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Diagnostic stability of first-episode psychosis

Comparison of ICD–10 and DSM–III–R systems

Published online by Cambridge University Press:  03 January 2018

Shazad Amin ,
Swaran P. Singh ,
John Brewin ,
Peter B. Jones ,
Ian Medley  and
Glyn Harrison
Shazad Amin*
Affiliation:
Trafford Healthcare NHS Trust
Swaran P. Singh
Affiliation:
Division of Psychiatry, University of Nottingham
John Brewin
Affiliation:
Division of Psychiatry, University of Nottingham
Peter B. Jones
Affiliation:
Division of Psychiatry, University of Nottingham
Ian Medley
Affiliation:
Division of Psychiatry, University of Nottingham
Glyn Harrison
Affiliation:
Division of Psychiatry, University of Bristol
*
Dr Shazad Amin, Moorside, Trafford General Hospital, Moorside Road, Davyhulme, Manchester M41 5SL
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Abstract

Background

The temporal stability of a diagnosis is one measure of its predictive validity.

Aims

To measure diagnostic stability in first-episode psychosis using ICD–10 and DSM–III–R.

Method

Between 1992 and 1994 we ascertained a cohort of persons with first-episode psychosis (n=168), assigning to each a consensus diagnosis. At three-year follow-up, longitudinal consensus diagnoses, blind to onset diagnoses, were made. Stability was measured by the positive predictive values (PPVs) of onset diagnoses. For onset schizophrenia, we also calculated sensitivity, specificity and concordance (κ).

Results

First-episode ICD–10 and DSM–III–R schizophrenia had a PPV of over 80% at three years. Over one-third of cases with ICD–10 F20 schizophrenia at three years had non-schizophrenia diagnoses at onset. Manic psychoses showed the highest PPV (91%). For onset schizophrenia, both systems had high specificity (ICD–10: 89; DSM–III–R: 93%), but low sensitivity (ICD–10: 64%; DSM–III–R: 51%) and moderate concordance (ICD–10: 0.54; DSM–III–R: 0.46).

Conclusions

Bipolar disorders and schizophrenia showed the highest stability. DSM–III–R schizophrenia did not have greater stability than ICD–10 schizophrenia.

Type
Papers
Information
The British Journal of Psychiatry , Volume 175 , Issue 6 , December 1999 , pp. 537 - 543
Copyright
Copyright © 1999 The Royal College of Psychiatrists 

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Footnotes

Declaration of interest

This study was supported by Trent National Health Service Executive and the Stanley Foundation.

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