Haahr Ulrik, Friis Svein, Larsen Tor K, Melle Ingrid, Johannessen Jan Olav, Opjordsmoen Stein, Simonsen Erik, Rund Bjørn Rishovd, Vaglum Per, McGlashan Thomas
Psychiatric Research Unit, Zealand Region Psychiatry Roskilde, Roskilde, Denmark.
Psychopathology. 2008;41(5):322-9. doi: 10.1159/000146070. Epub 2008 Jul 19.
Diagnostic stability is important for daily clinical work and planning of treatment. The aims of this study were to measure diagnostic stability in a clinical epidemiologic sample and to identify markers of change in diagnosis.
Diagnostic stability and change were measured in a sample of 301 patients with first-episode psychosis from four national health care sectors in Norway and Denmark at baseline, 1 and 2 years.
Diagnostic stabilities were high for schizophrenia and schizoaffective disorder (85-99%), low for schizophreniform disorder (16-19%), and intermediate for other diagnoses. Diagnostic change from schizophreniform to schizophrenia was frequent in year 1 (72%). Characteristics discriminating schizophreniform patients keeping their diagnosis (i.e. having recovered within 6 months with no relapse) from those developing schizophrenia at 1 year were female gender, better childhood premorbid functioning, shorter duration of untreated psychosis and more severe general psychotic symptoms, especially excitation.
Findings provide validation for the DSM-IV categories within the schizophrenic spectrum. The limitations of the study were: the raters were not blind to baseline assessments; patients with longer duration of untreated psychosis were more likely to refuse participation; not all patients were assessed at 1- and 2-year follow-up, but the attrition was rather low.
诊断稳定性对于日常临床工作和治疗规划至关重要。本研究的目的是在临床流行病学样本中测量诊断稳定性，并识别诊断变化的标志物。
在挪威和丹麦四个国家医疗保健部门的301例首发精神病患者样本中，于基线、1年和2年时测量诊断稳定性和变化情况。
精神分裂症和分裂情感性障碍的诊断稳定性较高（85%-99%），精神分裂症样障碍的诊断稳定性较低（16%-19%），其他诊断的诊断稳定性处于中等水平。在第1年，从精神分裂症样障碍转变为精神分裂症的诊断变化很常见（72%）。将在6个月内康复且无复发从而维持诊断的精神分裂症样患者与在1年时发展为精神分裂症的患者区分开来的特征包括女性、儿童期病前功能较好、未治疗精神病持续时间较短以及更严重的一般精神病性症状，尤其是激越。
研究结果为精神分裂症谱系内的DSM-IV类别提供了验证。本研究的局限性在于：评估者并非对基线评估不知情；未治疗精神病持续时间较长的患者更有可能拒绝参与；并非所有患者都在1年和2年随访时接受评估，但失访率相当低。
