Diagnostic Consistency of Major Depression With Psychosis Across 10 Years
| Autor: | Camilo J. Ruggero, Evelyn J. Bromet, David A. González, Marsha Tanenberg-Karant, Gabrielle A. Carlson, Roman Kotov |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
medicine.medical_specialty
Psychosis Bipolar Disorder Time Factors Psychotic depression Article mental disorders medicine Humans Longitudinal Studies Bipolar disorder Diagnostic Errors Psychiatry Depression (differential diagnoses) Observer Variation Psychiatric Status Rating Scales Depressive Disorder Major medicine.disease Psychiatry and Mental health Hypomania Psychotic Disorders Schizophrenia Major depressive disorder medicine.symptom Psychology Mania Clinical psychology |
| Zdroj: | The Journal of Clinical Psychiatry. 72:1207-1213 |
| ISSN: | 0160-6689 |
| Popis: | Major depressive disorder (MDD) with psychotic features is common. Between 15% and 19% of MDD cases in the community report psychotic symptoms.1, 2 MDD with psychosis is associated with worse symptoms, impairment and outcomes than MDD without psychosis.3, 4 There has been a longstanding debate over whether MDD with psychosis simply represents a severity dimension of MDD or constitutes a separate syndrome.5,6 A key piece of evidence in this discussion involves long-term follow-up.7 Many studies have considered long-term outcomes or treatment response,8-27 but few have performed follow-up diagnostic interviews to determine changes, if any, to the original diagnosis. With regard to symptomatology, the National Institute of Mental Health Collaborative Program on the Psychobiology of Depression reported that 10.2% of patients with depression developed mania or hypomania during a 10-year follow-up.28,29 Psychosis among the patients with MDD was highly recurrent across time.30 Two short-term follow-ups, however, raise questions about the stability of the diagnosis itself. The first was the one-year follow-up of the Epidemiologic Catchment Area (ECA) cohort which found that 10.1% of the cohort originally diagnosed with psychotic depression met criteria for schizophrenia one year later, and 3.3% met criteria for bipolar disorder.1 The second was the earlier follow-up of the Suffolk County cohort31 which found that among 103 participants diagnosed with MDD with psychosis at 6-month follow-up, 20 (19.4%) were rediagnosed at two-year follow-up with a non-affective psychosis and 7 (7.8%) with bipolar disorder. Assessment of diagnostic consistency is important for at least three reasons. First, it speaks to the reliability and validity of the diagnostic criteria.7 Second, it affects interpretation of existing literature. Low diagnostic consistency would mean that previous outcome studies may have included individuals who did not retain the MDD diagnosis, thereby biasing results. Third, frequent shifts in diagnosis have implications for case management and treatment. The primary goal of the present research therefore was to determine how often the diagnosis of MDD with psychosis was revised and changed to and from another psychotic disorder across 10 years. We considered shifts from MDD to bipolar disorder, from MDD to a schizophrenia spectrum disorder, as well as other patterns of diagnostic change. A final goal was to explore clinical factors associated with different diagnostic shifts. Data for the study were obtained as part of the Suffolk County Mental Health Project,32 a prospective, epidemiologic study of first admission patients with psychosis. Diagnoses were evaluated at four time points over the 10-year follow-up based on research-based diagnostic reassessments. Reports from the 10-year wave of the project have already considered the long-term consistency of the diagnosis of bipolar disorder33 and schizophrenia34 and the stability of the baseline diagnoses.35 This is the first study to focus on the frequency with which MDD with psychosis was diagnosed and the factors associated with its consistency. |
| Databáze: | OpenAIRE |
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