Diagnostic Instability in Early Psychosis

Amber Carroll, BA

McLean Hospital
Diagnostic Instability in Early Psychosis

Scientific Abstract


BACKGROUND: The extent to which diagnosis remains stable over time in people with psychosis is unclear. We aimed to examine diagnostic stability in people with psychosis. We hypothesized that a) diagnostic change from bipolar disorder (BP) to schizoaffective disorder (SZA) would be more common than the reverse; b) males would have a higher rate of diagnostic instability than females; and c) those with substance use disorders (SUDs) would have a higher rate of diagnostic instability.

METHODS: 142 subjects from McLean’s Schizophrenia and Bipolar Disorder Program with repeat assessments (SCID-IV-TR or SCID-5-RV) were included. Subjects’ diagnoses at initial and final SCIDs were compared to determine diagnostic stability. Associations between conversion and primary diagnosis, demographics, and secondary diagnoses were examined. Pearson’s chi- squared tests were used to determine statistical significance.

RESULTS: There were 339 SCIDs between all subjects (75.8% SCID-IV-TR). Mean number of assessments per subject was 2.38 (SD=0.98) and mean duration between assessments was 543.3 days (range 2-4575 days, SD=730.0 days). 22.2% of subjects with an unstable diagnosis initially had a SCID-IV-TR and then SCID-5-RV. There was a 25.4% conversion rate across the total. BP had the highest stability (86.9%), followed by schizophrenia (SZ; 66.7%) and SZA (63.6%). Psychosis not otherwise specified (Psych NOS) and schizophreniform (SZform) had the lowest stability rates at 33.3%. The majority of subjects with an unstable initial diagnosis of SZ, SZform, BP, or Psych NOS converted to a final diagnosis of SZA. Subjects with an unstable initial diagnosis of SZA were most likely to convert to a diagnosis of SZ. Primary diagnosis at initial SCID significantly correlated (p < .001) with a diagnostic change at a future SCID. Interestingly, lack of SUD was associated with diagnostic instability (p < .01).

CONCLUSION: A diagnostic change from BP to SZA (81.82%) was more prevalent than the reverse (12.50%). It was found that primary diagnosis at initial SCID and lack of SUDs significantly correlated with diagnostic change at a future SCID. No other analyses yielded significant results.

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research Areas


Amber R. Carroll, BA, Andrew J. Wood, BA, Ann K. Shinn, MD, MPH, Kathryn E. Lewandowski, PhD, Dost Ongur, MD, PhD

Principal Investigator

Kathryn E. Lewandowski, PhD