Diagnostic instability in psychiatry

Many clinicians in psychiatry are familiar with the uncertainty that arises when diagnosing a patient who experiences mental health symptoms for the first time. Research has consistently shown that psychiatric diagnoses often change over time. This diagnostic instability is especially common early in the course of illness, when limited information is available about the patient’s symptoms, social development, and response to treatment. At this stage, key signs that could later alter the diagnosis may not yet have appeared. As a result, it is both common and appropriate for clinicians to treat early diagnoses as provisional. In the ongoing absence of objective biological markers to predict the course of psychiatric disorders, having detailed knowledge about likely diagnostic pathways following an initial presentation can be highly valuable. Such insights can help clinicians guide patients and their families about possible outcomes, initiate appropriate interventions, and plan follow-up care that takes into account the risk of diagnostic changes over time.