title: Diagnostic shifts during the decade following first admission for psychosis.
abstract: OBJECTIVE
  Diagnostic shifts have been prospectively examined in the short term, but the long-term stability of diagnoses has rarely been evaluated. The authors examined diagnostic shifts over a 10-year follow-up period.
  
  
  METHODS
  A cohort of 470 first-admission patients with psychotic disorders was systematically assessed at baseline and at 6-month, 2-year, and 10-year follow-ups. Longitudinal best-estimate consensus diagnoses were formulated after each assessment.
  
  
  RESULTS
  At baseline, the diagnostic distribution was 29.6% schizophrenia spectrum disorders, 21.1% bipolar disorder with psychotic features, 17.0% major depression with psychotic features, 2.4% substance-induced psychosis, and 27.9% other psychoses. At year 10, the distribution changed to 49.8%, 24.0%, 11.1%, 7.0%, and 8.1%, respectively. Overall, diagnoses were changed for 50.7% of study participants at some point during the study. Most participants who were initially diagnosed with schizophrenia or bipolar disorder retained the diagnosis at year 10 (89.2% and 77.8%, respectively). However, 32.0% of participants (N=98) originally given a non-schizophrenia diagnosis had gradually shifted to a schizophrenia diagnosis by year 10. The second largest shift was to bipolar disorder (10.7% of those not given this diagnosis at baseline). Changes in the clinical picture explained many diagnostic shifts. In particular, poorer functioning and greater negative and psychotic symptom ratings predicted a subsequent shift to schizophrenia. Better functioning and lower negative and depressive symptom ratings predicted the shift to bipolar disorder.
  
  
  CONCLUSIONS
  First-admission patients with psychotic disorders run the risk of being misclassified at early stages in the illness course, including more than 2 years after first hospitalization. Diagnosis should be reassessed at all follow-up points.
authors.affiliation: Department of Psychiatry and Behavioral Science, Stony Brook University School of Medicine, NY 11794-8790, USA. evelyn.bromet@stonybrook.edu
authors.forename: Evelyn J
authors.initials: EJ
authors.lastname: Bromet
authors.forename: Roman
authors.initials: R
authors.lastname: Kotov
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Fochtmann
authors.forename: Gabrielle A
authors.initials: GA
authors.lastname: Carlson
authors.forename: Marsha
authors.initials: M
authors.lastname: Tanenberg-Karant
authors.forename: Camilo
authors.initials: C
authors.lastname: Ruggero
authors.forename: Su-wei
authors.initials: SW
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000175:diagnosis*; D012559:Schizophrenia / Q000175:diagnosis*