Objective: To evaluate the long‐term stability of International Classification of Diseases‐10th revision bipolar affective disorder (BD) in multiple settings.
Method: A total of 34 368 patients ...received psychiatric care in the catchment area of a Spanish hospital (1992–2004). The analyzed sample included patients aged ≥18 years who were assessed on ≥10 occasions and received a diagnosis of BD at least once (n = 1153; 71 543 assessments). Prospective and retrospective consistencies and the proportion of subjects who received a BD diagnosis in ≥75% of assessments were calculated. Factors related to diagnostic shift were analyzed with traditional statistical methods and Markov's models.
Results: Thirty per cent of patients received a BD diagnosis in the first assessment and 38% in the last assessment. Prospective and retrospective consistencies were 49% and 38%. Twenty‐three per cent of patients received a BD diagnosis during ≥75% of the assessments.
Conclusion: There was a high prevalence of misdiagnosis and diagnostic shift from other psychiatric disorders to BD. Temporal consistency was lower than in other studies.
The diagnosis of bipolar disorder is frequently modified during the course of the illness.
Diagnostic changes and associated errors are described for 1,153 patients diagnosed as bipolar disorder, ...aged over 18 years and with at least ten follow-up visits. Data was extracted from a clinical registry of out-patient care specialized in Psychiatry and psychiatric hospitalizations of 25,152 patients representative of an urban area of 240,000 inhabitants. Limit for diagnostic stability was established as the maintenance of the bipolar disorder diagnosis in at least 75% of the visits.
A total of 158 (46.1 %) out of 342 patients diagnosed as having a bipolar disorders in the first visit kept this diagnostic constant in subsequent evaluations. Infradiagnostic initial error was committed with 108 stable patients who were not diagnosed in the first visit. 184 patients diagnosed in the first visit with bipolar disorder had less than 75 % concordant diagnosis along the follow-up and could be considered as initial overdiagnosis. Two hundred and nine out of the 443 patients who were diagnosed as bipolar disorder in their last visit did not keep stability criteria in their follow-up and could be considered therefore as final overdiagnosis. Thirty two stable patients not diagnosed in their last visit could be considered as infradiagnosis final error. Diagnosis from schizophrenia spectrum (F2) appears in one of every four psychiatric visits of the patients included in this study. Overlap was seen in three other categories: anxiety disorders (F4), personality disorders (F6) and substance abuse disorders.
Initial course of bipolar disorder causes difficulties in the diagnosis.
New technologies and eating disorders de Pablo, G. Salazar; McDonagh, J. San Martin; Vallejo, S. Gomez ...
European neuropsychopharmacology,
10/2016, Letnik:
26
Journal Article
Limited studies have evaluated the effectiveness of vortioxetine in real-world settings, and none of them has involved patients with dual depression (major depressive disorder MDD and substance use ...disorder SUD). The objective of the study was to describe the effectiveness of vortioxetine in clinical practice and determine its effect on affective symptoms, cognitive function, quality of life, and substance use in patients with MDD and SUD.
Post-authorization, retrospective, multicenter, descriptive, and observational study in 80 patients with MDD and SUD receiving a maintenance treatment with vortioxetine for six months between January 2017 and April 2021.
Compared with baseline, scores significantly decreased after 3 and 6 months of treatment in the Montgomery-Åsberg Depression Rating Scale total (from 28.9 to 17.7 and 12.0), and global functional impairment of the Sheehan Disability Inventory (from 26.3 to 19.1 and 16.7). The number of correct answers in the symbol digit modalities test significantly improved during vortioxetine treatment (from 40.4 to 43.8 and 48.4). Regarding the clinical global impression scale, the score for disease severity significantly decreased from 3.8 to 3.0 and 2.4. Compared with baseline, there was a significant reduction in consumption of practically all substances, especially of alcohol, cannabis, and cocaine.
Vortioxetine was effective in clinical practice for alleviating depressive symptoms and functional impairment, and in improving cognitive and executive functions and disease severity in patients with MDD and SUD. Moreover, the treatment with vortioxetine favored a reduction in substance use and the severity of the SUDs.
One of the main aims of research on schizophrenia has been to pinpoint the early symptoms and signals of the disease before its appearance.
We have examined the diagnoses previously given to patients ...before they were diagnosed of schizophrenia.
This is a case-control study in which we used a data register including the fields of minimum basic data set (MBDS) whose time period included 1999 to 2005.
In our study, there was a 3.6% frequency of mental retardation and 2.1% one of behavioral and emotional disorders with onset usually occurring in childhood and adolescence, both diagnosed previously. The estimated odds ratio for a mentally retarded patient to suffer adult onset psychosis is 4.6 (95%CI 3.43-6.26), schizophrenia 5.8 (95% CI 4.20-7.88), paranoid schizophrenia 4.8 (95% CI 3.39 -6.93), residual schizophrenia 7.0 (95% CI 4.81 -10.09) and persistent delusional disorder 2.7 (95% CI 1.57 -4.73).
It can be concluded from our study that there is an increased frequency of mental retardation among the pathological records of subjects who will be diagnosed with paranoid schizophrenia and residual schizophrenia in the future. This fact supports the etiological thesis of schizophrenia involving neurodevelopment disorders.
