Ngoma M V, Mampunza M M, Joos S, Peuskens J, Vansteelandt K
Département de psychiatrie, centre neuropsychopathologique (CNPP), faculté de médecine, université de Kinshasa, BP 825, Kinshasa XI, République démocratique du Congo.
Encephale. 2011 Apr;37(2):101-9. doi: 10.1016/j.encep.2010.02.010. Epub 2010 Sep 15.
The fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM IV) distinguishes schizophrenia, schizophreniform disorder and brief psychotic disorder only according to the duration of the illness. Thus, the validity of these nosological concepts sounds uncertain.
The aim of this study was to evaluate the validity of the DSM IV concepts schizophrenia, schizophreniform disorder and brief psychotic disorder.
Seventy schizophrenics, 68 patients with brief psychotic disorder and 50 with schizophreniform disorder, all Congolese people, selected from the 'Telema' Mental Health Centre and the 'Neuropsychopathological centre of the University of Kinshasa, from 5(th) August 2003 to 14(th) March 2005 were compared with respect to the following clinical parameters: family schizophrenia and brief psychoses history, precipitating psychosocial factors, mode of onset of the disease, clinical syndromes linked to psychoses and general functioning. Statistical analyses included analysis of variances 'one way' (Anova), post hoc Tukey's test, discriminant analysis, and analysis of covariances.
Brief psychotic disorder differed from schizophrenia and schizophreniform Disorder in respect with positive syndrome (F=8.76, df=2; 179, p=0.0002), cognitive syndrome (F=3.79, df=2; 179, P=0.024), syndrome of excitement (F=3.23, df=2; 179, P=0.042), general functioning (F=13.73, df=2; 179, P<0.0001), family history of schizophrenia (χ(2)=8.65; P=0.013), precipitating psychosocial factors (χ(2)=19.82; P<0.0001), and mode of onset of the disease (χ(2)=91.3; P<0.0001). Schizophreniform disorder differered from schizophrenia only by a more frequent acute onset and a better general functioning. Two nosological realities were thus distinguishable: brief psychotic disorder and schizophrenia-schizophreniform disorder complex. Surprisingly, negative syndrome could not distinguish brief psychotic disorder from schizophrenia and schizophreniform (F=2.80, df=2; 179, P=0.063). Data of the discriminant analysis based on scores on general functioning, positive, negative, depressive, cognitive and excitement syndromes was conclusive (F=6.41, df=2; 185, P<0.0001) and allowed correct classification rates of 75% for brief psychotic disorder, 48% for schizophreniform disorder, 54% for schizophrenia. Schizophreniform disorder was thus the less distinguishable group; this is in the line with longitudinal studies, which demonstrated the lowest diagnostic stability of this affection, compared with the two other diseases. Total error rate was 41%.
Brief psychotic disorder could constitute a distinct affection from schizophrenia and schizophreniform disorder, whereas schizophreniform disorder and schizophrenia could be the same affection; the first being an acute and "good functioning" form of the second. However, these viewpoints need to be confirmed by data on long-term course. The data of this study validate ultimately a binary model of the major nonaffective functional psychoses, like that of the tenth edition of the International classification of mental and behavioural disorders (ICD-10).
《精神疾病诊断与统计手册》第四版（DSM-IV）仅根据病程来区分精神分裂症、分裂样精神障碍和短暂精神病性障碍。因此，这些疾病分类概念的有效性似乎不确定。
本研究的目的是评估DSM-IV中精神分裂症、分裂样精神障碍和短暂精神病性障碍概念的有效性。
从“泰勒马”心理健康中心和金沙萨大学神经精神病理中心选取了70例精神分裂症患者、68例短暂精神病性障碍患者和50例分裂样精神障碍患者，均为刚果人，时间跨度从2003年8月5日至2005年3月14日，比较以下临床参数：精神分裂症和短暂精神病家族史、促发心理社会因素、疾病发作方式、与精神病相关的临床综合征和总体功能。统计分析包括单因素方差分析（Anova）、事后Tukey检验、判别分析和协方差分析。
短暂精神病性障碍在阳性综合征（F=8.76，自由度=2；179，P=0.0002）、认知综合征（F=3.79，自由度=2；179，P=0.024）、兴奋综合征（F=3.23，自由度=2；179，P=0.042）、总体功能（F=13.73，自由度=2；179，P<0.0001）、精神分裂症家族史（χ²=8.65；P=0.013）、促发心理社会因素（χ²=19.82；P<0.0001）以及疾病发作方式（χ²=91.3；P<0.0001）方面与精神分裂症和分裂样精神障碍不同。分裂样精神障碍与精神分裂症的区别仅在于急性起病更为频繁且总体功能较好。因此可以区分出两种疾病分类实体：短暂精神病性障碍和精神分裂症-分裂样精神障碍复合体。令人惊讶的是，阴性综合征无法区分短暂精神病性障碍与精神分裂症和分裂样精神障碍（F=2.80，自由度=2；179，P=0.063）。基于总体功能、阳性、阴性、抑郁、认知和兴奋综合征得分的判别分析数据具有决定性意义（F=6.41，自由度=2；185，P<0.0001），短暂精神病性障碍的正确分类率为75%，分裂样精神障碍为48%，精神分裂症为54%。因此，分裂样精神障碍是最难区分的组；这与纵向研究一致，纵向研究表明与其他两种疾病相比，这种疾病的诊断稳定性最低。总错误率为41%。
短暂精神病性障碍可能是与精神分裂症和分裂样精神障碍不同的一种疾病，而分裂样精神障碍和精神分裂症可能是同一种疾病；前者是后者的急性且“功能良好”的形式。然而，这些观点需要长期病程数据的证实。本研究的数据最终验证了主要非情感性功能性精神病的二元模型，类似于《国际精神与行为障碍分类》第十版（ICD-10）的模型。
