Department of Psychology, University of North Texas, 1155 Union Cir #311280, Denton, TX 76203, USA.
J Clin Psychiatry. 2011 Sep;72(9):1207-13. doi: 10.4088/JCP.10m06774. Epub 2011 Aug 9.
The present study investigates how consistently DSM-IV major depressive disorder (MDD) with psychosis was diagnosed by research consensus across 10 years and the association of clinical characteristics with diagnostic consistency.
The sample included 146 participants, part of a larger first-admission cohort (N = 628) presenting to a psychiatric inpatient facility with psychosis, who were diagnosed with psychotic depression at least once across 4 assessments spanning 10 years (after first admission and at 6-month, 24-month, and 10-year follow-ups). The primary outcome of this prospective epidemiologic study was retention of the best-estimate consensus diagnosis at each assessment. Diagnoses at each assessment were determined from semistructured interviews, medical records, and informant reports. The participants were recruited from 1989 to 1995.
Fifty-five of the 146 participants (37.7%) were diagnosed with psychotic depression at each available assessment; 13 (8.9%) switched from MDD to bipolar disorder, 24 (16.4%) switched from MDD to schizophrenia or schizoaffective disorder, and the remaining 54 (37.0%) had other patterns of diagnostic change. Only 47 of 80 participants (58.8%) diagnosed with MDD at baseline retained a mood disorder diagnosis 10 years later (36 [45.0%] had MDD and 11 [13.8%] had bipolar disorder), while 16 of 52 participants (30.8%) who ended the study with MDD were initially misdiagnosed. Compared to participants who were consistently diagnosed with MDD, those switching from MDD to bipolar disorder had better premorbid adjustment, more first-degree relatives with MDD, better functioning, and fewer negative symptoms at baseline, whereas those shifting to the schizophrenia spectrum had a more insidious onset, longer initial hospital stays, worse functioning, and more negative symptoms (all P values < .05).
The diagnosis of MDD with psychosis among inpatients showed poor long-term consistency. For clinicians, results indicate that the diagnosis of MDD with psychosis based on a single assessment should be considered provisional.
本研究通过研究共识调查了在 10 年内如何一致诊断 DSM-IV 主要抑郁障碍 (MDD) 伴精神病，以及临床特征与诊断一致性的关系。
该样本包括 146 名参与者，他们是一家精神病住院机构的首次入院队列（N=628）的一部分，这些参与者在 4 次评估中至少被诊断出 1 次精神病性抑郁症，时间跨度为 10 年（首次入院后，6 个月、24 个月和 10 年随访）。这项前瞻性流行病学研究的主要结果是保留每个评估的最佳估计共识诊断。每次评估的诊断都是通过半结构化访谈、医疗记录和知情者报告确定的。这些参与者是在 1989 年至 1995 年期间招募的。
在可获得的每次评估中，有 146 名参与者中的 55 人被诊断为精神病性抑郁症；13 人（8.9%）从 MDD 转为双相障碍，24 人（16.4%）从 MDD 转为精神分裂症或分裂情感障碍，其余 54 人（37.0%）有其他类型的诊断变化。仅在基线时被诊断为 MDD 的 80 名参与者中的 47 名（58.8%）在 10 年后保留了心境障碍的诊断（36 名[45.0%]患有 MDD，11 名[13.8%]患有双相障碍），而在研究结束时患有 MDD 的 52 名参与者中有 16 名（30.8%）最初被误诊。与被一致诊断为 MDD 的参与者相比，从 MDD 转为双相障碍的参与者在发病前的适应能力更好，一级亲属中患有 MDD 的更多，功能更好，基线时的阴性症状更少，而转向精神分裂症谱系的参与者发病更隐匿，初始住院时间更长，功能更差，阴性症状更多（所有 P 值均<.05）。
住院患者 MDD 伴精神病的诊断显示出较差的长期一致性。对于临床医生来说，结果表明，基于单次评估的 MDD 伴精神病的诊断应被视为临时诊断。
