Schimmelmann Benno G, Conus Philippe, Edwards Jane, McGorry Patrick D, Lambert Martin
Centre for Psychosocial Medicine, Clinic for Child and Adolescent Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
J Clin Psychiatry. 2005 Oct;66(10):1239-46. doi: 10.4088/jcp.v66n1006.
(1) Assessment of diagnostic stability of psychotic disorders or psychotic mood disorders from 6 weeks to 18 months after initiation of treatment in a representative first-episode psychosis (FEP) sample. (2) Comparison between those patients who shifted from DSM-IV schizophreniform disorder to schizophrenia or schizo-affective disorder and those whose diagnosis of schizophreniform disorder remained stable.
The Early Psychosis Prevention and Intervention Centre (EPPIC) in Australia admitted 786 FEP patients from January 1998 to December 2000. Data were collected from patients' medical records (MRs) using a standardized questionnaire. Seven hundred four MRs were available, 36 of which were excluded owing to nonpsychotic diagnoses or a psychotic disorder due to a general medical condition. Of the remaining 668 patients, 176 (26.3%) were lost to follow-up. Four hundred ninety-two subjects were analyzed. Strategies to assure validity and reliability of diagnoses were applied.
The same diagnosis was made at baseline (< or = 6 weeks after admission into EPPIC) and 18 months for 69.9% of the patients. Among the most consistent diagnoses were schizophrenia (97.3%), schizoaffective disorder (94.1%), and bipolar disorder (83.2%); the least stable, as expected, was schizophreniform disorder (40.0%). In subjects with schizophreniform disorder at baseline, the best predictors of a shift from schizophreniform disorder to schizophrenia or schizoaffective disorder were a higher baseline Clinical Global Impressions-Severity of Illness scale score and lower premorbid Global Assessment of Functioning score, although the variance accounted for was small (R2 = .07).
A longitudinally based diagnostic process in FEP samples is needed, especially in schizophreniform disorder and bipolar disorder. However, a thorough initial assessment of patient and family by a specialized team of investigators regarding the kind and duration of patient symptoms may lead to high diagnostic stability, especially in schizophrenia and schizoaffective disorder, even in a FEP sample with a relatively short duration of untreated psychosis.
（1）在具有代表性的首发精神病（FEP）样本中，评估治疗开始后6周至18个月期间精神障碍或伴有精神病性症状的心境障碍的诊断稳定性。（2）比较从DSM-IV精神分裂症样障碍转变为精神分裂症或分裂情感性障碍的患者与精神分裂症样障碍诊断保持稳定的患者。
澳大利亚早期精神病预防与干预中心（EPPIC）在1998年1月至2000年12月期间收治了786例FEP患者。使用标准化问卷从患者病历（MRs）中收集数据。共获得704份病历，其中36份因非精神病性诊断或由躯体疾病所致的精神病性障碍而被排除。在其余668例患者中，176例（26.3%）失访。对492名受试者进行了分析。采用了确保诊断有效性和可靠性的策略。
69.9%的患者在基线时（进入EPPIC后≤6周）和18个月时诊断相同。最一致的诊断包括精神分裂症（97.3%）、分裂情感性障碍（94.1%）和双相情感障碍（83.2%）；正如预期的那样，最不稳定的是精神分裂症样障碍（40.0%）。在基线时患有精神分裂症样障碍的受试者中，从精神分裂症样障碍转变为精神分裂症或分裂情感性障碍的最佳预测因素是基线时较高的临床总体印象-疾病严重程度量表评分和较低的病前功能总体评定分数，尽管所解释的方差较小（R2 = 0.07）。
FEP样本需要基于纵向的诊断过程，尤其是在精神分裂症样障碍和双相情感障碍中。然而，由专业研究团队对患者及其家属进行全面的初始评估，了解患者症状的类型和持续时间，可能会导致较高的诊断稳定性，尤其是在精神分裂症和分裂情感性障碍中，即使是在未治疗精神病持续时间相对较短的FEP样本中也是如此。
