Ledda Maria Giuseppina, Fratta Anna Lisa, Pintor Manuela, Zuddas Alessandro, Cianchetti Carlo
Clinic of Child and Adolescent Neuropsychiatry, Department of Neurosciences, University of Cagliari, Cagliari, Italy.
Child Psychiatry Hum Dev. 2009 Sep;40(3):421-37. doi: 10.1007/s10578-009-0134-0. Epub 2009 Mar 12.
A comparison of clinical features and adult outcome in adolescents with three types of psychotic disorders: schizophrenic (SPh), schizoaffective (SA) and bipolar with psychotic features (BPP). Subjects (n = 41) were finally diagnosed (DSM-IV criteria) with SPh (n = 17), SA (n = 11) or BPP (n = 13). Clinical evaluation took place at onset and at a 3-year follow-up in all 41, and at least after 5 years in 36 patients. Symptoms were rated on the basis of the Positive and Negative Syndrome Scale (PANSS), integrating items from the Brief Psychiatric Rating Scale (BPRS) and the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). The Children Global Assessment Scale (C-GAS) and the Global Assessment Scale (GAF) were used to evaluate global functioning. Significant differences in clinical features were found in the three diagnostic groups as regards several parameters, some present on one and not on other rating scales, underscoring the insufficiency of a single scale for accurate analysis of the features of a psychotic disorder. At onset, a comparison using the simple presence/absence of symptoms showed scant differences among groups, while differences emerged if symptom severity was included in the comparison. Functioning at 3- and 5-year follow-ups showed a significantly better outcome in the BPP group and more substantial deterioration, with similar evolution, in the SPh and SA groups. The integration of several rating scales differentiated between diagnostic groups more effectively. The similar adult functioning outcome in the SPh and SA groups showed how difficult it is to clearly separate these two disorders.
精神分裂症（SPh）、分裂情感性障碍（SA）和伴有精神病性特征的双相情感障碍（BPP）。41名受试者最终依据《精神疾病诊断与统计手册》第四版（DSM-IV）标准被诊断为SPh（17例）、SA（11例）或BPP（13例）。41名受试者均在发病时及3年随访时接受临床评估，36名患者至少在5年后接受评估。症状依据阳性与阴性症状量表（PANSS）进行评定，该量表整合了简明精神病评定量表（BPRS）及学龄儿童情感障碍和精神分裂症量表-目前及终生版（K-SADS-PL）的项目。儿童总体评估量表（C-GAS）和总体评估量表（GAF）用于评估整体功能。在几个参数方面，三个诊断组的临床特征存在显著差异，有些参数在一种量表上有体现而在其他量表上没有，这突出了单一量表不足以准确分析精神障碍的特征。在发病时，仅比较症状的有无显示各组间差异不大，而若将症状严重程度纳入比较则差异显现。3年和5年随访时的功能状况显示，BPP组转归显著更好，SPh组和SA组则有更明显的恶化且演变相似。综合多个评定量表能更有效地区分诊断组。SPh组和SA组相似的成人功能转归表明，明确区分这两种障碍非常困难。
