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Am J Psychiatry 1996; 153:682-686
Copyright © 1996 by American Psychiatric Association
Stability of diagnosis in schizophrenia
YR Chen, AC Swann and DB Burt
Department of Psychiatry and Behavioral Sciences, University of Texas at Houston 77030, USA.
OBJECTIVE: The authors investigated factors associated with change in
diagnosis from schizophrenia to other disorders and from other disorders to
schizophrenia, as well as the time elapsed before diagnostic change.
METHODS: Using a longitudinal study design, they examined data collected
over a 7-year period at an urban acute care psychiatric hospital. The
subjects were 936 inpatients who had been hospitalized at least four times
during the study period. Changes to and from a diagnosis of schizophrenia
over the 7 years were investigated in relation to demographic variables,
socioeconomic factors, and clinical features. RESULTS: Fifty-six (21.9%) of
the 256 subjects with a diagnosis of schizophrenia at the beginning of the
study received a different diagnosis during a subsequent hospitalization.
Females and subjects of Hispanic origin were more likely to undergo a
diagnostic change from schizophrenia. Two hundred twenty-three (32.8%) of
the 680 subjects who initially had a diagnosis other than schizophrenia
were later diagnosed with schizophrenia. Males and African Americans had
significantly higher rates of change to a diagnosis of schizophrenia than
females and other ethnic groups. In addition, socio-economic factors and
clinical features were associated with a change in diagnosis from another
disorder to schizophrenia. CONCLUSIONS: The diagnosis of schizophrenia, in
current practice, is not static. Patients' characteristics interact with
longitudinal clinical changes to produce shifts in diagnosis. Longitudinal
follow-up is necessary to validate diagnoses.
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