Diagnostic stability of psychiatric disorders in clinical practice.
BACKGROUND
Psychiatric disorders are among the top causes worldwide of disease burden and disability. A major criterion for validating diagnoses is stability over time.


OBJECTIVE
To evaluate the long-term stability of the most prevalent psychiatric diagnoses in a variety of clinical settings.


METHODS
A total of 34 368 patients received psychiatric care in the catchment area of one Spanish hospital (1992-2004). This study is based on 10 025 adult patients who were assessed on at least ten occasions (360 899 psychiatric consultations) in three settings: in-patient unit, 2000-2004 (n=546); psychiatric emergency room, 2000-2004 (n=1408); and out-patient psychiatric facilities, 1992-2004 (n=10 016). Prospective consistency, retrospective consistency and the proportion of patients who received each diagnosis in at least 75% of the evaluations were calculated for each diagnosis in each setting and across settings.


RESULTS
The temporal consistency of mental disorders was poor, ranging from 29% for specific personality disorders to 70% for schizophrenia, with stability greatest for in-patient diagnoses and least for out-patient diagnoses.


CONCLUSIONS
The findings are an indictment of our current psychiatric diagnostic practice.
Baca-Garcia
Enrique
E
Department of Psychiatry, Fundacion Jimenez Diaz University Hospital, Autonomous University of Madrid, Avenida Reyes Catolicos 2, 28040 Madrid, Spain. ebacgar2@yahoo.es.
Perez-Rodriguez
Maria M
MM
Basurte-Villamor
Ignacio
I
Fernandez del Moral
Antonio L
AL
Jimenez-Arriero
Miguel A
MA
Gonzalez de Rivera
Jose L
JL
Saiz-Ruiz
Jeronimo
J
Oquendo
Maria A
MA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology