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Diagnostic stability of psychiatric disorders in clinical practice

Background Psychiatric disorders are among the top causes worldwide of disease burden and disability. A major criterion for validating diagnoses is stability over time. Aims To evaluate the long-term stability of the most prevalent psychiatric diagnoses in a variety of clinical settings. Method A total of 34 368 patients received psychiatric care in the catchment area of one Spanish hospital (1992–2004). This study is based on 10 025 adult patients who were assessed on at least ten occasions (360 899 psychiatric consultations) in three settings: in-patient unit, 2000–2004 (n=546); psychiatric emergency room, 2000–2004 (n=1408); and out-patient psychiatric facilities, 1992–2004 (n=10 016). Prospective consistency, retrospective consistency and the proportion of patients who received each diagnosis in at least 75% of the evaluations were calculated for each diagnosis in each setting and across settings. Results The temporal consistency of mental disorders was poor, ranging from 29% for specific personality disorders to 70% for schizophrenia, with stability greatest for in-patient diagnoses and least for out-patient diagnoses. Conclusions The findings are an indictment of our current psychiatric diagnostic practice.