PMID- 24089086 OWN - NLM STAT- MEDLINE DCOM- 20140224 LR - 20230324 IS - 2168-6238 (Electronic) IS - 2168-622X (Linking) VI - 70 IP - 12 DP - 2013 Dec TI - Boundaries of schizoaffective disorder: revisiting Kraepelin. PG - 1276-86 LID - 10.1001/jamapsychiatry.2013.2350 [doi] AB - IMPORTANCE: Established nosology identifies schizoaffective disorder as a distinct category with boundaries separating it from mood disorders with psychosis and from schizophrenia. Alternative models argue for a single boundary distinguishing mood disorders with psychosis from schizophrenia (kraepelinian dichotomy) or a continuous spectrum from affective to nonaffective psychosis. OBJECTIVE: To identify natural boundaries within psychotic disorders by evaluating associations between symptom course and long-term outcome. DESIGN, SETTING, AND PARTICIPANTS: The Suffolk County Mental Health Project cohort consists of first-admission patients with psychosis recruited from all inpatient units of Suffolk County, New York (72% response rate). In an inception cohort design, participants were monitored closely for 4 years after admission, and their symptom course was charted for 526 individuals; 10-year outcome was obtained for 413. MAIN OUTCOMES AND MEASURES: Global Assessment of Functioning (GAF) and other consensus ratings of study psychiatrists. RESULTS: We used nonlinear modeling (locally weighted scatterplot smoothing and spline regression) to examine links between 4-year symptom variables (ratio of nonaffective psychosis to mood disturbance, duration of mania/hypomania, depression, and psychosis) and 10-year outcomes. Nonaffective psychosis ratio exhibited a sharp discontinuity-10 days or more of psychosis outside mood episodes predicted an 11-point decrement in GAF-consistent with the kraepelinian dichotomy. Duration of mania/hypomania showed 2 discontinuities demarcating 3 groups: mania absent, episodic mania, and chronic mania (manic/hypomanic >1 year). The episodic group had a better outcome compared with the mania absent and chronic mania groups (12-point and 8-point difference on GAF). Duration of depression and psychosis had linear associations with worse outcome. CONCLUSIONS AND RELEVANCE: Our data support the kraepelinian dichotomy, although the study requires replication. A boundary between schizoaffective disorder and schizophrenia was not observed, which casts further doubt on schizoaffective diagnosis. Co-occurring schizophrenia and mood disorder may be better coded as separate diagnoses, an approach that could simplify diagnosis, improve its reliability, and align it with the natural taxonomy. FAU - Kotov, Roman AU - Kotov R AD - Department of Psychiatry and Behavioral Science, Stony Brook University, Stony Brook, New York. FAU - Leong, Shirley H AU - Leong SH FAU - Mojtabai, Ramin AU - Mojtabai R FAU - Erlanger, Ann C Eckardt AU - Erlanger AC FAU - Fochtmann, Laura J AU - Fochtmann LJ FAU - Constantino, Eduardo AU - Constantino E FAU - Carlson, Gabrielle A AU - Carlson GA FAU - Bromet, Evelyn J AU - Bromet EJ LA - eng GR - R01 MH044801/MH/NIMH NIH HHS/United States GR - R01 MH094398/MH/NIMH NIH HHS/United States GR - MH44801/MH/NIMH NIH HHS/United States GR - MH094398/MH/NIMH NIH HHS/United States PT - Comparative Study PT - Journal Article PT - Research Support, N.I.H., Extramural PL - United States TA - JAMA Psychiatry JT - JAMA psychiatry JID - 101589550 SB - IM MH - Adolescent MH - Adult MH - Bipolar Disorder/*classification/diagnosis/epidemiology MH - Disease Progression MH - England/epidemiology MH - Female MH - Humans MH - Longitudinal Studies MH - Male MH - Middle Aged MH - Psychotic Disorders/*classification/diagnosis/epidemiology MH - Regression Analysis MH - Time Factors MH - Young Adult EDAT- 2013/10/04 06:00 MHDA- 2014/02/25 06:00 CRDT- 2013/10/04 06:00 PHST- 2013/10/04 06:00 [entrez] PHST- 2013/10/04 06:00 [pubmed] PHST- 2014/02/25 06:00 [medline] AID - 1746122 [pii] AID - 10.1001/jamapsychiatry.2013.2350 [doi] PST - ppublish SO - JAMA Psychiatry. 2013 Dec;70(12):1276-86. doi: 10.1001/jamapsychiatry.2013.2350.