Summary: 47% of patients with a mental health disorder receive a different diagnosis within the first ten years of the initial diagnosis.
Source: University of Copenhagen
“Let’s see how things go.”
So psychiatrists often say to themselves after a patient has been diagnosed with the first disorder – not because the diagnosis is not correct, but because psychiatrists know that psychiatric diagnoses tend to change over the years. .
In fact, 47% of psychiatric patients receive 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 Anders Jørgensen, associate professor of clinical research in the Department of Clinical Medicine. He is not surprised by the results of the study.
“Mental disorders are dynamic. They change over a lifetime. 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, substance abuse, and depression.
The most certain, that is, those least likely to change, include diagnoses of functional disabilities, which are long-term physical disabilities without a physical cause, eating disorders, and disorders problems such as decreased interest in sex or erectile dysfunction without a physical cause.
The study is useful from the time a patient is diagnosed with their first disorder, as it allows physicians to see the diagnostic evolution over 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 this can help improve treatment and ensure evidence-based follow-up. The more you know about the likely course of the disease, the better the treatment will be,” says Anders Jørgensen.
The study is limited to patients treated in the psychiatric healthcare system. This means that people who visit 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 usually experience more severe disease courses than those who make an appointment with their GP,” says Anders Jørgensen.
Depression is one of the most uncertain diagnoses
Of 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 of the Department of Public Health’s Section of Social Medicine.
But the numbers can be misleading. Since the majority (20%) of people diagnosed with a single episode of depression are subsequently diagnosed with periodic depressionwhich is the name of recurring depressions.
“It is not surprising that a single episode of depression can turn into recurring depressions,” says Anders Jørgensen.
After periodic depression, personality disorders and stress reaction disorders are the diagnoses most likely to follow a diagnosis of depression. A stress reaction disorder occurs when a major incident such as a divorce or death causes the patient to develop a mental disorder resembling stress or depression.
Anders Jørgensen hopes the new data can help improve treatment for people with depression.
“Unlike patients experiencing their first psychosis, we currently have no uniform treatment option for patients experiencing their first depression. We could consider developing such an option, and our numbers may support the development of an effective treatment. says Anders Jørgensen.
What was the study about?
Using data from the Danish registry, the researchers identified psychiatric patients aged 18 or older diagnosed with one of the 20 most common mental disorders. This gave them a group of 184,949 individuals.
Researchers looked at how patients’ diagnoses have changed since the first diagnosis. They used what is called sequence analysis to analyze development.
Typical development for the three most common diagnoses analyzed in the study
The Depression: 60% of people diagnosed with a single depressive episode are diagnosed with a new disorder within 10 years. 20% develop periodic depression, 10% a stress disorder and 6% a personality disorder.
See also
Addiction: 52% are diagnosed with a new disorder within 10 years. Eight percent develop a stress disorder, five percent 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% 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: Live Poland
Source: University of Copenhagen
Contact: Liva Polack – University of Copenhagen
Image: Image is in public domain
Original research: Access closed.
“Mapping diagnostic trajectories from 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 to predict the diagnostic future of patients presenting with psychopathology for the first time. The objective of this study was to establish a complete mapping of subsequent diagnoses after an initial psychiatric hospital diagnosis.
Methods
Using the Danish National Patient Register, we identified patients aged 18 or older with contact with an inpatient or outpatient psychiatric hospital who had one of the 20 most common first psychiatric diagnoses (defined at the two-level level). ICD-10 figures, F00-F99) between January 1, 1995 and December 31, 2008. For each first diagnosis, the 20 most frequent subsequent psychiatric diagnoses (F00-F99) and deaths during the 10 years of follow-up were identified as outcomes. To assess diagnostic stability, we used social sequence analyses, assigning a subsequent diagnosis to each condition lasting 6 months after each first diagnosis. Subsequent diagnosis was defined as the last diagnosis given during each 6-month period. We calculated 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 single-digit level, F0-F9) after each first diagnosis.
Results
The cohort consisted of 184,949 adult patients (77,129 [41·7%] men and 107,820 [58·3%] femmes, âge moyen 42·5 ans[SD18·5;gamme18à>100)Lesdonnéessurl’ethnicitén’ontpasétéenregistréesSur10ansdesuivi86804(469%)patientsonteuaumoinsundiagnosticultérieurdifférentdeleurpremierdiagnosticMesurésparlesvaleursd’entropienormaliséesmoyenneslestroublesdélirantspersistants(codeF22delaCIM-10)lestroublesmentauxetcomportementauxdusàlaconsommationdeplusieursdroguesetàl’utilisationd’autressubstancespsychoactives(F19)etlestroublespsychotiquesaigusettransitoires(F23)avaientlediagnosticleplusélevévariabilitétandisquelestroublesdel’alimentation(F50)etlesdysfonctionnementssexuelsnonorganiques(F52)avaientlaplusfaibleLerisquederecevoirundiagnosticultérieurdetroublepsychiatriqued’ungroupedelaCIM-10différentdeceluidupremierdiagnosticvariaitconsidérablementparmilespremiersdiagnostics[SD18·5;range18to>100)EthnicitydatawerenotrecordedOver10yearsoffollow-up86804(46·9%)patientshadatleastonesubsequentdiagnosisthatdifferedfromtheirfirst-timediagnosisMeasuredbymeannormalisedentropyvaluespersistentdelusionaldisorders(ICD-10codeF22)mentalandbehaviouraldisordersduetomultipledruguseanduseofotherpsychoactivesubstances(F19)andacuteandtransientpsychoticdisorders(F23)hadthehighestdiagnosticvariabilitywhereaseatingdisorders(F50)andnon-organicsexualdysfunction(F52)hadthelowestTheriskofreceivingasubsequentdiagnosiswithapsychiatricdisorderfromanICD-10groupdifferentfromthatofthefirst-timediagnosisvariedsubstantiallyamongfirst-timediagnoses[SD18·5;gamme18à>100)Lesdonnéessurl’ethnicitén’ontpasétéenregistréesSur10ansdesuivi86804(469%)patientsonteuaumoinsundiagnosticultérieurdifférentdeleurpremierdiagnosticMesurésparlesvaleursd’entropienormaliséesmoyenneslestroublesdélirantspersistants(codeF22delaCIM-10)lestroublesmentauxetcomportementauxdusàlaconsommationdeplusieursdroguesetàl’utilisationd’autressubstancespsychoactives(F19)etlestroublespsychotiquesaigusettransitoires(F23)avaientlediagnosticleplusélevévariabilitétandisquelestroublesdel’alimentation(F50)etlesdysfonctionnementssexuelsnonorganiques(F52)avaientlaplusfaibleLerisquederecevoirundiagnosticultérieurdetroublepsychiatriqued’ungroupedelaCIM-10différentdeceluidupremierdiagnosticvariaitconsidérablementparmilespremiersdiagnostics[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 about possible diagnostic outcomes after an initial visit to a psychiatric hospital. This information could help clinicians plan appropriate follow-up and inform patients and families about the degree of diagnostic uncertainty associated with obtaining a first diagnosis in a psychiatric hospital, as well as the likely and unlikely trajectories of progression. of the diagnosis.
Funding
Mental Health Services, Capital Region of Denmark.
Translation
For the Danish translation of the summary, see the Additional Documents section.
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