Diagnostic stability of first onset psychoses: Implications for epidemiology

were reported for the first time on average 4.3 years before index admission and 3 years before the first psychotic symptom. 81% of our sample had depressive symptoms during the early course. At index admission, 71% demonstrated at least one of the depressive CATEGO syndromes and during the course over 5 years between 38% (after 2 years) and 24% (after 5 years) had a depressive syndrome. There is a close association of depression and negative symptoms (r>0.50 for all follow up measurements). Depression in the early course has only a mild reducing effect on negative symptom scores (SANS affective flattening and SANS global score) over five years. But there is no further influence on the course of symptom scores, neither on the CATEGO subscores DAH, BSO, SNR, NSN, nor on depressive CATEGO syndromes. We conclude, that depression is highly prevalent in the different phases of schizophrenia, and it is not totally independent from negative symptoms. However, early depression was not a predictor of the 5 year symptom course.

DIAGNOSTIC PSYCHOSES:

STABILITY

OF FIRST

IMPLICATIONS

ONSET

FOR

EPIDEMIOLOGY S. A m i n , J. Brewin, S.P. Singh, G.L. H a r r i s o n , I. M e d l e y , R. K w i e c i n s k i

Department of P,sTehiatrv, University of Nottingham, Duncan Macmillan House, Nottingham NG3 6DA, UK We have reported changes in the incidence of schizophrenia in Nottingham over a 14 year period 1978-1992. These were thought to be related to a sub-syndromal shift in the first presentation of psychosis; an increase in acute and substance induced disorders and a decrease in narrowly defined (F20) schizophrenia. The validity of this finding was tested with a three year follow up of the original 1992 94 cohort. This cohort (n= 168) of first onset psychoses was from a defined catchment area and assessed using the Schedules for Assessment in Neuropsychiatry (SCAN). Consensus ICD-10 diagnoses were made. The cohort was re-assessed at three years (n=166), longitudinal consensus ICD-10 diagnoses were assigned blind to the original diagnosis. Of 57 first onset psychoses of F20 schizophrenia, only 10% had been re-classified at three years. This diagnostic category was by far the most stable. However, approximately one third of F20 schizophrenia at follow up had originally received an alternative diagnosis. As a result the incidence of F20 schizophrenia based upon diagnosis at follow up increases from 0.87 to 1.00 per 10,000 per year. The statistical significance of the previous decline is lost. At three years the diagnosis of schizophrenia is relatively stable. Although first onset cohorts are a sine qua non for calculating incidence rates in schizophrenia, the timing of the diagnostic exercise following first onset is of crucial importance due to the inherent instability of other psychotic disorders.

LONGTERM

COURSE

OF

SCHIZOPHRENIA; IMPLICATIONS FOR TREATMENT, RESEARCH AND POLICIES AFTER

1996

C.J. Slooff, M D , P h D , C h a i r m a n D u t c h S c h i z o p h r e n i a F o u n d a t i o n , G . P . H . D r e n t h e Assen, State U n i v e r s i t y Groningen, The Netherlands G.H.P. Drenthe, P.O. Box 30.007, 9400 RA ASSEN, The

Netherlands During the 15 year WHO-Disability follow-up study of an incidence cohort of patients with a schizophrenia disorder we assessed a high rate of chronicity expressed by persistent positive and negative symptoms (resp. 27'¼>,38%), social disability and high relapse rates (70%), leading to social disadvantages. Within the framework of the 'Decennium of the Brain', 1996 was in the Netherlands 'A year for schizophrenia and thereafter, in view of better'. This was a joint venture of the family union Ypsilon, the patient union Anoiksis and the Dutch Schizophrenia Foundation. We fostered consensus on treatment and rehabilitation protocols, coping strategies, relapse preventions and early detection strategies as logical consequences of the findings of the cohort study. During this year new priorities were formulated in governmental policies. These concern among others vocational rehabilitation facilities, community education; proper care for the homeless, and the empowerment of patients and their family members.

RELIABILITY,

VALIDITY

AND

UTILITY

OF

THE HEALTH OF THE NATION OUTCOME SCALE (HoNOS) IN AUSTRALIAN ADULT PSYCHIATRIC

SERVICES

J.D. H o p e , T. Trauer, N . A . K e k s

Dept. Hospital and Community Psyehiato,, AlI?ed Hospital, and Monash UniversiO', Commercial Rd, Prahran 3181 Australia The proposed UK national mental health indicator, the Health of the Nation Outcome Scale (HoNOS) was examined with respect to interrater reliability, concurrent and predictive validity. Doctor versus case manager interrater reliability in naturalistic settings was found to be satisfactory for total scores (weighted kappa 0.63), but very low on some social items. External validation by locus of care found that the HoNOS was able to discriminate inpatients from outpatients. Examination of the symptoms subscale revealed a good correlation with log PANSS score (r=0.41, p<0.0(ll, n = 7 7 ) , which was almost entirely explained by HoNOS item 6 (hallucinations and delusions). The symptom subscale was well correlated with the Hamilton Depression Scale (r=0.50, p - 0 . 0 0 3 , n = 3 1 ) , which was highly related to item 7 (depression), but not to PANSS negative symptom subscore. The social subscale of the