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Systematic epidemiological and clinical comparisons across all 12 DSM-IV psychotic diagnoses in the Cavan–Monaghan First Episode Psychosis Study (CAMFEPS)

Published online by Cambridge University Press:  20 December 2019

Nnamdi Nkire
Affiliation:
Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland Molecular & Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
Paul J. Scully
Affiliation:
Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland Molecular & Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
David J. Browne
Affiliation:
Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland Molecular & Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
Patrizia A. Baldwin
Affiliation:
Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland Molecular & Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
Tara Kingston
Affiliation:
Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland Molecular & Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
Olabisi Owoeye
Affiliation:
Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland Molecular & Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
Anthony Kinsella
Affiliation:
Molecular & Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
Eadbhard O'Callaghan
Affiliation:
DETECT Early Psychosis Service, Blackrock, Co. Dublin, Ireland
Vincent 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
John L. Waddington*
Affiliation:
Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland Molecular & Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland Jiangsu Key Laboratory of Translational Research & Therapy for Neuro-Psychiatric-Disorders and Department of Pharmacology, College of Pharmaceutical Sciences, Soochow University, Suzhou, China
*
Author for correspondence: John L. Waddington, E-mail: jwadding@rcsi.ie

Abstract

Background

Research on psychotic illness is loosening emphasis on diagnostic stringency in favour of including a more dimensionally based conceptualization of psychopathology and pathobiology. However, to clarify these notions requires investigation of the full scope of psychotic diagnoses.

Methods

The Cavan–Monaghan First Episode Psychosis Study ascertained cases of first episode psychosis across all 12 DSM-IV psychotic diagnoses via all routes to care: public, private or forensic; home-based, outpatient or inpatient. There was no arbitrary upper age cut-off and minimal impact of factors associated with variations in social milieu, ethnicity or urbanicity. Cases were evaluated epidemiologically and assessed for psychopathology, neuropsychology, neurology, antecedent factors, insight and quality of life.

Results

Among 432 cases, the annual incidence of any DSM-IV psychotic diagnosis was 34.1/100 000 of population and encompassed functional psychotic diagnoses, substance-induced psychopathology and psychopathology due to general medical conditions, through to psychotic illness that defied contemporary diagnostic algorithms. These 12 DSM-IV diagnostic categories, including psychotic disorder not otherwise specified, showed clinical profiles that were consistently more similar than distinct.

Conclusions

There are considerable similarities and overlaps across a broad range of diagnostic categories in the absence of robust discontinuities between them. Thus, psychotic illness may be of such continuity that it cannot be fully captured by operational diagnostic algorithms that, at least in part, assume discontinuities. This may reflect the impact of diverse factors each of which acts on one or more overlapping components of a common, dysfunctional neuronal network implicated in the pathobiology of psychotic illness.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2019

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Footnotes

*

Deceased.

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