Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-25T07:36:44.793Z Has data issue: false hasContentIssue false
  • English
  • Français

Diagnostic trajectory, interplay and convergence/divergence across all 12 DSM-IV psychotic diagnoses: 6-year follow-up of the Cavan-Monaghan First Episode Psychosis Study (CAMFEPS)

Published online by Cambridge University Press:  12 March 2013

T. Kingston ,
P. J. Scully ,
D. J. Browne ,
P. A. Baldwin ,
A. Kinsella ,
V. Russell ,
E. O'Callaghan  and
J. L. Waddington
T. Kingston
Affiliation:
Cavan-Monaghan Mental Health Service, St Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
P. J. Scully
Affiliation:
Cavan-Monaghan Mental Health Service, St Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland
D. J. Browne
Affiliation:
Cavan-Monaghan Mental Health Service, St Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland
P. A. Baldwin
Affiliation:
Cavan-Monaghan Mental Health Service, St Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland
A. Kinsella
Affiliation:
Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland DETECT Early Psychosis Service, Blackrock, County Dublin, Ireland
V. Russell
Affiliation:
Cavan-Monaghan Mental Health Service, St Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
E. O'Callaghan
Affiliation:
DETECT Early Psychosis Service, Blackrock, County Dublin, Ireland
J. L. Waddington*
Affiliation:
Cavan-Monaghan Mental Health Service, St Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
*
*Address for correspondence: Professor J. L. Waddington, Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin 2, Ireland. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The boundaries of psychotic illness and the extent to which operational diagnostic categories are distinct in the long term remain poorly understood. Clarification of these issues requires prospective evaluation of diagnostic trajectory, interplay and convergence/divergence across psychotic illness, without a priori diagnostic or other restrictions.

Method

The Cavan-Monaghan First Episode Psychosis Study (CAMFEPS), conducted using methods to attain the closest approximation to epidemiological completeness, incepts all 12 DSM-IV psychotic diagnoses. In this study we applied methodologies to achieve diagnostic reassessments on follow-up, at a mean of 6.4 years after first presentation, for 196 (97%) of the first 202 cases, with quantification of prospective and retrospective consistency.

Results

Over 6 years, the 12 initial psychotic diagnoses were characterized by numerous transitions but only limited convergence towards a smaller number of more stable diagnostic nodes. In particular, for initial brief psychotic disorder (BrP), in 85% of cases this was the harbinger of long-term evolution to serious psychotic illness of diagnostic diversity; for initial major depressive disorder with psychotic features (MDDP), in 18% of cases this was associated with mortality of diverse causality; and for initial psychotic disorder not otherwise specified (PNOS), 31% of cases continued to defy DSM-IV criteria.

Conclusions

CAMFEPS methodology revealed, on an individual case basis, a diversity of stabilities in, and transitions between, all 12 DSM-IV psychotic diagnoses over 6 years; thus, psychotic illness showed longitudinal disrespect to current nosology and may be better accommodated by a dimensional model. In particular, a first episode of BrP or MDDP may benefit from more vigorous, sustained interventions.

Keywords

Diagnostic categoriesfirst-episode psychosispsychopathological dimensionspsychotic illness6-year follow-up
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 12 , December 2013 , pp. 2523 - 2533
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Addington, J, Chaves, AC, Addington, D (2006). Diagnostic stability over one year in first-episode psychosis. Schizophrenia Research 86, 71–75.CrossRefGoogle ScholarPubMed
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC.Google Scholar
Baldwin, P, Browne, D, Scully, PJ, Quinn, JF, Morgan, MG, Kinsella, A, Owens, MJ, Russell, V, O'Callaghan, E, Waddington, JL (2005). Epidemiology of first-episode psychosis: illustrating the challenges across diagnostic boundaries through the Cavan-Monaghan study at 8 years. Schizophrenia Bulletin 31, 624–638.CrossRefGoogle Scholar
Black, DW, Boffeli, TJ (1989). Simple schizophrenia: past, present, and future. American Journal of Psychiatry 146, 1267–1273.Google ScholarPubMed
Bromet, E, Naz, B, Fochtmann, LJ, Carlson, GA, Tanenberg-Karant, M (2005). Long-term diagnostic stability and outcome in recent first-episode cohort studies of schizophrenia. Schizophrenia Bulletin 31, 639–649.CrossRefGoogle ScholarPubMed
Bromet, E, Kotov, R, Fochtmann, JL, Carlson, GA, Tanenberg-Karant, M, Ruggero, C, Chang, SW (2011). Diagnostic shifts during the decade following first admission for psychosis. American Journal of Psychiatry 168, 1186–1194.CrossRefGoogle ScholarPubMed
Brown, ES, Suppes, T (1998). Mood symptoms during corticosteroid therapy: a review. Harvard Review of Psychiatry 5, 239–246.CrossRefGoogle ScholarPubMed
Castagnini, A, Berrios, GE (2009). Acute and transient psychotic disorders (ICD-10 F23): a review from a European perspective. European Archives of Psychiatry and Clinical Neuroscience 259, 433–443.CrossRefGoogle ScholarPubMed
Caton, CL, Hasin, DS, Shrout, PE, Drake, RE, Dominguez, B, First, MB, Samet, S, Schanzer, B (2007). Stability of early-phase primary psychotic disorders with concurrent substance use and substance-induced psychosis. British Journal of Psychiatry 190, 105–111.CrossRefGoogle ScholarPubMed
Central Statistics Office (2003). Database Direct. Central Statistics Office: Cork, Ireland (www.cso.ie/census).Google Scholar
Chang, WC, Pang, SLK, Chung, DWS, Chan, SSM (2009). Five-year stability of ICD-10 diagnoses among Chinese patients presented with first-episode psychosis in Hong Kong. Schizophrenia Research 115, 351–357.CrossRefGoogle ScholarPubMed
Cheniaux, E, Landeira-Fernandez, J, Telles, LL, Lessa, JLM, Dias, A, Duncan, T, Versiani, M (2008). Does schizoaffective disorder really exist? A systematic review of the studies that compared schizoaffective disorder with schizophrenia or mood disorders. Journal of Affective Disorders 106, 209–217.CrossRefGoogle ScholarPubMed
Conus, P, Abdel-Baki, A, Harrigan, S, Lambert, M, McGorry, PD, Berk, M (2010). Pre-morbid and outcome correlates of first episode mania with psychosis: is a distinction between schizoaffective and bipolar I disorder valid in the early phase of psychotic disorders? Journal of Affective Disorders 126, 88–95.CrossRefGoogle ScholarPubMed
Craddock, N, Owen, MJ (2010). The Kraepelinian dichotomy – going, going… but still not gone. British Journal of Psychiatry 196, 92–95.CrossRefGoogle Scholar
Daly, I, Walsh, D, Moran, R, O'Doherty, YK (2004). Activities of Irish Psychiatric Services 2003. Health Research Board: Dublin.Google Scholar
Daray, FM, Thommi, SB, Ghaemi, SN (2010). The pharmacogenetics of antidepressant-induced mania: a systematic review and meta-analysis. Bipolar Disorders 12, 702–706.CrossRefGoogle Scholar
Demjaha, A, Morgan, K, Morgan, C, Landau Dean, K, Reichenberg, A, Sham, P, Fearon, P, Hutchinson, G, Jones, PB, Murray, RM, Dazzan, P (2009). Combining dimensional and categorical representation of psychosis: the way forward for DSM-V and ICD-11? Psychological Medicine 39, 1943–1955.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JB (2002). Structured Clinical Interview for the DSM-IV Axis I Disorders. Biometrics Research: New York.Google Scholar
Fischer, BA, Carpenter, WT (2009). Will the Kraepelinian dichotomy survive DSM-V? Neuropsychopharmacology 34, 2081–2087.CrossRefGoogle ScholarPubMed
Goldberg, JF, Truman, CJ (2003). Antidepressant-induced mania: an overview of current controversies. Bipolar Disorders 5, 407–420.CrossRefGoogle ScholarPubMed
Jablensky, A (1999). The conflict of the nosologists: views on schizophrenia and manic-depressive illness in the early part of the 20th century. Schizophrenia Research 39, 95–100.CrossRefGoogle Scholar
Kelly, BD, O'Callaghan, E, Waddington, JL, Feeney, L, Browne, S, Scully, PJ, Clarke, M, Quinn, JF, McTigue, O, Morgan, MG, Kinsella, A, Larkin, C (2010). Schizophrenia and the city: a review of literature and prospective study of psychosis and urbanicity in Ireland. Schizophrenia Research 116, 75–89.CrossRefGoogle ScholarPubMed
Kenna, HA, Poon, AW, de los Angeles, CP, Koran, LM (2011). Psychiatric complications of treatment with corticosteroids: review with case report. Psychiatry and Clinical Neurosciences 65, 549–560.CrossRefGoogle ScholarPubMed
Ketter, TA, Wang, PW, Becker, OV, Nowarkowska, C, Yang, Y (2004). Psychotic bipolar disorders: dimensionally similar to or categorically different from schizophrenia? Journal of Psychiatric Research 38, 47–61.CrossRefGoogle ScholarPubMed
Lake, CR, Hurwitz, N (2006). Schizoaffective disorders are psychotic mood disorders; there are no schizoaffective disorders. Psychiatry Research 143, 255–287.CrossRefGoogle ScholarPubMed
Linscott, RJ, van Os, J (2010). Systematic reviews of categorical versus continuum models in psychosis: evidence for discontinuous subpopulations underlying a psychometric continuum. Implications for DSM-V, DSM-VI, and DSM-VII. Annual Review of Clinical Psychology 6, 391–419.CrossRefGoogle ScholarPubMed
MacDonald, AW, Schulz, SC (2009). What we know: findings that every theory of schizophrenia should explain. Schizophrenia Bulletin 35, 493–508.CrossRefGoogle ScholarPubMed
Mahli, GS, Green, M, Fagiolini, A, Peselow, ED, Kumari, V (2008). Schizoaffective disorder: diagnostic issues and future recommendations. Bipolar Disorders 10, 215–230.Google Scholar
Maier, W (2006). Do schizoaffective disorders exist at all? Acta Psychiatrica Scandinavica 113, 369–371.CrossRefGoogle ScholarPubMed
Malla, AK, Payne, J (2005). First episode psychosis: psychopathology, quality of life and functional outcome. Schizophrenia Bulletin 31, 650–671.CrossRefGoogle ScholarPubMed
Marchesi, C, Paini, M, Ruju, L, Rosi, L, Turrini, G, Maggini, C (2007). Predictors of the evolution towards schizophrenia or mood disorder in patients with schizophreniform disorder. Schizophrenia Research 97, 1–5.CrossRefGoogle ScholarPubMed
McCauley, M, Rooney, S, Clarke, K, Carey, T, Owens, J (2003). Home-based treatment in Monaghan: the first two years. Irish Journal of Psychological Medicine 20, 11–14.CrossRefGoogle ScholarPubMed
Menezes, NM, Arenovich, T, Zipursky, RB (2006). A systematic review of longitudinal outcome studies of first-episode psychosis. Psychological Medicine 36, 1349–1362.CrossRefGoogle ScholarPubMed
Müller-Oerlinghausen, B, Berghöfer, A, Bauer, M (2002). Bipolar disorder. Lancet 359, 241–247.CrossRefGoogle ScholarPubMed
Nelson, B, Yuen, K, Yung, AR (2011). Ultra high risk (UHR) for psychosis criteria: are there different levels of risk for transition to psychosis? Schizophrenia Research 125, 62–68.CrossRefGoogle ScholarPubMed
Owoeye, O, Kingston, T, Hennessy, RJ, Baldwin, PA, Browne, D, Scully, PJ, Kinsella, A, Russell, V, O'Callaghan, E, Waddington, JL (2010). The ‘totality’ of psychosis: epidemiology and developmental pathobiology. In Advances in Schizophrenia Research (ed. Gattaz, W. and Busatto, G.), pp. 377–385. Springer: New York.Google Scholar
Parnas, J (2011). A disappearing heritage: the clinical core of schizophrenia. Schizophrenia Bulletin 37, 1121–1130.CrossRefGoogle ScholarPubMed
Ropacki, SA, Jeste, DV (2005). Epidemiology of and risk factors for psychosis of Alzheimer's disease: a review of 55 studies published from 1990 to 2003. American Journal of Psychiatry 162, 2022–2030.CrossRefGoogle ScholarPubMed
Ruggero, CJ, Carlson, GA, Kotov, R, Bromet, EJ (2010). Ten-year diagnostic consistency of bipolar disorder in a first-admission sample. Bipolar Disorders 12, 21–31.CrossRefGoogle Scholar
Ruggero, CJ, Kotov, R, Carlson, GA, Tanenberg-Karant, M, Gonzáles, DA, Bromet, EJ (2011). Diagnostic consistency of major depression with psychosis across 10 years. Journal of Clinical Psychiatry 72, 1207–1213.CrossRefGoogle Scholar
Schimmelmann, BG, Conus, P, Edwards, J, McGorry, PD, Lambert, M (2005). Diagnostic stability 18 months after treatment initiation for first-episode psychosis. Journal of Clinical Psychiatry 66, 1239–1246.CrossRefGoogle ScholarPubMed
Scully, PJ, Quinn, JF, Morgan, MG, Kinsella, A, O'Callaghan, E, Owens, JM, Waddington, JL (2002). First-episode schizophrenia, bipolar disorder and other psychoses in a rural Irish catchment area: incidence and gender in the Cavan-Monaghan study at 5 years. British Journal of Psychiatry. Supplement 181, s3–s9.CrossRefGoogle Scholar
Serra-Mestres, J, Gregory, CA, Tandon, S, Stansfield, AJ, Kemp, PM, McKenna, PJ (2000). Simple schizophrenia revisited: a clinical, neuropsychological, and neuroimaging analysis of nine cases. Schizophrenia Bulletin 26, 479–493.CrossRefGoogle ScholarPubMed
Strakowski, SM (1994). Diagnostic validity of schizophreniform disorder. American Journal of Psychiatry 151, 815–824.Google ScholarPubMed
Tandon, R, Keshavan, MS, Nasrallah, HA (2008). Schizophrenia, ‘Just the Facts’: What we know in 2008. Part 1: Overview. Schizophrenia Research 100, 4–19.CrossRefGoogle Scholar
Tandon, R, Nasrallah, HA, Keshavan, MS (2009). Schizophrenia, ‘Just the Facts’ 4. Clinical features and conceptualization. Schizophrenia Research 110, 1–23.CrossRefGoogle ScholarPubMed
Tohen, M, Khalsa, HM, Salvatore, P, Vieta, E, Ravichandran, C, Baldessarini, RJ (2012). Two-year outcomes in first-episode psychotic depression. The McLean-Harvard First-Episode Project. Journal of Affective Disorders 136, 1–8.CrossRefGoogle ScholarPubMed
van Os, J, Linscott, RJ, Myin-Germeys, I, Delespaul, P, Krabbendam, L (2009). A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness-persistence-impairment model of psychotic disorder. Psychological Medicine 39, 179–195.CrossRefGoogle ScholarPubMed
van Os, J, Kapur, S (2009). Schizophrenia. Lancet 374, 635–645.CrossRefGoogle ScholarPubMed
Waddington, JL, Hennessy, RJ, O'Tuathaigh, CMP, Owoeye, O, Russell, V (2012). Schizophrenia and the lifetime trajectory of psychotic illness: developmental neuroscience and pathobiology, redux. In The Origins of Schizophrenia (ed. Brown, A. S. and Patterson, P. H.), pp. 3–21. Columbia University Press: New York.Google Scholar
Whitty, P, Clarke, M, McTigue, O, Browne, S, Kamali, M, Larkin, C, O'Callaghan, E (2005). Diagnostic stability four years after a first episode of psychosis. Psychiatric Services 56, 1084–1088.CrossRefGoogle ScholarPubMed