Abstract：
OBJECTIVE: Diagnostic stability for people with First Episode Psychosis (FEP) is essential for treatment, but it remains poorly investigated, especially in adolescents and within a prospective design. The aims of this research were: (a) to examine diagnostic change in Italian adolescents with FEP treated within an \"Early Intervention in Psychosis\" program during a 2-year follow-up period and (b) to investigate any sociodemographic and clinical predictors at baseline.
METHODS: At baseline, 66 adolescents with FEP was recruited. Their primary diagnosis was formulated both at baseline and at the end of follow-up. At presentation, FEP adolescents completed the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA). As for diagnostic stability, the Kappa statistic was calculated. The associations of diagnostic change with baseline clinical and sociodemographic features were analyzed using a logistic model with the diagnostic shift as dependent variable. A propensity score was finally calculated based on logistic analysis results.
RESULTS: 38 (57.6%) FEP adolescents changed their opening diagnosis. The highest prospective diagnostic stability was for initial diagnosis of schizophrenia (95.4%) and affective spectrum psychoses (75%). Diagnostic instability was high for opening diagnosis of psychosis not otherwise specified, brief psychosis and schizophreniform disorder (100%). The best predictors of diagnostic change were fewer years of education, shorter duration of untreated psychosis and higher baseline levels of psychiatric symptoms.
CONCLUSIONS: Diagnostic stability is crucial for treatment and clinical decision making. Addressing instability in FEP diagnoses is an important challenge for future diagnostic development in early psychosis, especially in adolescence.
METHODS: At baseline, 66 adolescents with FEP was recruited. Their primary diagnosis was formulated both at baseline and at the end of follow-up. At presentation, FEP adolescents completed the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA). As for diagnostic stability, the Kappa statistic was calculated. The associations of diagnostic change with baseline clinical and sociodemographic features were analyzed using a logistic model with the diagnostic shift as dependent variable. A propensity score was finally calculated based on logistic analysis results.
RESULTS: 38 (57.6%) FEP adolescents changed their opening diagnosis. The highest prospective diagnostic stability was for initial diagnosis of schizophrenia (95.4%) and affective spectrum psychoses (75%). Diagnostic instability was high for opening diagnosis of psychosis not otherwise specified, brief psychosis and schizophreniform disorder (100%). The best predictors of diagnostic change were fewer years of education, shorter duration of untreated psychosis and higher baseline levels of psychiatric symptoms.
CONCLUSIONS: Diagnostic stability is crucial for treatment and clinical decision making. Addressing instability in FEP diagnoses is an important challenge for future diagnostic development in early psychosis, especially in adolescence.
摘要：
目的：首次发作精神病（FEP）患者的诊断稳定性对治疗至关重要，但它仍然缺乏调查，特别是在青少年和前瞻性设计中。这项研究的目的是：（a）在2年的随访期内检查在“精神病早期干预”计划中接受FEP治疗的意大利青少年的诊断变化；（b）调查任何社会人口统计学和临床预测因素。基线。
方法：在基线时，招募了66名FEP青少年。他们的主要诊断是在基线和随访结束时制定的。在介绍时,FEP青少年完成了国家儿童和青少年健康成果量表（HoNOSCA）。至于诊断稳定性，计算了Kappa统计量。使用逻辑模型分析了诊断变化与基线临床和社会人口统计学特征的关联，并将诊断变化作为因变量。最后根据逻辑分析结果计算倾向得分。
结果：38（57.6％）FEP青少年改变了他们的开放诊断。前瞻性诊断稳定性最高的是精神分裂症（95.4％）和情感性谱系精神病（75％）的初始诊断。对于未另作说明的精神病的开放诊断，诊断不稳定性很高，短暂的精神病和精神分裂症样障碍（100％）。诊断变化的最佳预测因素是受教育年限较少，未治疗的精神病持续时间较短，精神症状的基线水平较高。
结论：诊断稳定性对于治疗和临床决策至关重要。解决FEP诊断中的不稳定性是未来早期精神病诊断发展的重要挑战。尤其是在青春期。
方法：在基线时，招募了66名FEP青少年。他们的主要诊断是在基线和随访结束时制定的。在介绍时,FEP青少年完成了国家儿童和青少年健康成果量表（HoNOSCA）。至于诊断稳定性，计算了Kappa统计量。使用逻辑模型分析了诊断变化与基线临床和社会人口统计学特征的关联，并将诊断变化作为因变量。最后根据逻辑分析结果计算倾向得分。
结果：38（57.6％）FEP青少年改变了他们的开放诊断。前瞻性诊断稳定性最高的是精神分裂症（95.4％）和情感性谱系精神病（75％）的初始诊断。对于未另作说明的精神病的开放诊断，诊断不稳定性很高，短暂的精神病和精神分裂症样障碍（100％）。诊断变化的最佳预测因素是受教育年限较少，未治疗的精神病持续时间较短，精神症状的基线水平较高。
结论：诊断稳定性对于治疗和临床决策至关重要。解决FEP诊断中的不稳定性是未来早期精神病诊断发展的重要挑战。尤其是在青春期。
