Dept of Psychiatry, Tai Po Hospital, Tai Po, New Territories, Hong Kong SAR, China.
Schizophr Res. 2009 Dec;115(2-3):351-7. doi: 10.1016/j.schres.2009.09.037. Epub 2009 Oct 17.
Diagnostic stability is one measure of predictive validity for psychiatric syndromes. It is an under-studied area in functional psychosis despite its clinical and research implications. We aimed at evaluating the stability of ICD-10 diagnoses in a sample of young people with first-episode psychosis.
One hundred and sixty-six Hong Kong Chinese enrolled in a regional first-episode psychosis treatment program were studied. Subjects' baseline and final 5-year consensus diagnoses were established via systematic medical records' review to determine diagnostic stability and to identify predictors of diagnostic shift towards schizophrenia spectrum.
The overall diagnostic consistency was 80.7%. Bipolar affective disorder and schizophrenia were the most stable diagnostic categories over 5 years with prospective consistency of 100% and 95.8% respectively. The least stable baseline diagnoses were unspecified non-organic psychosis, acute and transient psychotic disorders and delusional disorder. Around one-fifth (19.3%) of subjects had diagnostic revision in 5 years. The predominant pattern of diagnostic shift was towards schizophrenia spectrum disorder. Family history of psychosis and longer duration of untreated psychosis were associated with diagnostic transition towards schizophrenia spectrum.
Schizophrenia and bipolar affective disorder were diagnostically stable and could be reliably classified at intake in a Chinese first-episode psychosis sample using the ICD-10 criteria. Diagnostic instability in the least prevalent categories of functional psychosis highlights the limitations of current taxonomies and calls for ongoing revision of diagnostic criteria. In the absence of biological marker, longitudinal validation across consecutive episodes is necessary for accurate diagnostic ascertainment.
诊断稳定性是精神综合征预测效度的一种衡量标准。尽管其具有临床和研究意义，但在功能性精神病学领域，这一领域的研究还很不足。我们旨在评估首次发作精神分裂症患者样本中 ICD-10 诊断的稳定性。
对参加香港地区首发精神病治疗项目的 166 名香港华人进行了研究。通过系统的病历回顾确定了受试者的基线和最终 5 年的共识诊断，以确定诊断的稳定性，并确定向精神分裂症谱系转变的预测因素。
总体诊断一致性为 80.7%。双相情感障碍和精神分裂症是最稳定的诊断类别，5 年的前瞻性一致性分别为 100%和 95.8%。最不稳定的基线诊断是未特指的非器质性精神病、急性和短暂性精神病障碍以及妄想障碍。约五分之一（19.3%）的患者在 5 年内进行了诊断修订。诊断转变的主要模式是向精神分裂症谱系障碍转变。精神病家族史和未治疗精神病的持续时间较长与向精神分裂症谱系的诊断转变相关。
在使用 ICD-10 标准的首发精神分裂症中国患者样本中，精神分裂症和双相情感障碍的诊断是稳定的，可以可靠地分类。功能性精神病中最常见的类别诊断不稳定，突显了当前分类法的局限性，并呼吁不断修订诊断标准。在缺乏生物标志物的情况下，需要对连续发作进行纵向验证，以准确确定诊断。
