Cargando…

Diagnostic Stability of ICD/DSM First Episode Psychosis Diagnoses: Meta-analysis

BACKGROUND: Validity of current International Classification of Disease/Diagnostic and Statistical Manual of Mental Disorders (ICD/DSM) first episode psychosis diagnoses is essential in clinical practice, research, training and public health. METHOD: We provide a meta-analytical estimate of prospect...

Descripción completa

Detalles Bibliográficos
Autores principales: Fusar-Poli, Paolo, Cappucciati, Marco, Rutigliano, Grazia, Heslin, Margaret, Stahl, Daniel, Brittenden, Zera, Caverzasi, Edgardo, McGuire, Philip, Carpenter, William T.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5049518/
https://www.ncbi.nlm.nih.gov/pubmed/26980142
http://dx.doi.org/10.1093/schbul/sbw020
_version_ 1782457736292728832
author Fusar-Poli, Paolo
Cappucciati, Marco
Rutigliano, Grazia
Heslin, Margaret
Stahl, Daniel
Brittenden, Zera
Caverzasi, Edgardo
McGuire, Philip
Carpenter, William T.
author_facet Fusar-Poli, Paolo
Cappucciati, Marco
Rutigliano, Grazia
Heslin, Margaret
Stahl, Daniel
Brittenden, Zera
Caverzasi, Edgardo
McGuire, Philip
Carpenter, William T.
author_sort Fusar-Poli, Paolo
collection PubMed
description BACKGROUND: Validity of current International Classification of Disease/Diagnostic and Statistical Manual of Mental Disorders (ICD/DSM) first episode psychosis diagnoses is essential in clinical practice, research, training and public health. METHOD: We provide a meta-analytical estimate of prospective diagnostic stability and instability in ICD-10 or DSM-IV first episode diagnoses of functional psychoses. Independent extraction by multiple observers. Random effect meta-analysis conducted with the “metaprop,” “metaninf,” “metafunnel,” “metabias,” and “metareg” packages of STATA13.1. Moderators were tested with meta-regression analyses. Heterogeneity was assessed with the I (2) index. Sensitivity analyses tested robustness of results. Publication biases were assessed with funnel plots and Egger’s test. FINDINGS: 42 studies and 45 samples were included, for a total of 14 484 first episode patients and an average follow-up of 4.5 years. Prospective diagnostic stability ranked: schizophrenia 0.90 (95% CI 0.85–0.95), affective spectrum psychoses 0.84 (95% CI 0.79–0.89), schizoaffective disorder 0.72 (95% CI 0.61–0.73), substance-induced psychotic disorder 0.66 (95% CI 0.51–0.81), delusional disorder 0.59 (95% CI 0.47–0.71), acute and transient psychotic disorder/brief psychotic disorder 0.56 (95% CI 0.62–0.60), psychosis not otherwise specified 0.36 (95% CI 0.27–0.45, schizophreniform disorder 0.29 (95% CI 0.22–0.38). Diagnostic stability within schizophrenia spectrum psychoses was 0.93 (95% CI 0.89–0.97); changes to affective spectrum psychoses were 0.05 (95% CI 0.01–0.08). About 0.10 (95% CI 0.05–0.15) of affective spectrum psychoses changed to schizophrenia spectrum psychosis. Across the other psychotic diagnoses there was high diagnostic instability, mostly to schizophrenia. INTERPRETATION: There is meta-analytical evidence for high prospective diagnostic stability in schizophrenia spectrum and affective spectrum psychoses, with no significant ICD/DSM differences. These results may inform the development of new treatment guidelines for early psychosis and impact drug licensing from regulatory agencies.
format Online
Article
Text
id pubmed-5049518
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-50495182016-10-05 Diagnostic Stability of ICD/DSM First Episode Psychosis Diagnoses: Meta-analysis Fusar-Poli, Paolo Cappucciati, Marco Rutigliano, Grazia Heslin, Margaret Stahl, Daniel Brittenden, Zera Caverzasi, Edgardo McGuire, Philip Carpenter, William T. Schizophr Bull Regular Article BACKGROUND: Validity of current International Classification of Disease/Diagnostic and Statistical Manual of Mental Disorders (ICD/DSM) first episode psychosis diagnoses is essential in clinical practice, research, training and public health. METHOD: We provide a meta-analytical estimate of prospective diagnostic stability and instability in ICD-10 or DSM-IV first episode diagnoses of functional psychoses. Independent extraction by multiple observers. Random effect meta-analysis conducted with the “metaprop,” “metaninf,” “metafunnel,” “metabias,” and “metareg” packages of STATA13.1. Moderators were tested with meta-regression analyses. Heterogeneity was assessed with the I (2) index. Sensitivity analyses tested robustness of results. Publication biases were assessed with funnel plots and Egger’s test. FINDINGS: 42 studies and 45 samples were included, for a total of 14 484 first episode patients and an average follow-up of 4.5 years. Prospective diagnostic stability ranked: schizophrenia 0.90 (95% CI 0.85–0.95), affective spectrum psychoses 0.84 (95% CI 0.79–0.89), schizoaffective disorder 0.72 (95% CI 0.61–0.73), substance-induced psychotic disorder 0.66 (95% CI 0.51–0.81), delusional disorder 0.59 (95% CI 0.47–0.71), acute and transient psychotic disorder/brief psychotic disorder 0.56 (95% CI 0.62–0.60), psychosis not otherwise specified 0.36 (95% CI 0.27–0.45, schizophreniform disorder 0.29 (95% CI 0.22–0.38). Diagnostic stability within schizophrenia spectrum psychoses was 0.93 (95% CI 0.89–0.97); changes to affective spectrum psychoses were 0.05 (95% CI 0.01–0.08). About 0.10 (95% CI 0.05–0.15) of affective spectrum psychoses changed to schizophrenia spectrum psychosis. Across the other psychotic diagnoses there was high diagnostic instability, mostly to schizophrenia. INTERPRETATION: There is meta-analytical evidence for high prospective diagnostic stability in schizophrenia spectrum and affective spectrum psychoses, with no significant ICD/DSM differences. These results may inform the development of new treatment guidelines for early psychosis and impact drug licensing from regulatory agencies. Oxford University Press 2016-11 2016-03-15 /pmc/articles/PMC5049518/ /pubmed/26980142 http://dx.doi.org/10.1093/schbul/sbw020 Text en © The Author 2016. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. http://creativecommons.org/licenses/by/3.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Regular Article
Fusar-Poli, Paolo
Cappucciati, Marco
Rutigliano, Grazia
Heslin, Margaret
Stahl, Daniel
Brittenden, Zera
Caverzasi, Edgardo
McGuire, Philip
Carpenter, William T.
Diagnostic Stability of ICD/DSM First Episode Psychosis Diagnoses: Meta-analysis
title Diagnostic Stability of ICD/DSM First Episode Psychosis Diagnoses: Meta-analysis
title_full Diagnostic Stability of ICD/DSM First Episode Psychosis Diagnoses: Meta-analysis
title_fullStr Diagnostic Stability of ICD/DSM First Episode Psychosis Diagnoses: Meta-analysis
title_full_unstemmed Diagnostic Stability of ICD/DSM First Episode Psychosis Diagnoses: Meta-analysis
title_short Diagnostic Stability of ICD/DSM First Episode Psychosis Diagnoses: Meta-analysis
title_sort diagnostic stability of icd/dsm first episode psychosis diagnoses: meta-analysis
topic Regular Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5049518/
https://www.ncbi.nlm.nih.gov/pubmed/26980142
http://dx.doi.org/10.1093/schbul/sbw020
work_keys_str_mv AT fusarpolipaolo diagnosticstabilityoficddsmfirstepisodepsychosisdiagnosesmetaanalysis
AT cappucciatimarco diagnosticstabilityoficddsmfirstepisodepsychosisdiagnosesmetaanalysis
AT rutiglianograzia diagnosticstabilityoficddsmfirstepisodepsychosisdiagnosesmetaanalysis
AT heslinmargaret diagnosticstabilityoficddsmfirstepisodepsychosisdiagnosesmetaanalysis
AT stahldaniel diagnosticstabilityoficddsmfirstepisodepsychosisdiagnosesmetaanalysis
AT brittendenzera diagnosticstabilityoficddsmfirstepisodepsychosisdiagnosesmetaanalysis
AT caverzasiedgardo diagnosticstabilityoficddsmfirstepisodepsychosisdiagnosesmetaanalysis
AT mcguirephilip diagnosticstabilityoficddsmfirstepisodepsychosisdiagnosesmetaanalysis
AT carpenterwilliamt diagnosticstabilityoficddsmfirstepisodepsychosisdiagnosesmetaanalysis