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Diagnostic stability in a Dutch psychosis incidence cohort

Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Centre, Utrecht

Diede Schols, MD, Winfried Laan, MD and Hans W. Hoek, MD, PhD

Parnassia Psycho Medical Centre, The Hague

Ingeborg van der Tweel

Centre for Biostatistics, Utrecht University

Rene S. Kahn, MD, PhD

Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Centre, Utrecht, The Netherlands

Correspondence: Dr Natalie D. Veen, Department of Psychiatry (A 00.241), University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. Tel: +31 30 250 8180; e-mail: n.veen{at}psych.azu.nl

Declaration of interest None.

Background No study outside the UK has examined the diagnostic stability of psychotic disorders in a population-based sample.

Aims To determine diagnostic stability in a Dutch population-based psychosis incidence cohort, to examine the frequencies of diagnostic shifts to and from schizophrenic disorders and to report the revised relative risks of schizophrenic disorders for immigrants.

Method A 30-month follow-up study assessed the cohort (n=181) by means of face-to-face diagnostic interviews.

Results Diagnostic stability of schizophrenic disorders was high (91%), but lower for other psychotic disorders. At follow-up, the initial diagnosis was adjusted to schizophrenic disorder more often than that the reverse occurred. Almost half (49%) of the patients who were not initially diagnosed as having a schizophrenic disorder received this diagnosis at follow-up. The relative risks for most immigrant groups were stable.

Conclusions Schizophrenic disorders are underdiagnosed, rather than overdiagnosed, at first presentation.

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