Diagnostic stability of psychiatric disorders in clinical practice

Br J Psychiatry. 2007 Mar:190:210-6. doi: 10.1192/bjp.bp.106.024026.

Abstract

Background: Psychiatric disorders are among the top causes worldwide of disease burden and disability. A major criterion for validating diagnoses is stability over time.

Aims: To evaluate the long-term stability of the most prevalent psychiatric diagnoses in a variety of clinical settings.

Method: A total of 34 368 patients received psychiatric care in the catchment area of one Spanish hospital (1992-2004). This study is based on 10 025 adult patients who were assessed on at least ten occasions (360 899 psychiatric consultations) in three settings: in-patient unit, 2000-2004 (n=546); psychiatric emergency room, 2000-2004 (n=1408); and out-patient psychiatric facilities, 1992-2004 (n=10 016). Prospective consistency, retrospective consistency and the proportion of patients who received each diagnosis in at least 75% of the evaluations were calculated for each diagnosis in each setting and across settings.

Results: The temporal consistency of mental disorders was poor, ranging from 29% for specific personality disorders to 70% for schizophrenia, with stability greatest for in-patient diagnoses and least for out-patient diagnoses.

Conclusions: The findings are an indictment of our current psychiatric diagnostic practice.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Ambulatory Care / statistics & numerical data
  • Emergency Service, Hospital / statistics & numerical data
  • Emergency Treatment
  • Female
  • Humans
  • Male
  • Mental Disorders / diagnosis*
  • Mental Disorders / epidemiology
  • Middle Aged
  • Prospective Studies
  • Recurrence
  • Retrospective Studies
  • Spain / epidemiology