Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, Germany.
Institute of Medical Statistics, Informatics, and Epidemiology, University of Cologne Medical School, Cologne, Germany.
J Affect Disord. 2014 Mar;156:111-8. doi: 10.1016/j.jad.2013.12.001. Epub 2013 Dec 19.
Schizoaffective disorder is viewed as a heterogeneous diagnosis among psychotic illnesses. Different diagnostic systems differ in their definition with DSM (-IIIR, -IV, and -V) providing a narrower definition than RDC and ICD-10. It is unclear whether this difference is reflected in patient samples diagnosed according to different diagnostic systems.
Exploratory study based on a systematic review of studies of schizoaffective disorder samples diagnosed by either RDC and ICD-10 (group of "broad criteria") or DSM-IIIR and -IV ("narrow criteria"); comparison (by Mann-Whitney-U-tests) of key characteristics, such as age, number of hospitalizations, or scores in psychometric tests, between more broadly and more narrowly defined schizoaffective disorder samples using standard deviations as a measurement of heterogeneity as well as weighted means and percentages. To reduce selection bias only studies including schizoaffective patient samples together with affective disorder and schizophrenia samples were selected.
55 studies were included, 14 employing RDC, 4 ICD-10, 20 DSM-IIIR, and 17 DSM-IV. Thirteen characteristics were compared: patients diagnosed according to broader criteria had fewer previous hospitalizations (2.2 vs. 5.4) and were both less often male (42 vs. 51%) and married (21 vs. 40%). Heterogeneity was similar in both groups but slightly higher in RDC and ICD-10 samples than in DSM-IIIR and -IV-samples: +4% regarding demographic and clinical course data and +13% regarding psychometric tests (pooled SD).
Secular trends and different designs may have confounded the results and limit generalizability. Some comparisons were underpowered.
Differences in diagnostic criteria are reflected in key characteristics of samples. The association of larger heterogeneity with wider diagnostic criteria supports employing standard deviations as a measurement of heterogeneity.
精神分裂症谱系障碍在精神疾病中被视为一种异质诊断。不同的诊断系统在定义上有所不同，DSM（-III-R、-IV 和 -V）的定义比 RDC 和 ICD-10 更窄。目前尚不清楚这种差异是否反映在根据不同诊断系统诊断的患者样本中。
本研究基于对 RDC 和 ICD-10（“广泛标准”组）或 DSM-III-R 和 -IV（“严格标准”）诊断的精神分裂症谱系障碍样本的研究进行的系统综述，进行探索性研究；使用标准偏差作为异质性的衡量标准，并使用加权平均值和百分比，比较更广泛和更严格定义的精神分裂症谱系障碍样本之间的关键特征，如年龄、住院次数或心理测量测试得分；为了减少选择偏差，仅选择了包括精神分裂症谱系障碍患者样本以及情感障碍和精神分裂症患者样本的研究。
共纳入 55 项研究，其中 14 项采用 RDC、4 项采用 ICD-10、20 项采用 DSM-III-R、17 项采用 DSM-IV。比较了 13 个特征：根据更广泛标准诊断的患者住院次数较少（2.2 次与 5.4 次），男性（42%与 51%）和已婚（21%与 40%）的比例也较低。两组的异质性相似，但 RDC 和 ICD-10 样本的异质性略高于 DSM-III-R 和 -IV 样本：人口统计学和临床病程数据的异质性增加了 4%，心理测量测试的异质性增加了 13%（汇总标准偏差）。
可能存在时间趋势和不同设计的偏倚，从而影响结果的普遍性。一些比较的效力不足。
诊断标准的差异反映在样本的关键特征中。更大的异质性与更广泛的诊断标准之间的关联支持使用标准偏差作为异质性的衡量标准。
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