Leboyer M, Jay M, D'Amato T, Campion D, Guilloud-Bataille M, Hillaire D, Drouet A, Lépine J P, Bois E, Feingold J
Unité de Recherches d'Epidémiologie Génétique, I.N.S.E.R.M. U 155, Paris, France.
Psychiatry Res. 1990 Oct;34(1):77-88. doi: 10.1016/0165-1781(90)90059-e.
This report examines the reliability, concordance, and long-term stability of the subtypes of schizophrenia defined by four major diagnostic systems (DSM-III, DSM-III-R, ICD-10, and Tsuang-Winokur criteria) and rated both for the first hospitalization and for a best estimate diagnosis reflecting lifetime evolution of symptomatology. Schizophrenics studied belonged to two samples of multiply affected families, namely a sample selected in France and a sample of non-metropolitan French identified in the island of La Réunion. ICD-10 and DSM-III-R show opposite stringency regarding subtyping of schizophrenia, with DSM-III-R having a narrow and ICD-10 a broader definition of specific subtypes. Long-term stability of each subtype was fairly good, stability being the highest for hebephrenics and only intermediate for paranoid and undifferentiated subtypes. Comparison of two different cultural and geographical regions reveals an overall similarity of subtype frequencies in familial schizophrenia. The implications of the results for the choice of diagnostic procedures in family studies of schizophrenia are discussed.
本报告考察了由四种主要诊断系统（《精神疾病诊断与统计手册》第三版、《精神疾病诊断与统计手册》第三版修订版、《国际疾病分类》第十版以及Tsuang-Winokur标准）所定义的精神分裂症亚型的可靠性、一致性和长期稳定性，并针对首次住院情况以及反映症状学终生演变的最佳估计诊断进行了评定。所研究的精神分裂症患者来自两个多重患病家庭样本，即一个在法国选取的样本以及在留尼汪岛确定的非法国本土样本。在精神分裂症亚型分类方面，《国际疾病分类》第十版和《精神疾病诊断与统计手册》第三版修订版表现出相反的严格程度，《精神疾病诊断与统计手册》第三版修订版对特定亚型的定义较窄，而《国际疾病分类》第十版的定义较宽泛。各亚型的长期稳定性相当良好，青春型的稳定性最高，偏执型和未分化型亚型的稳定性仅为中等。对两个不同文化和地理区域的比较显示，家族性精神分裂症中各亚型频率总体相似。文中讨论了这些结果对精神分裂症家族研究中诊断程序选择的影响。
