Boonstra Nynke, Wunderink Lex, Sytema Sjoerd, Wiersma Durk
GGZ Friesland, Research Department, Leeuwarden, The Netherlands.
Clin Pract Epidemiol Ment Health. 2008 Dec 16;4:29. doi: 10.1186/1745-0179-4-29.
Detection of psychotic disorders is an important issue, since early treatment might improve prognosis. Timely diagnosis of psychotic disorders depends on recognition of psychotic symptoms and their interpretation. The aim of this study is to examine to what extent reported psychotic symptoms are accounted for in clinical diagnosis.
The medical files of all patients who had a first contact with one of two mental health care services (N = 6477) were screened for reported psychotic symptoms and subsequent clinical diagnosis. Patients who reported psychotic symptoms and who were diagnosed with a psychotic disorder were followed-up for two years to register prescription of antipsychotic treatment and continuity of care.
In the files of 242 (3.7%) patients specific psychotic symptoms were recorded. 37% of these patients were diagnosed with a non-affective psychotic disorder, 7% with other psychotic disorders and 56% with non-psychotic disorders or no diagnosis at all. About 90% of the patients diagnosed with a psychotic disorder did receive any prescription of antipsychotics, and about 50% were in continuous care during the first 2 years.
Relatively large proportions of patients presenting with psychotic symptoms were diagnosed with a non-psychotic diagnosis or not diagnosed at all. This applies also to patients reporting at least two or more psychotic symptoms. Although we did not verify the appropriateness of clinical diagnosis, these findings are an indication that psychotic disorders may be underdetected. Improving the diagnostic process in mental health care services may be the most obvious way to promote early intervention in psychosis.
精神障碍的检测是一个重要问题，因为早期治疗可能改善预后。精神障碍的及时诊断取决于对精神症状的识别及其解读。本研究的目的是考察在临床诊断中所报告的精神症状在多大程度上得到考虑。
对首次接触两家精神卫生保健服务机构之一的所有患者（N = 6477）的病历进行筛查，以查找所报告的精神症状及后续临床诊断情况。对报告有精神症状且被诊断为精神障碍的患者进行了两年随访，以记录抗精神病药物治疗的处方情况及护理的连续性。
在242名（3.7%）患者的病历中记录了特定的精神症状。这些患者中37%被诊断为非情感性精神障碍，7%为其他精神障碍，56%为非精神障碍或根本未被诊断。约90%被诊断为精神障碍的患者确实接受了抗精神病药物处方，约50%在最初两年接受持续护理。
出现精神症状的患者中相当大比例被诊断为非精神障碍或根本未被诊断。这也适用于报告至少两种或更多精神症状的患者。尽管我们未核实临床诊断的恰当性，但这些发现表明精神障碍可能未被充分检测到。改善精神卫生保健服务中的诊断流程可能是促进精神病早期干预的最明显方式。
