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Bromet EJ, Kotov R, Fochtmann LJ, Carlson GA, Tanenberg-Karant M, Ruggero C, Chang SW. Diagnostic Shifts During the Decade Following First Admission for Psychosis. Am J Psychiatry . 2011 Jun 15 ; PubMed Abstract

Comments on Paper and Primary News
Comment by:  Patrick McGorry, SRF Advisor
Submitted 11 July 2011 Posted 11 July 2011

Rather than showing "misclassification" early on, Bromet et al. really show how inadequate these concepts, especially schizophrenia, are for early diagnosis and treatment. We need a model which links stage of illness to treatment selection and allows people with a need for care (often months or years before the current diagnostic approach really makes sense) to receive the help they need. Our Clinical Staging Model is an attempt to work towards this (McGorry et al., 2006).


McGorry PD, Hickie IB, Yung AR, Pantelis C, Jackson HJ. 2006. Clinical staging of psychiatric disorders: a heuristic framework for choosing earlier, safer and more effective interventions. The Australian and New Zealand Journal of Psychiatry 40(8): 616-622.

McGorry PD, Nelson B, Goldstone S, Yung R. 2010. Clinical staging: a heuristic and practical strategy for new research and better health and social outcomes for psychotic and related mood disorders. Canadian Journal of Psychiatry 55(8): 486-497.

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Comment by:  Lawrence YangEzra Susser (SRF Advisor)
Submitted 27 July 2011 Posted 27 July 2011

We believe that the paper by Evelyn Bromet and colleagues will come to be viewed as a classic in psychiatric research. It addresses a fundamental problem that has long been recognized, but nevertheless is often overlooked in published papers, and sometimes in clinical practice and mental health service policies. One of the reasons that has made it easier to overlook this problem is that it has not been directly addressed with high-quality empirical data. This study changes that.

Briefly, the problem is that psychiatric diagnoses are often made based on the state of an individual at a given point in time. Yet we know that individual states change over time, and that longitudinal information (not always available) will generate a more valid diagnosis. As noted in their paper, this was recognized in the classic paper of Robins and Guze (1970), but it has also been emphasized by others since then. A paper by Robert Spitzer suggested that, while we have no “gold standard” in psychiatry, we could use a “LEAD” (“Longitudinal, Expert, and All Data”) standard, a central feature of...  Read more

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Comment by:  John Strauss
Submitted 10 August 2011 Posted 10 August 2011

This is an important and valuable piece of work. The attention to the reliability of ratings and diagnosis is well done, and achieving an 80 percent follow-up over 10 years in a U.S. sample is impressive indeed. I would be interested to know how they managed that. Documenting diagnostic consistency and shifts provides important data for our understanding of: 1) diagnostic processes and 2) the course of psychiatric disorder. I put “diagnostic processes” first because we have such an unscientific tendency to treat diagnoses like real “things,” as though we were talking about something like a Toyota Corolla, rather than as complex interactions occurring in social contexts. Questions crucial to the diagnostic process include, among other things, how and where the patient is seen, the training of the person giving the diagnosis, the diagnostic system in use, and (sometimes finally), the characteristics of the person being given the label. Although some of these concerns are impressively considered in this study, one important assumption discussed below is not.

Diagnoses are a...  Read more

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