Onset of schizophrenia diagnoses in a large clinical cohort

Abstract

We aimed to describe the diagnostic patterns preceding and following the onset of schizophrenia diagnoses in outpatient clinics. A large clinical sample of 26,163 patients with a diagnosis of schizophrenia in at least one outpatient visit was investigated. We applied a Continuous Time Hidden Markov Model to describe the probability of transition from other diagnoses to schizophrenia considering time proximity. Although the most frequent diagnoses before schizophrenia were anxiety and mood disorders, direct transitions to schizophrenia usually came from psychotic-spectrum disorders. The initial diagnosis of schizophrenia was not likely to change for two of every three patients if it was confirmed some months after its onset. When not confirmed, the most frequent alternative diagnoses were personality, affective or non-schizophrenia psychotic disorders. Misdiagnosis or comorbidity with affective, anxiety and personality disorders are frequent before and after the diagnosis of schizophrenia. Our findings give partial support to a dimensional view of schizophrenia and emphasize the need for longitudinal assessment.

Figure 1

Probabilistic links of ICD-10 diagnoses converging into schizophrenia (F20). The size of the circles indicates the frequency of the diagnoses in our sample. The color and width of the arrows describe the strength of the interactions according to the model. F04/F05: Organic amnesic syndrome/Delirium, not induced by alcohol and other psychoactive substances; F11/12/F16/F19: Mental and behavioral disorders due to use of opioids/cannabinoids/hallucinogens/multiple drug use and use of other psychoactive substances; F21: Schizotypal disorder; F22: Persistent delusional disorders; F23: Acute and transient psychotic disorders; F24: Induced delusional disorder; F25: Schizoaffective disorders; F29: Unspecified nonorganic psychosis; F38: Other mood disorders; F39: Unspecified mood disorder; F70/F71: Mild/moderate mental retardation.

Figure 2

Diagnostic evolution of the first diagnosis of schizophrenia (F20) in the following 48 months. The upper section shows the probability (0.5–1) of maintaining the F20 diagnosis. The lower section shows the probability (0–0.05) of changing this diagnosis.