Summary: 47% of patients with a mental health disorder receive a different diagnosis within ten years of receiving their initial diagnosis.
Font: University of Copenhagen
“Let’s see how things go.”
That is what psychiatrists often tell each other after a patient has been diagnosed with the first disorder, not because the diagnosis is incorrect, but because psychiatrists know that psychiatric diagnoses tend to change over the years.
In fact, 47 percent of psychiatric patients are diagnosed with a different diagnosis within 10 years of receiving their first diagnosis.
This is the result of a new study mapping the diagnostic development of more than 180,000 psychiatric patients in Denmark.
One of the researchers behind the study is Associate Professor of Clinical Research in the Department of Clinical Medicine Anders Jørgensen. He is not surprised by the study results.
“Mental disorders are dynamic. They change throughout life. Therefore, I am not surprised by the relatively large diagnostic development in these patients”, says Anders Jørgensen.
The study shows which development is likely and which is unlikely for the 20 most common mental diagnoses. The most uncertain, that is, those most likely to change, include diagnoses of acute psychosis, addiction, and depression.
The safest, that is, the least likely to change, include the diagnoses functional disabilities, which are long-term physical disabilities without a physical cause, eating disorders, and sexual disorders such as decreased sexual interest or erectile dysfunction without a physical cause.
The study is useful from the moment a patient is diagnosed with their first disorder, as it allows clinicians to refer to the diagnostic development of 10 years of other patients.
“Doctors who want to plan the right treatment and be able to tell patients what to expect need these numbers. Ultimately, we hope it can help improve treatment and ensure evidence-based follow-up. The more you know about the probable course of the disease, the better the treatment will be,” says Anders Jørgensen.
The study is limited to patients treated in the psychiatric health system. This means that people who see their GP and are referred to a psychologist are not included in the study.
“We only look at people who have been diagnosed in psychiatric hospitals and who typically experience a more severe course of illness than those who make an appointment with their GP,” says Anders Jørgensen.
Depression is one of the most uncertain diagnoses
Among the three most common diagnoses analyzed in the study, patients diagnosed with a single episode of depression have the highest risk of being diagnosed with a new disorder within 10 years.
“According to the study, patients with this diagnosis have a 60% chance of being diagnosed with a new disorder within 10 years,” says Associate Professor Terese Sara Høj Jørgensen from the Department of Health’s Section of Social Medicine. public.
But the numbers can be misleading. Because the majority (20 percent) of those diagnosed with a single episode of depression are later diagnosed with periodic depressionwhich is the name of recurring depressions.
“It is not surprising that a single episode of depression can turn into recurrent depressions,” says Anders Jørgensen.
Along with recurrent depression, personality disorder and stress reaction disorders are the diagnoses most likely to follow a diagnosis of depression. A stress reaction disorder is when a major incident, such as divorce or death, causes the patient to develop a stress-like mental disorder or depression.
Anders Jørgensen hopes that the new data can help improve the treatment of people suffering from depression.
“Unlike patients experiencing their first psychosis, we currently do not have a uniform treatment option for patients experiencing their first depression. We may look into developing such an option, and our numbers may support the development of an effective treatment,” says Anders Jørgensen.
What did the study entail?
Using data from the Danish registry, the researchers identified psychiatric patients aged 18 and over diagnosed with one of the 20 most common mental disorders. This gave them a group of 184,949 individuals.
The researchers looked at how patients’ diagnoses have changed since they were first diagnosed. They used so-called sequence analysis to analyze development.
Typical development for the three most common diagnoses analyzed in the study
Depression: 60 percent of those diagnosed with a single depressive episode are diagnosed with a new disorder within 10 years. Twenty percent develop periodic depression, 10 percent a stress disorder, and six percent a personality disorder.
See also
Addiction: 52 percent are diagnosed with a new disorder within 10 years. Eight percent develop a stress disorder, five percent a personality disorder and five percent schizophrenia. The category includes all addiction diagnoses such as alcohol, opioids, cannabis, etc. Some forms of addiction are more uncertain than others.
Stress Reaction Disorder: 36 percent are diagnosed with a new disorder within 10 years. Eight percent develop a single depressive episode, seven percent a personality disorder, and six percent periodic depression.
About this mental health research news
Author: polish liva
Font: University of Copenhagen
Contact: Liva Polack – University of Copenhagen
Image: The image is in the public domain.
original research: closed access.
“Mapping diagnostic trajectories from the first hospital diagnosis of a psychiatric disorder: a Danish national cohort study using sequence analysis” by Anders Jørgensen et al. Lancet Psychiatry
Summary
Mapping diagnostic trajectories from the first hospital diagnosis of a psychiatric disorder: a Danish national cohort study using sequence analysis
Background
A key clinical problem in psychiatry is predicting the future diagnosis of patients presenting with psychopathology for the first time. The objective of this study was to establish a complete map of diagnoses after a first psychiatric hospital diagnosis.
methods
Through the Danish National Patient Registry, we identified patients aged 18 years or older with a psychiatric hospital contact as inpatient or outpatient and who had received one of the 20 most common first-time psychiatric diagnoses (defined at the two-digit level). ICD-10, F00–F99) between January 1, 1995, and December 31, 2008. For each initial diagnosis, the 20 most frequent subsequent psychiatric diagnoses (F00–F99) and deaths that occurred during the 10 years of follow-up were identified as outcomes. To assess diagnostic stability, we used social sequence analysis, assigning a subsequent diagnosis to each state with a duration of 6 months after each initial diagnosis. Subsequent diagnosis was defined as the last diagnosis given within each 6-month period. We calculate the normalized entropy of each sequence to show the uncertainty of predicting the states in a given sequence. Cox proportional hazards models were used to assess the risk of receiving a subsequent diagnosis (at the level of a code, F0-F9) after each initial diagnosis.
recommendations
The cohort consisted of 184,949 adult patients (77,129 [41·7%] men and 107 820 [58·3%] mujeres, edad media 42,5 años[DE185;rangode18a>100)NoseregistrarondatosdeetnicidadDurante10añosdeseguimiento86804(469%)pacientestuvieronalmenosundiagnósticoposteriorquediferíadesudiagnósticoinicialMedidosporlosvaloresmediosdeentropíanormalizadoslostrastornosdelirantespersistentes(CIE-10códigoF22)lostrastornosmentalesydelcomportamientodebidosalconsumodemúltiplesdrogasyalconsumodeotrassustanciaspsicoactivas(F19)ylostrastornospsicóticosagudosytransitorios(F23)tuvieronlosvaloresdiagnósticosmásaltosvariabilidadmientrasquelostrastornosalimentarios(F50)yladisfunciónsexualnoorgánica(F52)tuvieronlamenorElriesgoderecibirundiagnósticoposteriorconuntrastornopsiquiátricodeungrupoICD-10diferentealdeldiagnósticoinicialvariósustancialmenteentrelosdiagnósticosiniciales[SD18·5;range18to>100)EthnicitydatawerenotrecordedOver10yearsoffollow-up86804(469%)patientsshadatleastonesubsequentdiagnosisthatdifferedfromtheirfirst-timediagnosisMeasuredbymeannormalisedentropyvaluespersistentdelusionaldisorders(ICD-10codeF22)mentalandbehaviouraldisordersduetomultipledruguseanduseofotherpsychoactivesubstances(F19)andacuteandtransientpsychoticdisorders(F23)hadthehighestdiagnosticvariabilitywhereaseatingdisorders(F50)andnon-organicsexualdysfunction(F52)hadthelowestTheriskofreceivingasubsequentdiagnosiswithapsychiatricdisorderfromanICD-10groupdifferentfromthatofthefirst-timediagnosisvariedsubstantiallyamongfirst-timediagnoses[DE185;rangode18a>100)NoseregistrarondatosdeetnicidadDurante10añosdeseguimiento86804(469%)pacientestuvieronalmenosundiagnósticoposteriorquediferíadesudiagnósticoinicialMedidosporlosvaloresmediosdeentropíanormalizadoslostrastornosdelirantespersistentes(CIE-10códigoF22)lostrastornosmentalesydelcomportamientodebidosalconsumodemúltiplesdrogasyalconsumodeotrassustanciaspsicoactivas(F19)ylostrastornospsicóticosagudosytransitorios(F23)tuvieronlosvaloresdiagnósticosmásaltosvariabilidadmientrasquelostrastornosalimentarios(F50)yladisfunciónsexualnoorgánica(F52)tuvieronlamenorElriesgoderecibirundiagnósticoposteriorconuntrastornopsiquiátricodeungrupoICD-10diferentealdeldiagnósticoinicialvariósustancialmenteentrelosdiagnósticosiniciales[SD18·5;range18to>100)EthnicitydatawerenotrecordedOver10yearsoffollow-up86 804(46·9%)patientshadatleastonesubsequentdiagnosisthatdifferedfromtheirfirst-timediagnosisMeasuredbymeannormalisedentropyvaluespersistentdelusionaldisorders(ICD-10codeF22)mentalandbehaviouraldisordersduetomultipledruguseanduseofotherpsychoactivesubstances(F19)andacuteandtransientpsychoticdisorders(F23)hadthehighestdiagnosticvariabilitywhereaseatingdisorders(F50)andnon-organicsexualdysfunction(F52)hadthelowestTheriskofreceivingasubsequentdiagnosiswithapsychiatricdisorderfromanICD-10groupdifferentfromthatofthefirst-timediagnosisvariedsubstantiallyamongfirst-timediagnoses
Interpretation
These data provide detailed information on possible diagnostic outcomes after a first visit to a psychiatric hospital. This information could help clinicians plan relevant follow-up and inform patients and their families about the degree of diagnostic uncertainty associated with receiving a first psychiatric hospital diagnosis, as well as the likely and unlikely trajectories of diagnostic progression.
Money
Mental Health Services, Capital Region of Denmark.
Translation
For the Danish translation of the abstract, see the Supplementary Materials section.
