CHANGES IN DIAGNOSIS IN A 9-YEAR NATIONAL LONGITUDINAL SAMPLE

Studied are changes in diagnosis in a random sample of 10% of all firs t admissions to psychiatric hospitals and psychiatric wards of general hospitals in Israel from 1983 to 1990 with follow-up evaluation to 19 91. This included 4,570 hospitalizations of 2,220 patients. Data were extracted from the National Psychiatric Case Registry of the Ministry of Health. Almost 59% of the sample had one admission, 18% had two, 9% had three, and 14% had four or more. From the first admission td the last discharge (a mean of 2.15 years), 59.2% of the patients' diagnose s did not change. In 89.46% of the cases in which the diagnosis change d, the changes took place during the first admission. Diagnostic chang e differed between diagnostic groups. In descending order of stability in diagnosis from the first admission to the last discharge were neur otic and personality disorder (73.6%), mental retardation (73.5%), sch izophrenia (73.0%), organic conditions (70.6%), affective disorders (6 6.2%), substance abuse (65.6%); childhood disorders (60%), paranoid di sorder (43.6%), other nonorganic psychosis (30.3%), and V-codes (25.0% ). The average level of diagnostic agreement between the first admissi on and the last discharge was a kappa of .52. The average length of st ay for patients whose diagnosis became more severe was considerably lo nger than for patients whose diagnosis became less severe or did not c hange in level of severity. Older age was related to less change in di agnosis. For patients aged less than 18 years, diagnosis changed in 46 .7% of the cases, for patients aged 19 to 44, 31.2%, and for patients older than 45, 27.8%. Copyright (C) 1994 by W.B. Saunders Company