Subramaniam Mythily, Pek Elaine, Verma Swapna, Chan Yiong Huak, Chong Siow Ann
Institute of Mental Health, 10 Buangkok View, Singapore.
Aust N Z J Psychiatry. 2007 Jun;41(6):495-500. doi: 10.1080/00048670701332276.
To evaluate the diagnostic stability of psychotic disorders over a 2 year period in patients presenting with first-episode psychosis.
One hundred and fifty-four patients were recruited from an early psychosis intervention programme (EPIP). They were diagnosed by the attending psychiatrist using the Structured Clinical Interview for DSM-IV Axis I at first contact (baseline) and after 24 months. The diagnoses were classified into the following categories: schizophrenia spectrum disorders (schizophrenia, schizophreniform disorder and schizoaffective disorder), affective psychosis (bipolar and major depressive disorders with psychotic symptoms), and other non-affective psychosis (delusional disorder, psychosis not otherwise specified and brief psychotic disorder). Two measures of stability, the prospective and the retrospective consistency were determined for each diagnosis.
The diagnoses with the best prospective consistency were schizophrenia (87.0%) and affective psychosis (54.5%). The shift into schizophrenia spectrum disorder was the most frequent diagnostic change. Duration of untreated psychosis was found to be the only significant predictor of shift.
It is difficult to make a definitive diagnosis at first contact. The clinical need to review the diagnosis throughout the period of follow up is emphasized.
评估首发精神病患者在两年时间内精神障碍诊断的稳定性。
从早期精神病干预项目（EPIP）中招募了154名患者。主治精神科医生在首次接触（基线）时和24个月后使用《精神疾病诊断与统计手册》第四版轴I障碍的结构化临床访谈对他们进行诊断。诊断分为以下几类：精神分裂症谱系障碍（精神分裂症、分裂样障碍和分裂情感性障碍）、情感性精神病（伴有精神病性症状的双相情感障碍和重度抑郁症）以及其他非情感性精神病（妄想障碍、未另行说明的精神病和短暂精神病性障碍）。针对每种诊断确定了两种稳定性测量方法，即前瞻性一致性和回顾性一致性。
前瞻性一致性最佳的诊断是精神分裂症（87.0%）和情感性精神病（54.5%）。向精神分裂症谱系障碍的转变是最常见的诊断变化。未治疗精神病的持续时间被发现是转变的唯一显著预测因素。
首次接触时很难做出明确诊断。强调在整个随访期间临床需要对诊断进行复查。
