Pihlajamaa Johanna, Suvisaari Jaana, Henriksson Markus, Heilä Hannele, Karjalainen Elisa, Koskela Johanna, Cannon Mary, Lönnqvist Jouko
Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland.
Nord J Psychiatry. 2008;62(3):198-203. doi: 10.1080/08039480801983596.
The purpose of this study was to investigate the diagnostic validity of schizophrenia in the Finnish Hospital Discharge Register (FHDR) with a large, epidemiologically representative sample using a multidiagnostic approach (DSM-III-R, DSM-IV, ICD-10), and to find additional criteria that could be used to improve the validity of schizophrenia diagnosis in future register-based research that utilizes the FHDR. The study population consisted of all individuals (n=877) who were born in Helsinki, Finland, between 1 January 1951 and 31 December 1960, and who had had at least one diagnosis of schizophrenia, schizophreniform disorder or schizoaffective disorder in the FHDR. All their available hospital case notes were collected. The total number of subjects for whom case notes were obtained was 806. We used the OPCRIT system (version 3.4) to produce diagnoses according to ICD-10, DSM-III-R and DSM-IV criteria based on the information extracted from the hospital case notes. We examined the distribution of the DSM-III-R, DSM-IV and ICD-10 diagnoses generated by the OPCRIT and calculated the proportion of individuals who received the same diagnosis in the FHDR and in the OPCRIT assessment. The proportion of subjects who received a core schizophrenia spectrum diagnosis (schizophrenia, schizoaffective disorder or schizophreniform disorder) in both the FHDR and OPCRIT assessment varied between 75% (DSM-III-R criteria) and 78% (ICD-10 criteria). Of the subjects with a narrow schizophrenia diagnosis in the FHDR, between 74% (DSM-IV) and 78% (ICD-10) received a diagnosis of schizophrenia in the reassessment depending on the diagnostic criteria applied. Eighty per cent of those who had received a core schizophrenia spectrum FHDR diagnosis after 1982 (vs. 56% of those who had received their last schizophrenia diagnosis in 1982 or before) received a DSM-IV diagnosis of core schizophrenia spectrum disorder. Of the 58 subjects in the sample who had been given at various times diagnoses of both core schizophrenia diagnosis and bipolar I diagnosis in FHDR, 43% received a core schizophrenia spectrum diagnosis according to DSM-IV criteria. The validity of the FHDR schizophrenia diagnosis is acceptable for large-scale register studies and comparable with that of other Nordic registers. Diagnostic validity can be further improved by selecting subjects who have core schizophrenia spectrum disorder as the latest diagnosis, by omitting cases diagnosed before 1982, and by excluding cases with a register diagnoses of both a core schizophrenia spectrum and bipolar I disorder.
本研究的目的是采用多诊断方法（DSM-III-R、DSM-IV、ICD-10），通过一个具有流行病学代表性的大样本，调查芬兰医院出院登记册（FHDR）中精神分裂症诊断的有效性，并找出可用于在未来利用FHDR进行的基于登记册的研究中提高精神分裂症诊断有效性的其他标准。研究人群包括1951年1月1日至1960年12月31日在芬兰赫尔辛基出生、且在FHDR中至少有一次精神分裂症、分裂样障碍或分裂情感性障碍诊断的所有个体（n = 877）。收集了他们所有可用的医院病例记录。获得病例记录的受试者总数为806人。我们使用OPCRIT系统（3.4版），根据从医院病例记录中提取的信息，按照ICD-10、DSM-III-R和DSM-IV标准进行诊断。我们检查了OPCRIT生成 的DSM-III-R、DSM-IV和ICD-10诊断的分布情况，并计算了在FHDR和OPCRIT评估中获得相同诊断的个体比例。在FHDR和OPCRIT评估中均获得核心精神分裂症谱系诊断（精神分裂症、分裂情感性障碍或分裂样障碍）的受试者比例在75%（DSM-III-R标准）至78%（ICD-10标准）之间。在FHDR中被诊断为狭义精神分裂症的受试者中，根据所应用的诊断标准，在重新评估中有74%（DSM-IV）至78%（ICD-10）被诊断为精神分裂症。1982年后在FHDR中获得核心精神分裂症谱系诊断的患者中有80%（而在1982年或之前获得最后一次精神分裂症诊断的患者中这一比例为56%）获得了DSM-IV核心精神分裂症谱系障碍诊断。在样本中曾在不同时间在FHDR中被诊断为核心精神分裂症诊断和双相I型诊断的58名受试者中，43%根据DSM-IV标准获得了核心精神分裂症谱系诊断。FHDR中精神分裂症诊断的有效性对于大规模登记册研究是可以接受的，并且与其他北欧登记册相当。通过选择以核心精神分裂症谱系障碍作为最新诊断 的受试者、排除1982年之前诊断的病例以及排除在登记册中同时诊断为核心精神分裂症谱系和双相I型障碍的病例，可以进一步提高诊断有效性。
