cautious attitude in the diagnosis of schizophrenia in patients with shorter DUP who had schizophrenia diagnosis after 10 years.
(© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)