Stability of diagnosis: a 20-year retrospective cohort study of Israeli psychiatric adolescent inpatients

Outcome according to diagnosis and stability of diagnosis were investigated in a follow, back study of 351 adolescents with various psychiatric disord ers hospitalized in a closed psychiatric ward. The duration of follow-back was 15-19 years. All diagnoses were based on the ICD-9. Data were collected from the Health Ministry registry and, in the patients who could be locate d, by structured telephone interview. Special attention was directed at the diagnosis of transient adolescent psychosis (TAP) vs. schizophrenia and pr ognostic indicators of suicide. The results showed that the most stable dia gnosis was anxiety disorder. The stability of the different diagnoses over time was greater between the second and last admission than between the fir st and last (for patients with three or more admissions). Number of hospita lizations correlated negatively with prognosis. TAP at second admission was an unstable diagnosis; 66% of these patients had a final diagnosis of schi zophrenia. However, patients with a diagnosis of TAP at first admission had a higher predictive index score and a higher outcome score than schizophre nic patients. TAP appeared to be a valid diagnostic entity, distinguishable from schizophrenia in course, frequency of suicidal behaviour and social-o ccupational outcome. Suicide victims had a higher cumulative length of stay than age- and sex-matched non-suicidal patients. Fifty per cent of the sui cide victims had a final diagnosis of schizophrenia, compared to 30 per cen t for the whole sample. In conclusion, these findings indicate that TAP is associated with a relatively good prognosis and should probably be differen tiated from schizophrenia. Further retrospective and prospective studies of adolescent psychiatric inpatients may help delineate the nature and course of psychosis and other psychopathology in this age group. (C) 2001 The Ass ociation for Professionals in Services for Adolescents.