Symptom Course in Psychiatric and Neurodevelopmental Diagnostic Reasoning: An Exploratory Vignette-Based Study
Hugo Peyre1,2, Emmanuel Madieu3, Paul Audoyer3
1Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence Sur l'Autisme et les Troubles du Neurodéveloppement (CeAND), CHU Montpellier, Montpellier, France, hugo.peyre@chu-montpellier.fr.
Psychopathology
|June 18, 2026
Summary
Clinicians consider symptom course in diagnoses. Symptoms resolving quickly led to single diagnoses, while persistent symptoms often resulted in dual diagnoses, impacting clinical reasoning.
Area of Science:
- Psychiatry
- Neurodevelopmental Disorders
- Clinical Psychology
Background:
- Psychiatric and neurodevelopmental diagnoses typically require symptom specificity and separation from medical causes.
- Clinical practice may involve considering symptom duration and resolution when making diagnostic decisions.
Purpose of the Study:
- To investigate whether clinicians incorporate the longitudinal course of symptoms (persistence and reversibility) into diagnostic decisions.
- To examine how symptom trajectories influence diagnostic judgments in complex cases.
Main Methods:
- Twenty-seven French health professionals evaluated six vignettes with psychiatric/neurodevelopmental symptoms linked to medical conditions or comorbidities.
- Vignettes featured differing symptom trajectories: rapid resolution post-treatment or persistent, typical courses.
- Clinicians decided whether symptoms were solely due to the associated condition or if dual diagnoses were warranted.
Main Results:
- Diagnostic decisions were strongly influenced by symptom evolution.
- Rapidly resolving symptoms predominantly led to attributing the presentation to the underlying condition alone (77.8-92.6%).
- Persistent symptom trajectories largely resulted in maintaining dual diagnoses (81.5-96.3%).
Conclusions:
- Symptom course significantly impacts clinicians' diagnostic judgments in complex psychiatric and neurodevelopmental cases.
- Further research is needed to fully understand the role of symptom trajectories in clinical reasoning.
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