Maj M, Starace F, Pirozzi R
Department of Psychiatry, First Medical School, University of Naples, Italy.
Am J Psychiatry. 1991 May;148(5):612-6. doi: 10.1176/ajp.148.5.612.
To assess the validity of DSM-III-R schizoaffective disorder, the authors explored the morbid risks for schizophrenia and major affective disorders in the first-degree relatives of patients with schizoaffective disorder and relevant other diagnoses.
In addition to patients with DSM-III-R schizoaffective disorder, depressive type (N = 21), the probands included patients with mood-incongruent psychotic depression (N = 22), mood-congruent psychotic depression (N = 19), nonpsychotic depression (N = 27), or schizophrenia (N = 28) and normal subjects (N = 18). The patients were consecutively recruited from the outpatient facilities of a university psychiatry department; the normal subjects were students and nurses. All probands were directly interviewed, with the Schedule for Affective Disorders and Schizophrenia--Lifetime Version (SADS-L), by a psychiatrist blind to information about relatives. Consenting relatives were directly interviewed, with the SADS-L, by two psychiatrists blind to the probands' diagnoses. The direct interview was supplemented--or replaced, when an interview was not possible (24%)--by family history data from all available sources. Morbid risks in relatives were calculated according to the Weinberg method.
The relatives of the schizoaffective patients had almost the same risk for schizophrenia as the relatives of the schizophrenic patients. In the relatives of the patients mood-incongruent psychotic depression, the morbid risk for major affective disorders was about one-half that of the relatives of the patients with mood-congruent psychotic depression and one-third that of the relatives of the patients with nonpsychotic depression, but these differences did not reach statistical significance.
These results suggest that DSM-III-R schizoaffective disorder is close to schizophrenia and largely corresponds to mainly schizophrenic schizoaffective disorder in the Research Diagnostic Criteria, whereas DSM-III-R mood-incongruent psychotic depression is probably quite heterogeneous and should be studied further.
为评估《精神疾病诊断与统计手册》第三版修订本（DSM - III - R）精神分裂症性情感障碍的效度，作者探讨了精神分裂症性情感障碍患者及相关其他诊断患者的一级亲属患精神分裂症和重性情感障碍的患病风险。
除了DSM - III - R精神分裂症性情感障碍（抑郁型，N = 21）患者外，先证者还包括情绪不协调的精神病性抑郁症患者（N = 22）、情绪协调的精神病性抑郁症患者（N = 19）、非精神病性抑郁症患者（N = 27）或精神分裂症患者（N = 28）以及正常受试者（N = 18）。患者是从一所大学精神科门诊连续招募的；正常受试者为学生和护士。所有先证者均由一位对亲属信息不知情的精神科医生使用《情感障碍与精神分裂症问卷——终身版》（SADS - L）进行直接访谈。同意参与的亲属由两位对先证者诊断不知情的精神科医生使用SADS - L进行直接访谈。当无法进行访谈时（24%），直接访谈由所有可用来源的家族史数据补充（或替代）。亲属的患病风险根据温伯格方法计算。
精神分裂症性情感障碍患者的亲属患精神分裂症的风险与精神分裂症患者的亲属几乎相同。在情绪不协调的精神病性抑郁症患者的亲属中，患重性情感障碍的患病风险约为情绪协调的精神病性抑郁症患者亲属的一半，是非精神病性抑郁症患者亲属的三分之一，但这些差异未达到统计学意义。
这些结果表明，DSM - III - R精神分裂症性情感障碍与精神分裂症相近，在很大程度上对应于《研究诊断标准》中主要为精神分裂症的精神分裂症性情感障碍，而DSM - III - R情绪不协调的精神病性抑郁症可能相当异质，应进一步研究。
