Hostname: page-component-857557d7f7-nbs69 Total loading time: 0 Render date: 2025-11-23T15:06:11.552Z Has data issue: false hasContentIssue false
  • English
  • Français

Long-term diagnostic stability, predictors of diagnostic change, and time until diagnostic change of first-episode psychosis: a 21-year follow-up study

Published online by Cambridge University Press:  26 August 2025

D. P. Donner ,
L. Janda ,
E. Garcia de Jalon ,
L. Moreno-Izco ,
A. M. Sanchez-Torres ,
M. J. Cuesta  and
V. Peralta
D. P. Donner*
Affiliation:
Mental Health Department, Servicio Navarro de Salud
L. Janda
Affiliation:
Mental Health Department, Servicio Navarro de Salud
E. Garcia de Jalon
Affiliation:
Mental Health Department, Servicio Navarro de Salud Department of Psychiatry, Instituto de Investigacion Sanitaria de Navarra (IdiSNA)
L. Moreno-Izco
Affiliation:
Department of Psychiatry, Instituto de Investigacion Sanitaria de Navarra (IdiSNA) Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain
A. M. Sanchez-Torres
Affiliation:
Department of Psychiatry, Instituto de Investigacion Sanitaria de Navarra (IdiSNA) Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain
M. J. Cuesta
Affiliation:
Department of Psychiatry, Instituto de Investigacion Sanitaria de Navarra (IdiSNA) Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain
V. Peralta
Affiliation:
Mental Health Department, Servicio Navarro de Salud Department of Psychiatry, Instituto de Investigacion Sanitaria de Navarra (IdiSNA)
*
*Corresponding author.

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Introduction

Although diagnostic instability in first-episode psychosis (FEP) is of major concern, little is known about its determinants.

Objectives

To examine the long-term diagnostic stability of FEP diagnoses, the baseline predictors of diagnostic change to schizophrenia and the timing of diagnostic change.

Methods

This was a longitudinal and naturalistic study of 243 subjects with FEP who were assessed at baseline and reassessed after a mean follow-up of 21 years. The diagnostic stability of DSM-5 psychotic disorders was examined using prospective and retrospective consistencies, logistic regression was used to establish the predictors of diagnostic change to schizophrenia, and survival analysis was used to compare time to diagnostic change across diagnostic categories.

Results

The overall diagnostic stability was 47.7%. Schizophrenia and bipolar disorder were the most stable diagnoses, with other categories having low stability. Predictors of diagnostic change to schizophrenia included a family history of schizophrenia, obstetric complications, developmental delay, childhood adversity, poor premorbid functioning in several domains, long duration of untreated continuous psychosis, spontaneous dyskinesia, lack of psychosocial stressors, and poor early treatment response (Table 1). There were no significant differences between specific diagnoses regarding time to diagnostic change. At 10-year follow-up, around 80% of the diagnoses had changed.

Table 1. Main baseline predictors of diagnostic change to schizophrenia over the follow-up (univariate logistic regression)

No diagnostic change (n=124) †Diagnostic change (n=47) †OR (95% CI)p
Family history of schizophrenia spectrum disorders16 (12.9)16 (34.0)3.48 (1.56 – 7.75)0.002
Obstetric complications, any definite9 (7.3)12 (25.5)4.38 (1.70 – 11.2)0.002
Developmental delay at year 3, any30 (24.2)30 (63.8)5.52 (2.68 – 11.3)<0.001
Childhood adversity score, high (< 77)39 (31.5)24 (55.1)2.27 (1.14 – 4.51)0.019
Premorbid adjustment score, poor (≥ 4)30 (24.2)23 (48.9)3.00 (1.48 – 7.07)0.002
Acute psychosocial stressors, any62 (50.0)11 (23.4)0.30 (0.14 – 0.65)0.002
Duration of untreated continous psychosis, long (≥ 1 month)34 (27.4)26 (55.3)3.27 (1.63 – 6.58)0.001
Spontaneous dyskinesia, Schooler & Kane criteria2 (1.9)9 (24.3)17.0 (3.48 – 83.3)<0.001
CGI-EI at index discharge, marked improvement100 (80.6)28 (59.6)0.35 (0.17 – 0.73)0.005
†

Data are number (and percentages) of the stated features

CGI-EI = Clinical global impression-Efficacy Index

Conclusions

FEP diagnoses other than schizophrenia or bipolar disorder should be considered as provisional. Considering baseline and background predictors of diagnostic change to schizophrenia may help to enhance diagnostic accuracy and guide therapeutic interventions.

Disclosure of Interest

None Declared

Information

Type
Abstract
Information
European Psychiatry , Volume 68 , Special Issue S1: Abstracts of the 33rd European Congress of Psychiatry , April 2025 , pp. S893
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of European Psychiatric Association
Submit a response

Comments

No Comments have been published for this article.