Evaluation of the diagnostic continuity of unspecified mood disorders

Objective: According to ICD-10, the diagnosis of unspecified mood disorder (UMD), coded ‘F39,’ is used when there is insufficient or contradictory information about the patient and the symptoms of mood disorder are not sufficient to diagnose a specific mood disorder. Information about the frequency, diagnostic validity and continuity of this diagnosis is unsatisfactory. Therefore, we aimed to evaluate the prevalence and diagnostic continuity of this diagnosis among individuals diagnosed with UMD in our outpatient clinic. Method: Included in the study were patients who presented to the psychiatry outpatient unit for the first time between January 2011 and December 2017, were diagnosed with mood disorder code ‘F39’ at the first admission, and presented at least three times in different periods (n=48). Outpatient unit records were evaluated retrospectively and the data were analyzed with SPSS version 19.0. Results: The mean follow-up period of 48 patients included in the study was 14.4±13.9 months. The final diagnoses of the patients after follow-up were UMD (42%), depressive disorder (25%), bipolar disorder (17%), and anxiety disorder (10%). It was found that the duration of the follow-up for individuals diagnosed with UMD was significantly shorter than for those with a different diagnosis. No significant difference was found between final diagnoses in terms of age, gender, level of education, and marital status. Conclusion: UMD has less diagnostic stability than other mood disorders. Therefore, longer follow-up durations are needed in patients with UMD, and it is crucial to reconsider the diagnosis during follow-up. Further studies with larger samples are needed to elucidate the stability of UMD.

PDF

___

Fennig S, Kovasznay B, Rich C, Ram R, Pato C, Miller A, Rubinstein J, Carlson G, Schwartz JE, Phelan J. Six-month stability of psychiatric diagnoses in first-admission patients with psychosis. Am J Psychiatry 1994; 151:1200-1208.

Vieta E, Phillips ML. Deconstructing bipolar disorder: a critical review of its diagnostic validity and a proposal for DSM-V and ICD-11. Schizophr Bull 2007; 33:886-892.

Haahr U, Friis S, Larsen TK, Melle I, Johannessen JO, Opjordsmoen S, Simonsen E, Rund BR, Vaglum P, McGlashan T. First-episode psychosis: diagnostic stability over one and two years. Psychopathology 2008; 41:322-329.

Kim JS, Baek JH, Choi JS, Lee D, Kwon JS, Hong KS. Diagnostic stability of first-episode psychosis and predictors of diagnostic shift from non-affective psychosis to bipolar disorder: a retrospective evaluation after recurrence. Psychiatry Res 2011; 188:29-33.

Pope MA, Joober R, Malla AK. Diagnostic stability of firstepisode psychotic disorders and persistence of comorbid psychiatric disorders over 1 year. Can J Psychiatry 2013; 58:588- 594.

Queirazza F, Semple DM, Lawrie SM. Transition to schizophrenia in acute and transient psychotic disorders. Br J Psychiatry 2014; 204:299-305.

Kessing LV. Diagnostic stability in bipolar disorder in clinical practise as according to ICD-10. J Affect Disord 2005; 85:293- 299.

Chen YR, Swann AC, Johnson BA. Stability of diagnosis in bipolar disorder. J Nerv Ment Dis 1998; 186:17-23.

Baca-Garcia E, Perez-Rodriguez MM, Basurte-Villamor I, Fernandez del Moral AL, Jimenez-Arriero MA, Gonzalez de Rivera JL, Saiz-Ruiz J, Oquendo MA. Diagnostic stability of psychiatric disorders in clinical practice. Br J Psychiatry 2007; 190:210-216.

Sorias S. Overcoming the limitations of the descriptive and categorical approaches in psychiatric diagnosis: a proposal based on Bayesian networks. Turk Psikiyatri Derg 2014; 26:1-12. (Turkish)

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth ed., Washington, D.C: American Psychiatric Association, 2000.

World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders. https://www.who.int/classifications/ icd/en/bluebook.pdf. Accessed October 15, 2018.

Alavi F, Nakhaee N, Sabahi A. Diagnostic stability of psychiatric disorders in re-admitted psychiatric patients in Kerman, Iran. Glob J Health Sci 2014; 6:294-300.

Kim W, Woo YS, Chae JH, Bahk WM. The diagnostic stability of DSM-IV diagnoses: an examination of major depressive disorder, bipolar I disorder, and schizophrenia in Korean patients. Clin Psychopharmacol Neurosci 2011; 9:117-121.

Baca-Garcia E, Perez-Rodriguez MM, Basurte-Villamor I, LopezCastroman J, Fernandez del Moral AL, Jimenez-Arriero MA, Gronzalez de Rivera JL, Saiz-Ruiz J, Leiva-Murillo JM, de PradoCumplido M, Santiago-Mozos R, Artes-Rodriguez A, Oquendo MA, de Leon J. Diagnostic stability and evolution of bipolar disorder in clinical practice: a prospective cohort study. Acta Psychiatr Scand 2007; 115:473-480.

Kessing LV. Diagnostic stability in depressive disorder as according to ICD-10 in clinical practice. Psychopathology 2005; 38:32-37.

Birmaher B, Axelson D, Goldstein B, Strober M, Gill MK, Hunt J, Houck P, Ha W, Iyengar S, Kim E, Yen S, Hower H, Esposito-Smythers C, Goldstein T, Ryan N, Keller M. Four-year longitudinal course of children and adolescents with bipolar spectrum disorders: the course and outcome of bipolar youth (COBY) study. Am J Psychiatry 2009; 166:795-804.

Birmaher B, Axelson D, Strober M, Gill MK, Valeri S, Chiappetta L, Ryan N, Leonard H, Hunt J, Iyengar S, Keller M. Clinical course of children and adolescents with bipolar spectrum disorders. Arch Gen Psychiatry 2006; 63:175-183.

Axelson DA, Birmaher B, Strober MA, Goldstein BI, Ha W, Gill MK, Goldstein TR, Yen S, Hower H, Hunt JI, Liao F, Iyengar S, Dickstein D, Kim E, Ryan ND, Frankel E, Keller MB. Course of subthreshold bipolar disorder in youth: diagnostic progression from bipolar disorder not otherwise specified. J Am Acad Child Adolesc Psychiatry 2011; 50:1001-1016.

Baldwin P, Browne D, Scully PJ, Quinn JF, Morgan MG, Kinsella A, Owens JM, Russell V, O’Callaghan E, Waddington JL. Epidemiology of first-episode psychosis: illustrating the challenges across diagnostic boundaries through the CavanMonaghan study at 8 years. Schizophr Bull 2005; 31:624-638.

Amin S, Singh SP, Brewin J, Jones PB, Medley I, Harrison G. Diagnostic stability of first-episode psychosis. Comparison of ICD-10 and DSM-III-R systems. Br J Psychiatry 1999; 175:537- 543.

Clayton PJ, Guze SB, Cloninger CR, Martin RL. Unipolar depression: diagnostic inconsistency and its implications. J Affect Disord 1992; 26:111-116.

Heslin M, Lomas B, Lappin JM, Donoghue K, Reininghaus U, Onyejiaka A, Crudace T, Jones PB, Murray RM, Fearon P, Dazzan P, Morgan C, Doody GA. Diagnostic change 10 years after a first episode of psychosis. Psychol Med 2015; 45:2757-2769.

Tas HI, Celik M, Altinbas K. Evaluation of four-year stability of unspecified psychosis. Noro Psikiyatr Ars 2019; 56:47-51.

Schindler A, Hiller W, Witthoft M. What predicts outcome, response, and drop-out in CBT of depressive adults? a naturalistic study. Behav Cogn Psychother 2013;41:365-370.