{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T01:20:58Z","timestamp":1787793658293,"version":"build-2784847793"},"reference-count":39,"publisher":"Royal College of Psychiatrists","issue":"5","license":[{"start":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T00:00:00Z","timestamp":1750636800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Br J Psychiatry"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec id=\"S0007125025001072_as1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Electronic health records\u00a0(EHRs), increasingly available in low- and middle-income countries (LMICs), provide an opportunity to study transdiagnostic features of serious mental illness (SMI) and its trajectories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125025001072_as2\">\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Characterise transdiagnostic features and diagnostic trajectories of SMI using an EHR database in an LMIC institution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125025001072_as3\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study using EHRs from 2005\u20132022 at Cl\u00ednica San Juan de Dios Manizales, a specialised mental health facility in Colombia, including 22 447 patients with schizophrenia (SCZ), bipolar disorder (BPD) or severe\/recurrent major depressive disorder (MDD). Using diagnostic codes and clinical notes, we analysed the frequency of suicidality and psychosis across diagnoses, patterns of diagnostic switching\u00a0and the accumulation of comorbidities. Mixed-effect logistic regression was used to identify factors influencing diagnostic stability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125025001072_as4\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>High frequencies of suicidality and psychosis were observed across diagnoses of SCZ, BPD\u00a0and MDD. Most patients (64%) received multiple diagnoses over time, including switches between primary SMI diagnoses (19%), diagnostic comorbidities (30%) or both (15%). Predictors of diagnostic switching included mentions of delusions (odds ratio = 1.47, 95% CI 1.34\u20131.61), prior diagnostic switching (odds ratio = 4.01, 95% CI 3.7\u20134.34) and time in treatment, independent of age (log of visit number; odds ratio = 0.57, 95% CI 0.54\u20130.61). Over 80% of patients reached diagnostic stability within 6 years of their first record.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125025001072_as5\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Integrating structured and unstructured EHR data reveals transdiagnostic patterns in SMI and predictors of disease trajectories, highlighting the potential of EHR-based tools for research and precision psychiatry in LMICs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1192\/bjp.2025.107","type":"journal-article","created":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T00:01:41Z","timestamp":1750636901000},"page":"446-453","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":3,"title":["Characterisation of serious mental illness trajectories through transdiagnostic clinical features"],"prefix":"10.1192","volume":"228","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5584-7511","authenticated-orcid":false,"given":"Juan F.","family":"De la Hoz","sequence":"first","affiliation":[{"name":"Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Arias","sequence":"additional","affiliation":[{"name":"University of Caldas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan K.","family":"Service","sequence":"additional","affiliation":[{"name":"Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1071-6307","authenticated-orcid":false,"given":"Mauricio","family":"Casta\u00f1o","sequence":"additional","affiliation":[{"name":"University of Caldas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6907-6017","authenticated-orcid":false,"given":"Ana M.","family":"D\u00edaz-Zuluaga","sequence":"additional","affiliation":[{"name":"Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3379-1104","authenticated-orcid":false,"given":"Janet","family":"Song","sequence":"additional","affiliation":[{"name":"Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian","family":"Gallego","sequence":"additional","affiliation":[{"name":"University of Caldas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Ruiz-S\u00e1nchez","sequence":"additional","affiliation":[{"name":"University of Antioquia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4046-3731","authenticated-orcid":false,"given":"Javier I.","family":"Escobar","sequence":"additional","affiliation":[{"name":"Florida International University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4702-1373","authenticated-orcid":false,"given":"Alex A. T.","family":"Bui","sequence":"additional","affiliation":[{"name":"University of California Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8516-923X","authenticated-orcid":false,"given":"Carrie E.","family":"Bearden","sequence":"additional","affiliation":[{"name":"Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8193-5697","authenticated-orcid":false,"given":"Victor","family":"Reus","sequence":"additional","affiliation":[{"name":"University of California San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1875-1369","authenticated-orcid":false,"given":"Carlos","family":"L\u00f3pez-Jaramillo","sequence":"additional","affiliation":[{"name":"University of Antioquia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelson B.","family":"Freimer","sequence":"additional","affiliation":[{"name":"Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3327-7837","authenticated-orcid":false,"given":"Loes M.","family":"Olde Loohuis","sequence":"additional","affiliation":[{"name":"Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"170","published-online":{"date-parts":[[2025,6,23]]},"reference":[{"key":"S0007125025001072_ref3","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.clinpsy.3.022806.091532"},{"key":"S0007125025001072_ref6","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291723003173"},{"key":"S0007125025001072_ref33","doi-asserted-by":"publisher","DOI":"10.1038\/ejhg.2011.257"},{"key":"S0007125025001072_ref37","doi-asserted-by":"publisher","DOI":"10.1038\/s41398-019-0612-5"},{"key":"S0007125025001072_ref23","doi-asserted-by":"publisher","DOI":"10.1007\/s00038-018-1196-1"},{"key":"S0007125025001072_ref29","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2011.11010048"},{"key":"S0007125025001072_ref8","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2018.3658"},{"key":"S0007125025001072_ref14","doi-asserted-by":"publisher","DOI":"10.1038\/s43856-024-00441-x"},{"key":"S0007125025001072_ref38","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-021-26903-7"},{"key":"S0007125025001072_ref11","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbaa126"},{"key":"S0007125025001072_ref28","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2020.12.184"},{"key":"S0007125025001072_ref10","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.3221"},{"key":"S0007125025001072_ref25","first-page":"124","article-title":"Systematic review of risk factors for suicide and suicide attempt among psychiatric patients in Latin America and Caribbean","volume":"36","author":"Teti","year":"2014","journal-title":"Rev Panam Salud Publica"},{"key":"S0007125025001072_ref20","doi-asserted-by":"publisher","DOI":"10.1111\/bdi.12499"},{"key":"S0007125025001072_ref2","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20292"},{"key":"S0007125025001072_ref36","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2020.19111195"},{"key":"S0007125025001072_ref27","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-017-1398-8"},{"key":"S0007125025001072_ref16","doi-asserted-by":"publisher","DOI":"10.1111\/j.1943-278X.1998.tb00622.x"},{"key":"S0007125025001072_ref39","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-65645-6"},{"key":"S0007125025001072_ref35","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2019.18060721"},{"key":"S0007125025001072_ref19","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20525"},{"key":"S0007125025001072_ref30","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-019-46109-8"},{"key":"S0007125025001072_ref24","first-page":"351","article-title":"Suicide rates among people with serious mental illness: a systematic review and meta-analysis","volume":"53","author":"Fu","year":"2023","journal-title":"Psychol Med"},{"key":"S0007125025001072_ref15","unstructured":"15 World Health Organization (WHO). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines (2nd edn). WHO, 2004."},{"key":"S0007125025001072_ref17","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(19)30056-8"},{"key":"S0007125025001072_ref21","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2023.01.007"},{"key":"S0007125025001072_ref32","doi-asserted-by":"publisher","DOI":"10.1111\/bdi.13512"},{"key":"S0007125025001072_ref4","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2012.12070999"},{"key":"S0007125025001072_ref12","doi-asserted-by":"publisher","DOI":"10.1093\/jamiaopen\/ooab011"},{"key":"S0007125025001072_ref31","doi-asserted-by":"publisher","DOI":"10.1038\/s41380-024-02533-5"},{"key":"S0007125025001072_ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2022.05.017"},{"key":"S0007125025001072_ref5","doi-asserted-by":"crossref","first-page":"eaap8757","DOI":"10.1126\/science.aap8757","article-title":"Analysis of shared heritability in common disorders of the brain","volume":"360","author":"Anttila","year":"2018","journal-title":"Science"},{"key":"S0007125025001072_ref18","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2018.3514"},{"key":"S0007125025001072_ref7","doi-asserted-by":"publisher","DOI":"10.1111\/acps.13490"},{"key":"S0007125025001072_ref9","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(22)00367-4"},{"key":"S0007125025001072_ref26","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l94"},{"key":"S0007125025001072_ref34","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2021.102"},{"key":"S0007125025001072_ref22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2016.03.035"},{"key":"S0007125025001072_ref1","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291723002544"}],"container-title":["The British Journal of Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0007125025001072","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T08:37:37Z","timestamp":1785314257000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0007125025001072\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,23]]},"references-count":39,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["S0007125025001072"],"URL":"https:\/\/doi.org\/10.1192\/bjp.2025.107","relation":{},"ISSN":["0007-1250","1472-1465"],"issn-type":[{"value":"0007-1250","type":"print"},{"value":"1472-1465","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,23]]},"assertion":[{"value":"\u00a9 The Author(s), 2025. Published by Cambridge University Press on behalf of Royal College of Psychiatrists","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}