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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: jwadding@rcsi.ie)
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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 

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