Peralta Victor, Cuesta Manuel J
Psychiatric Unit, Virgen del Camino Hospital, Pamplona, Spain.
Psychol Med. 2003 Apr;33(3):443-53. doi: 10.1017/s0033291702007055.
Despite its clinical relevance, the diagnosis of cycloid psychosis has been relatively neglected in the psychiatric literature and in the current nosological systems. This study examined the clinical validity and nosological status of the cycloid psychosis concept.
Six-hundred and sixty psychotic in-patients were assessed for psychosis-related variables and diagnosed according to DSM-III-R, DSM-IV, ICD-10 and the Perris & Brockington criteria forcycloid psychosis. The cycloid psychosis diagnosis (N = 68, 10.3%) was examined in regard to its discriminant validity, concordance with other psychotic disorders, and predictive validity in relation to schizophrenia and psychotic mood disorders. To address putative heterogeneity within cycloid psychosis, affective (N = 38) and non-affective (N = 30) subgroups were examined.
Cycloid psychosis had good discriminant validity regarding other psychoses (95% of correctly classified cases) and poor concordance with individual diagnoses from the formal diagnostic systems (K < 0.22). Cycloid patients had levels of psychotic, disorganization and first-rank symptoms comparable to schizophrenia, and levels of affective symptoms in-between schizophrenia and mood disorders. Regarding most clinical variables and morbidity risk of mood disorders, cycloid psychosis was closer to mood disorders. Cycloid psychosis had higher psychosocial stressors than schizophrenia and mood disorders. Affective and non-affective groups of cycloid psychosis differed in a number of variables indicating an overall better outcome for the non-affective group.
Cycloid psychosis does not correspond closely to any DSM-III-R, DSM-IV or ICD-10 category of psychosis, and more specifically this nosological concept is not well represented by the different formal definitions of remitting psychotic disorders. Cycloid psychosis seems to be an heterogeneous condition in that affective and non-affective subgroups can be differentiated.
尽管环性精神病具有临床相关性，但在精神病学文献和当前的疾病分类系统中，其诊断相对受到忽视。本研究探讨了环性精神病概念的临床效度和疾病分类学地位。
对660名精神病住院患者进行与精神病相关变量的评估，并根据《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）、《精神疾病诊断与统计手册》第四版（DSM-IV）、《国际疾病分类》第十版（ICD-10）以及佩里斯和布罗金顿的环性精神病标准进行诊断。对68例（10.3%）环性精神病诊断病例，考察其判别效度、与其他精神障碍的一致性以及相对于精神分裂症和精神病性心境障碍的预测效度。为解决环性精神病可能存在的异质性问题，对情感性（n = 38）和非情感性（n = 30）亚组进行了考察。
环性精神病相对于其他精神病具有良好的判别效度（95%的病例分类正确），但与正式诊断系统中的个体诊断一致性较差（K < 0.22）。环性精神病患者的精神病性症状、紊乱症状和一级症状水平与精神分裂症相当，情感症状水平介于精神分裂症和心境障碍之间。就大多数临床变量和心境障碍的发病风险而言，环性精神病更接近心境障碍。环性精神病患者所面临的社会心理应激源比精神分裂症和心境障碍患者更多。环性精神病的情感性和非情感性亚组在一些变量上存在差异，表明非情感性亚组的总体预后更好。
环性精神病与DSM-III-R、DSM-IV或ICD-10中的任何精神病类别都不太相符，更具体地说，这种疾病分类学概念在缓解性精神病性障碍的不同正式定义中并未得到很好的体现。环性精神病似乎是一种异质性疾病，因为可以区分情感性和非情感性亚组。
