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Utilising symptom dimensions with diagnostic categories improves prediction of time to first remission in first-episode psychosis.

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Version 2 2022-01-24, 15:51
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posted on 2022-01-24, 15:51 authored by Olesya Ajnakina, John LallyJohn Lally, Marta Di Forti, Simona A. Stilo, Anna Kolliakou, Poonam Gardner-Sood, Paola Dazzan, Carmine Pariante, Tiago Reis Marques, Valeria Mondelli, James MacCabe, Fiona Gaughran, Anthony S. David, Daniel Stamate, Robin M. Murray, Helen L. Fisher

There has been much recent debate concerning the relative clinical utility of symptom dimensions versus conventional diagnostic categories in patients with psychosis. We investigated whether symptom dimensions rated at presentation for first-episode psychosis (FEP) better predicted time to first remission than categorical diagnosis over a four-year follow-up. The sample comprised 193 FEP patients aged 18-65years who presented to psychiatric services in South London, UK, between 2006 and 2010. Psychopathology was assessed at baseline with the Positive and Negative Syndrome Scale and five symptom dimensions were derived using Wallwork/Fortgang's model; baseline diagnoses were grouped using DSM-IV codes. Time to start of first remission was ascertained from clinical records. The Bayesian Information Criterion (BIC) was used to find the best fitting accelerated failure time model of dimensions, diagnoses and time to first remission. Sixty percent of patients remitted over the four years following first presentation to psychiatric services, and the average time to start of first remission was 18.3weeks (SD=26.0, median=8). The positive (BIC=166.26), excited (BIC=167.30) and disorganised/concrete (BIC=168.77) symptom dimensions, and a diagnosis of schizophrenia (BIC=166.91) predicted time to first remission. However, a combination of the DSM-IV diagnosis of schizophrenia with all five symptom dimensions led to the best fitting model (BIC=164.35). Combining categorical diagnosis with symptom dimension scores in FEP patients improved the accuracy of predicting time to first remission. Thus our data suggest that the decision to consign symptom dimensions to an annexe in DSM-5 should be reconsidered at the earliest opportunity.


This work was supported by the Maudsley Charitable Fund; Institute of Psychiatry, Psychology & Neuroscience at King's College London; UK National Institute of Health Research (NIHR; RP-PG-0606-1049); NIHR Specialist Biomedical Research Centre for Mental Health grant (BRC-SLAM); and an MQ Fellows Award (MQ14F40 to H.L.F.). R.M.M. and A.S.D. receive salary support from the NIHR BRC. The views expressed are those of the author(s) and not necessarily those of the National Health Service (NHS), the NIHR or the Department of Health.



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Ajnakina O, Lally J, Di Forti M, Stilo SA, Kolliakou A, Gardner-Sood P, Dazzan P, Pariante C, Reis Marques T, Mondelli V, MacCabe J, Gaughran F, David AS, Stamate D, Murray RM, Fisher HL. Utilising symptom dimensions with diagnostic categories improves prediction of time to first remission in first-episode psychosis. Schizophrenia Research. 2017;pii: S0920-9964(17)30453-X. doi: 10.1016/j.schres.2017.07.042

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