Sarah Salamon1, Hanno Santelmann2, Jeremy Franklin3, Christopher Baethge4. 1. Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, Germany; Clinical and Experimental Neurosciences, University of Cologne, Cologne, Germany. 2. Department of Obstetrics and Gynecology, University Medical Centre Freiburg, Freiburg, Germany. 3. Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne Medical School, Cologne, Germany. 4. Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, Germany. Electronic address: cbaethge@uni-koeln.de.
Abstract
OBJECTIVES: Reliability of schizoaffective disorder (SAD) diagnoses is low in adults but unclear in children and adolescents (CAD). We estimate the test-retest reliability of SAD and its key differential diagnoses (schizophrenia, bipolar disorder, and unipolar depression). METHODS: Systematic literature search of Medline, Embase, and PsycInfo for studies on test-retest reliability of SAD, in CAD. Cohen's kappa was extracted from studies. We performed meta-analysis for kappa, including subgroup and sensitivity analysis (PROSPERO protocol: CRD42013006713). RESULTS: Out of > 4000 records screened, seven studies were included. We estimated kappa values of 0.27 [95%-CI: 0.07 0.47] for SAD, 0.56 [0.29; 0.83] for schizophrenia, 0.64 [0.55; 0.74] for bipolar disorder, and 0.66 [0.52; 0.81] for unipolar depression. In 5/7 studies kappa of SAD was lower than that of schizophrenia; similar trends emerged for bipolar disorder (4/5) and unipolar depression (2/3). Estimates of positive agreement of SAD diagnoses supported these results. LIMITATIONS: The number of studies and patients included is low. CONCLUSIONS: The point-estimate of the test-retest reliability of schizoaffective disorder is only fair, and lower than that of its main differential diagnoses. All kappa values under study were lower in children and adolescents samples than those reported for adults. Clinically, schizoaffective disorder should be diagnosed in strict adherence to the operationalized criteria and ought to be re-evaluated regularly. Should larger studies confirm the insufficient reliability of schizoaffective disorder in children and adolescents, the clinical value of the diagnosis is highly doubtful.
OBJECTIVES:Reliability of schizoaffective disorder (SAD) diagnoses is low in adults but unclear in children and adolescents (CAD). We estimate the test-retest reliability of SAD and its key differential diagnoses (schizophrenia, bipolar disorder, and unipolar depression). METHODS: Systematic literature search of Medline, Embase, and PsycInfo for studies on test-retest reliability of SAD, in CAD. Cohen's kappa was extracted from studies. We performed meta-analysis for kappa, including subgroup and sensitivity analysis (PROSPERO protocol: CRD42013006713). RESULTS: Out of > 4000 records screened, seven studies were included. We estimated kappa values of 0.27 [95%-CI: 0.07 0.47] for SAD, 0.56 [0.29; 0.83] for schizophrenia, 0.64 [0.55; 0.74] for bipolar disorder, and 0.66 [0.52; 0.81] for unipolar depression. In 5/7 studies kappa of SAD was lower than that of schizophrenia; similar trends emerged for bipolar disorder (4/5) and unipolar depression (2/3). Estimates of positive agreement of SAD diagnoses supported these results. LIMITATIONS: The number of studies and patients included is low. CONCLUSIONS: The point-estimate of the test-retest reliability of schizoaffective disorder is only fair, and lower than that of its main differential diagnoses. All kappa values under study were lower in children and adolescents samples than those reported for adults. Clinically, schizoaffective disorder should be diagnosed in strict adherence to the operationalized criteria and ought to be re-evaluated regularly. Should larger studies confirm the insufficient reliability of schizoaffective disorder in children and adolescents, the clinical value of the diagnosis is highly doubtful.
Authors: Shile Qi; Gunter Schumann; Juan Bustillo; Jessica A Turner; Rongtao Jiang; Dongmei Zhi; Zening Fu; Andrew R Mayer; Victor M Vergara; Rogers F Silva; Armin Iraji; Jiayu Chen; Eswar Damaraju; Xiaohong Ma; Xiao Yang; Michael Stevens; Daniel H Mathalon; Judith M Ford; James Voyvodic; Bryon A Mueller; Aysenil Belger; Steven G Potkin; Adrian Preda; Chuanjun Zhuo; Yong Xu; Congying Chu; Tobias Banaschewski; Gareth J Barker; Arun L W Bokde; Erin Burke Quinlan; Sylvane Desrivières; Herta Flor; Antoine Grigis; Hugh Garavan; Penny Gowland; Andreas Heinz; Jean-Luc Martinot; Marie-Laure Paillère Martinot; Eric Artiges; Frauke Nees; Dimitri Papadopoulos Orfanos; Tomáš Paus; Luise Poustka; Sarah Hohmann; Juliane H Fröhner; Michael N Smolka; Henrik Walter; Robert Whelan; Vince D Calhoun; Jing Sui Journal: Biol Psychiatry Date: 2021-01-30 Impact factor: 12.810