Rice J P, Rochberg N, Endicott J, Lavori P W, Miller C
Department of Psychiatry, Washington University School of Medicine, St Louis, MO 63110.
Arch Gen Psychiatry. 1992 Oct;49(10):824-30. doi: 10.1001/archpsyc.1992.01820100068012.
In the National Institute of Mental Health Collaborative Program on the Psychobiology of Depression study, data were collected on 2226 first-degree relatives of 612 probands. A second, "blind" reassessment of all relatives was attempted 6 years after the initial evaluation. We report on a final sample of 1629 relatives assessed twice using the Schedule for Affective Disorders and Schizophrenia-Lifetime version. We summarize methods for using stability of diagnosis to model the relationship between clinical covariates and the probability of being a true case. Moreover, we define an index of caseness that can be used to narrow the criteria for who is a case. Of those positive for major depressive disorder at initial evaluation, 74% were positive (on a lifetime basis) at follow-up (ie, were stable). There is a gradient: 48% of those who had three symptoms and no treatment were stable, compared with 96% of those with eight symptoms and treatment. For major depressive disorder, we found the caseness index for those with lifetime mania more severe than that of nonbipolar patients, with those who had hypomania being intermediate. A hierarchical analysis indicated that bipolar I tends to be diagnosed as schizoaffective-manic across occasions, and vice versa. This is consistent with the prior familial analyses that suggest these two diagnoses be combined into a single bipolar phenotype. The analysis for major depressive disorder indicates that caseness appears to represent quantitative, rather than qualitative, differences, with no natural cutoff to identify distinct subgroups. Finally, we discuss implications including utility in genetic analyses, estimation of incidence or prevalence allowing for diagnostic error, and examination of cohort effects.
在国立精神卫生研究所抑郁症心理生物学合作项目研究中，收集了612名先证者的2226名一级亲属的数据。在首次评估6年后，尝试对所有亲属进行第二次“盲法”重新评估。我们报告了1629名亲属的最终样本，这些亲属使用《情感障碍与精神分裂症量表-终生版》进行了两次评估。我们总结了利用诊断稳定性来模拟临床协变量与真正病例概率之间关系的方法。此外，我们定义了一个病例指数，可用于缩小病例的标准范围。在首次评估时患有重度抑郁症呈阳性的患者中，74%在随访时（即终生基础上）仍呈阳性（即病情稳定）。存在一个梯度：有三种症状且未接受治疗的患者中，48%病情稳定，而有八种症状且接受治疗的患者中，这一比例为96%。对于重度抑郁症，我们发现终生患有躁狂症的患者的病例指数比非双相情感障碍患者更严重，患有轻躁狂症的患者则介于两者之间。分层分析表明，双相I型障碍在不同场合往往被诊断为分裂情感性障碍-躁狂型，反之亦然。这与先前的家族分析一致，表明这两种诊断应合并为单一的双相表型。对重度抑郁症的分析表明，病例似乎代表了数量上而非质量上的差异，没有自然的界限来识别不同的亚组。最后，我们讨论了其影响，包括在基因分析中的效用、考虑诊断误差情况下发病率或患病率的估计，以及队列效应的检查。
