The following is a summary of the “Mapping diagnostic trajectories from the first hospital diagnosis of a psychiatric disorder: a Danish nationwide cohort study using sequence analysis,” published in the January 2023 issue of Psychiatry by Jørgensen, et al.

Predicting the diagnostic future of patients presenting with psychopathology for the first time is a critical clinical problem in psychiatry. The goal of this study was to create a comprehensive map of subsequent diagnoses following a first psychiatric hospitalization.

They identified patients aged 18 years or older with an inpatient or outpatient psychiatric hospital contact and received one of the 20 most common first-time psychiatric diagnoses (defined at the ICD-10 two-cipher level, F00-F99) between January 1, 1995, and December 31, 2008. In addition, the 20 most common subsequent psychiatric diagnoses (F00-F99) and death occurring during the 10 years of follow-up were identified as outcomes for each first-time diagnosis. 

They used social sequence analyses to assess diagnostic stability, assigning a subsequent diagnosis to each state 6 months after each first-time diagnosis. The last diagnosis given within each 6-month period was defined as the subsequent diagnosis. The normalized entropy of each sequence was calculated to show the uncertainty in predicting the states in a given sequence. After each first-time diagnosis, Cox proportional hazards models were used to assess the risk of receiving a subsequent diagnosis (at the one-cipher level, F0-F9).

The study included 184 949 adult patients (77 129 [417%] men and 107 820 [583%] women, with a mean age of 425 years [SD 185; range 18 to >100]. Data on ethnicity were not collected. 86 804 (469%) patients had at least one subsequent diagnosis that differed from their initial diagnosis over a 10-year period of follow-up. 

The highest diagnostic variability was found in persistent delusional disorders (ICD-10 code F22), mental and behavioral disorders due to multiple drug use and use of other psychoactive substances (F19), and acute and transient psychotic disorders (F23), while eating disorders (F50) and non-organic sexual dysfunction (F52) had the lowest. The risk of receiving a subsequent diagnosis of a psychiatric disorder from a different ICD-10 group than the first-time diagnosis varied significantly among first-time diagnoses. These data provide specific information on possible diagnostic outcomes following a first-time visit to a psychiatric hospital. This information could assist clinicians in planning appropriate follow-up and informing patients and families about the degree of diagnostic uncertainty associated with receiving a first psychiatric hospital diagnosis, as well as likely and unlikely diagnostic progression trajectories

Source: sciencedirect.com/science/article/abs/pii/S2215036622003674