PSYCHOTIC-PATIENTS WITH UNCLEAR DIAGNOSES - A DESCRIPTIVE ANALYSIS

This report describes the clinical characteristics of psychotic patien ts who received a 6-month longitudinal research diagnosis of psychosis not otherwise specified (NOS) or for whom no consensus diagnosis was reached. The reasons why these subjects could not be classified into a specific DSM-III-R category, their classification under the proposed DSM-IV criteria, their reclassification at 24-month follow-up, and dif ferences between these groups and patients with schizophrenia and affe ctive disorders in demographic characteristics, initial clinical featu res, and short-term course are explored. Data were drawn from the firs t phase of the Suffolk County Mental Health Project. Longitudinal cons ensus procedures were used to derive 6- and 24-month DSM-III-R diagnos es based on information from a structured diagnostic interview, an int erview with the patient's clinician, the medical record and discharge summary, and significant others. Thirteen subjects (4.7%) received a d iagnosis of psychosis NOS, and 12 (4.3%) had no consensus diagnosis. S even with psychosis NOS had an acute onset with rapid remission; this subgroup met DSM-IV criteria for brief psychosis without stressors. As a group, the psychosis NOS subjects were significantly older and had a lower rate of lifetime alcohol abuse/dependence than the schizophren ic and affective ire disorder groups. Their short-term course was sign ificantly better than that of the schizophrenics and similar to that o f patients with an affective disorder. Subjects with no consensus diag nosis were more likely to have lifetime drug abuse/dependence than the other two groups. Compared with patients with an affective disorder, these subjects showed poorer psychosocial functioning before and 6 mon ths after hospitalization these levels of functioning were not signifi cantly different from those of schizophrenic subjects.