Document Type : Original Article


1 Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran

2 Department of Psychiatry, School of Medicine, University of Michigan, Ann Arbor, USA

3 Counseling, Department of Counseling, Faculty of Psychology & Education, Ardekan University, Yazd, IR Iran

4 Counseling Department, Faculty of Psychology & Education, Alzahra University, Tehran, IR Iran


Background: Hospitalization compared to outpatient care leads to better diagnosis. Stability of diagnosis varies among different psychiatric disorders and is associated with some demographic and mental health variables.
Objective: The current study evaluated the stability of diagnosis in Baqiyatallah Hospital Psychiatric Ward. 
Methods: In this retrospective study, 908 inpatient records from the psychiatric ward of Baqiyatallah Hospital in the years 1997-2015 were randomly selected. Having primary and final diagnoses was the inclusion criterion. Demographic variables (age, sex, marital status, education, and employment) and mental health variables (primary and final psychiatric diagnoses, duration of hospitalization, psychiatric history, and medication history) were recorded. Ultimately, 429 cases were entered into the study.
Results: The overall diagnostic stability rate was 57.6%. In mood, anxiety, psychotic, and personality disorders, the diagnostic stability rates were 84%, 63.8%, 46.3%, and 36.4%, respectively. For depressive and bipolar disorders, the stability of diagnosis rates were 85.5% and 86%, respectively. A significant relation between diagnosis axis, number of diagnoses, drug abuse and somatic disease history and diagnostic stability was seen (p<0.05).
Conclusion: According to the present study, the maximum diagnostic stability rate was related to mood disorders with anxiety disorders ranking second. The minimum stability was related to personality disorders. Other studies have reported completely different results which may be due to different situations. Future studies in this field seem to be essential.


  1. Kim JE, Saw A, Zane NW, Murphy BL. Patterns of utilization and outcomes of inpatient psychiatric treatment in Asian Americans. Asian Am J Psychol. 2014;5(1):35-43. doi: 10.1037/a0034439
  2. Bewernick BH, Kayser S, Sturm V, Schlaepfer TE. Long-term effects of nucleus accumbens deep brain stimulation in treatment-resistant depression: evidence for sustained efficacy. Neuropsychopharmacology. 2012;37(9):1975-85. doi: 10.1038/npp.2012.44
  3. Kroll M, Carpenter L, Murphy M, Stiller C. Effects of changes in diagnosis and registration on time trends in recorded childhood cancer incidence in Great Britain. Br J Cancer. 2012;107(7):1159-62. doi: 10.1038/bjc.2012.296
  4. Zhang T, Good M-JD, Good BJ, Chow A, Wang L, Dai Y, et al. Age and remission of personality pathology in the psychotic disorders compared to mood and/or anxiety disorders. Int J Psychiatry Med. 2012;44(3):241-55. doi: 10.2190/PM.44.3.e
  5. Dutta R, Murray RM, Allardyce J, Jones PB, Boydell J. Early risk factors for suicide in an epidemiological first episode psychosis cohort. Schizophr Res. 2011;126(1):11-9. doi: 10.1016/j.schres.2010.11.021
  6. Möller H, Jäger M, Riedel M, Obermeier M, Strauss A, Bottlender R. The Munich 15-year follow-up study (MUFUSSAD) on first-hospitalized patients with schizophrenic or affective disorders: assessing courses, types and time stability of diagnostic classification. Eur Psychiatry. 2011;26(4):231-43. doi: 10.1016/j.eurpsy.2010.04.012
  7. Simpson GM, Glick ID, Weiden PJ, Romano SJ, Siu CO. Randomized, controlled, double-blind multicenter comparison of the efficacy and tolerability of ziprasidone and olanzapine in acutely ill inpatients with schizophrenia or schizoaffective disorder. Am J Psychiatry. 2004;161:1837-47. doi: 10.1176/ajp.161.10.1837
  8. Fusar-Poli P, Cappucciati M, Rutigliano G, Heslin M, Stahl D, Brittenden Z, et al. Diagnostic stability of ICD/DSM first episode psychosis diagnoses: Meta-analysis. Schizophr Bull. 2016. pii:sbw020. doi: 10.1093/schbul/sbw020
  9. Strejilevich S, Martino D, Murru A, Teitelbaum J, Fassi G, Marengo E, et al. Mood instability and functional recovery in bipolar disorders. Acta Psychiatr Scand. 2013;128(3):194-202. doi: 10.1111/acps.12065
  10. Albert N, Bertelsen M, Thorup A, Petersen L, Jeppesen P, Le Quack P, et al. Predictors of recovery from psychosis: analyses of clinical and social factors associated with recovery among patients with first-episode psychosis after 5years. Schizophr Res. 2011;125(2):257-66. doi: 10.1016/j.schres.2010.10.013
  11. Mataix‐Cols D, Frost RO, Pertusa A, Clark LA, Saxena S, Leckman JF, et al. Hoarding disorder: a new diagnosis for DSM‐V? Depress Anxiety. 2010;27(6):556-72. doi: 10.1002/da.20693
  12. Roshanaei-Moghaddam B, Katon W. Premature mortality from general medical illnesses among persons with bipolar disorder: a review. Psychiatr Serv. 200960(2):147-56. doi: 10.1176/
  13. Omer S, Golden E, Priebe S. Exploring the Mechanisms of a Patient-Centred Assessment with a Solution Focused Approach (DIALOG+) in the Community Treatment of Patients with Psychosis: A Process Evaluation within a Cluster-Randomised Controlled Trial. PloS One. 2016;11(2):e0148415. doi: 10.1371/journal.pone.0148415
  14. Guzzetta F, Miglio R, Santone G, Picardi A, Norcio B, Bracco R, et al. First-ever admitted psychiatric inpatients in Italy: clinical characteristics and reasons contributing to admission: findings from a national survey. Psychiatry Res. 2010;176(1):62-8. doi: 10.1016/j.psychres.2008.11.005
  15. Schulz JB, Boesch S, Bürk K, Dürr A, Giunti P, Mariotti C, et al. Diagnosis and treatment of Friedreich ataxia: a European perspective. Nat Rev Neurol. 2009;5(4):222-34. doi: 10.1038/nrneurol.2009.26
  16. Haas M, DelBello MP, Pandina G, Kushner S, Van Hove I, Augustyns I, et al. Risperidone for the treatment of acute mania in children and adolescents with bipolar disorder: a randomized, double‐blind, placebo‐controlled study. Bipolar Disord. 2009;11(7):687-700. doi: 10.1111/j.1399-5618.2009.00750.x
  17. Carballo JJ, Baca-Garcia E, Blanco C, Perez-Rodriguez MM, Arriero MAJ, Artes-Rodriguez A, et al. Stability of childhood anxiety disorder diagnoses: a follow-up naturalistic study in psychiatric care. Eur Child Adolesc Psychiatry. 2010;19(4):395-403. doi: 10.1007/s00787-009-0064-1
  18. Lenzenweger MF. Current status of the scientific study of the personality disorders: an overview of epidemiological, longitudinal, experimental psychopathology, and neurobehavioral perspectives. J Am Psychoanal Assoc. 2010;58(4):741-78. doi: 10.1177/0003065110386111
  19. Atwoli L, Ndambuki D, Owiti P, Manguro G, Omulimi N. Short-term diagnostic stability among re-admitted psychiatric in-patients in Eldoret, Kenya. Afr J Psychiatry (Johannesbg). 2012;15(2):114-8. doi: 10.4314/ajpsy.v15i2.15
  20. Huguelet P, Schneider El Gueddari N, Glauser D. Stability of DSM-III-R diagnoses: Study of a case register. Psychopathology. 2001;34(3):118-22. doi: 10.1159/000049293
  21. Skodol AE, Gunderson JG. Personality disorders and mood disorders: perspectives on diagnosis and classification from studies of longitudinal course and familial associations. J Pers Disord. 2010;24(1):83. doi: 10.1521/pedi.2010.24.1.83
  22. Shankman SA, Lewinsohn PM, Klein DN, Small JW, Seeley JR, Altman SE. Subthreshold conditions as precursors for full syndrome disorders: a 15‐year longitudinal study of multiple diagnostic classes. J Child Psychol Psychiatry. 2009;50(12):1485-94. doi: 10.1111/j.1469-7610.2009.02117.x
  23. Sanislow CA, Little TD, Ansell EB, Grilo CM, Daversa M, Markowitz JC, et al. Ten-year stability and latent structure of the DSM–IV schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders. J Abnorm Psychol. 2009;118(3):507. doi: 10.1037/a0016478
  24. Schirmbeck F, Rausch F, Englisch S, Eifler S, Esslinger C, Meyer-Lindenberg A, et al. Stable cognitive deficits in schizophrenia patients with comorbid obsessive-compulsive symptoms: a 12-month longitudinal study. Schizophr Bull. 2013;39(6):1261-71. doi: 10.1093/schbul/sbs123
  25. Keshavan MS, Morris DW, Sweeney JA, Pearlson G, Thaker G, Seidman LJ, et al. A dimensional approach to the psychosis spectrum between bipolar disorder and schizophrenia: the Schizo-Bipolar Scale. Schizophr Res. 2011;133(1):250-4. doi: 10.1016/j.schres.2011.09.005
  26. Bromet EJ, Kotov R, Fochtmann LJ, Carlson GA, Tanenberg-Karant M, Ruggero C, et al. Diagnostic shifts during the decade following first admission for psychosis. Am J Psychiatry. 2011;168(11):1186-94. doi: 10.1176/appi.ajp.2011.11010048
  27. Schwartz JE, Fennig S, Tanenberg-Karant M, Carlson G, Craig T, Galambos N, et al. Congruence of diagnoses 2 years after a first-admission diagnosis of psychosis. Arch Gen Psychiatry. 2000;57(6):593-600. doi: 10.1001/archpsyc.57.6.593
  28. Lavigne JV, LeBailly SA, Gouze KR, Binns HJ, Keller J, Pate L. Predictors and correlates of completing behavioral parent training for the treatment of oppositional defiant disorder in pediatric primary care. Behav Ther. 2010;41(2):198-211. doi: 10.1016/j.beth.2009.02.006
  29. Castellini G, Sauro CL, Mannucci E, Ravaldi C, Rotella CM, Faravelli C, et al. Diagnostic crossover and outcome predictors in eating disorders according to DSM-IV and DSM-V proposed criteria: a 6-year follow-up study. Psychosom Med. 2011;73(3):270-9. doi: 10.1097/PSY.0b013e31820a1838
  30. Amminger GP, Henry LP, Harrigan SM, Harris MG, Alvarez-Jimenez M, Herrman H, et al. Outcome in early-onset schizophrenia revisited: findings from the Early Psychosis Prevention and Intervention Centre long-term follow-up study. Schizophr Res. 2011;131(1):112-9. doi: 10.1016/j.schres.2011.06.009