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The Prediction of Diagnostic Change From Bipolar Disorder to Schizophrenia and Schizophrenia to Bipolar Disorder in a Population-Based, Longitudinal, National Swedish Sample

Kendler, Kenneth S. ; Abrahamsson, Linda LU ; Sundquist, Jan LU and Sundquist, Kristina LU (2025) In Schizophrenia Bulletin 51(3). p.710-721
Abstract

Background and Hypothesis: To clarify, in a large, representative, longitudinal sample, the rate and predictors of diagnostic conversion from Bipolar Disorder (BD) to Schizophrenia (SZ) and from SZ→BD. Design: From individuals born in Sweden 1950–1995 and living there in 1970 or later, we identified at least one initial diagnoses of SZ (n = 8449) and BD (n = 8438) followed for a minimum of 10 and a mean of 24 years. Diagnostic conversion required, respectively, at least two final diagnoses of BD and SZ 30 days apart with no intervening diagnosis of SZ or BD. Results: At follow-up, rates of BD→SZ and SZ→BD conversion were 10.1 and 4.5%, respectively. Conversions occurred slowly, with around 50% completed in the first decade. Using a... (More)

Background and Hypothesis: To clarify, in a large, representative, longitudinal sample, the rate and predictors of diagnostic conversion from Bipolar Disorder (BD) to Schizophrenia (SZ) and from SZ→BD. Design: From individuals born in Sweden 1950–1995 and living there in 1970 or later, we identified at least one initial diagnoses of SZ (n = 8449) and BD (n = 8438) followed for a minimum of 10 and a mean of 24 years. Diagnostic conversion required, respectively, at least two final diagnoses of BD and SZ 30 days apart with no intervening diagnosis of SZ or BD. Results: At follow-up, rates of BD→SZ and SZ→BD conversion were 10.1 and 4.5%, respectively. Conversions occurred slowly, with around 50% completed in the first decade. Using a diverse range of variables available at first onset including family genetic risk scores, BD→SZ conversion was predicted with greater accuracy (AUC = 0.78) than SZ→BD conversion (AUC = 0.65). The strongest predictors of BD→SZ conversion were earlier years of birth, younger age at BD onset, low BD genetic risk, and being unmarried at BD onset. SZ→BD conversion was most strongly predicted by high BD genetic risk, being married at SZ onset, female sex, early age at SZ onset, and an MD episode prior to SZ onset. Cases of BD and SZ in the highest decile for conversion risk had HRs for a diagnostic change of, respectively, 12.5 and 3.4. Conclusions: Diagnostic conversion of BD→SZ and SZ→BD are not rare, are moderately predictable, and should likely be accounted for in many research designs.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
bipolar disorder, diagnostic, longitudinal, national, population-based, schizophrenia
in
Schizophrenia Bulletin
volume
51
issue
3
pages
12 pages
publisher
Oxford University Press
external identifiers
  • scopus:105004862749
  • pmid:39037415
ISSN
0586-7614
DOI
10.1093/schbul/sbae118
language
English
LU publication?
yes
additional info
Publisher Copyright: © The Author(s) 2024. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved.
id
2d2cd95a-d4fe-49f3-9fd0-dde432f02d37
date added to LUP
2025-08-11 13:11:06
date last changed
2025-08-11 13:11:19
@article{2d2cd95a-d4fe-49f3-9fd0-dde432f02d37,
  abstract     = {{<p>Background and Hypothesis: To clarify, in a large, representative, longitudinal sample, the rate and predictors of diagnostic conversion from Bipolar Disorder (BD) to Schizophrenia (SZ) and from SZ→BD. Design: From individuals born in Sweden 1950–1995 and living there in 1970 or later, we identified at least one initial diagnoses of SZ (n = 8449) and BD (n = 8438) followed for a minimum of 10 and a mean of 24 years. Diagnostic conversion required, respectively, at least two final diagnoses of BD and SZ 30 days apart with no intervening diagnosis of SZ or BD. Results: At follow-up, rates of BD→SZ and SZ→BD conversion were 10.1 and 4.5%, respectively. Conversions occurred slowly, with around 50% completed in the first decade. Using a diverse range of variables available at first onset including family genetic risk scores, BD→SZ conversion was predicted with greater accuracy (AUC = 0.78) than SZ→BD conversion (AUC = 0.65). The strongest predictors of BD→SZ conversion were earlier years of birth, younger age at BD onset, low BD genetic risk, and being unmarried at BD onset. SZ→BD conversion was most strongly predicted by high BD genetic risk, being married at SZ onset, female sex, early age at SZ onset, and an MD episode prior to SZ onset. Cases of BD and SZ in the highest decile for conversion risk had HRs for a diagnostic change of, respectively, 12.5 and 3.4. Conclusions: Diagnostic conversion of BD→SZ and SZ→BD are not rare, are moderately predictable, and should likely be accounted for in many research designs.</p>}},
  author       = {{Kendler, Kenneth S. and Abrahamsson, Linda and Sundquist, Jan and Sundquist, Kristina}},
  issn         = {{0586-7614}},
  keywords     = {{bipolar disorder; diagnostic; longitudinal; national; population-based; schizophrenia}},
  language     = {{eng}},
  month        = {{05}},
  number       = {{3}},
  pages        = {{710--721}},
  publisher    = {{Oxford University Press}},
  series       = {{Schizophrenia Bulletin}},
  title        = {{The Prediction of Diagnostic Change From Bipolar Disorder to Schizophrenia and Schizophrenia to Bipolar Disorder in a Population-Based, Longitudinal, National Swedish Sample}},
  url          = {{http://dx.doi.org/10.1093/schbul/sbae118}},
  doi          = {{10.1093/schbul/sbae118}},
  volume       = {{51}},
  year         = {{2025}},
}