Bayes A J, Parker G B
School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.
Black Dog Institute, Randwick, NSW, Australia.
Acta Psychiatr Scand. 2017 Mar;135(3):259-265. doi: 10.1111/acps.12678. Epub 2016 Dec 15.
To investigate the extent and reasons contributing to discrepancies between those receiving a DSM as against a clinical diagnosis of a bipolar disorder (BP) and/or a borderline personality disorder (BPD).
We interviewed participants previously receiving a BP or BPD diagnosis, studying those who met DSM or clinical criteria for one or both conditions. We compared the numbers of participants allocated to the three diagnostic categories according to rater strategy to calculate concordance rates and determine reasons for discordance.
Rates of assignment to BP, BPD and comorbid BP/BPD varied according to the diagnostic strategy. Concordance rates were reduced as BP disorder duration criteria were relaxed, with discordance mainly arising from clinical allocation of a BP disorder for those DSM assigned as unipolar depression. Rates of BPD allocation varied marginally, with discordance mostly arising from so clinically diagnosed receiving a comorbid BP/BPD DSM diagnosis. Finally, DSM overestimated comorbidity compared with clinician diagnoses. Of central importance, not imposing the DSM duration criteria for BP did not increase the prevalence of misdiagnosing BPD, a finding at variance with the literature.
Rates and reasons for discordance between clinical and DSM diagnosis are detailed, which should assist clinical decision-making.
调查接受双相情感障碍（BP）和/或边缘型人格障碍（BPD）的DSM诊断与临床诊断之间存在差异的程度及原因。
我们对之前被诊断为BP或BPD的参与者进行了访谈，研究那些符合DSM或一种或两种疾病临床标准的参与者。我们根据评估者策略比较了分配到三种诊断类别的参与者数量，以计算一致性率并确定不一致的原因。
根据诊断策略，BP、BPD和共病BP/BPD的分配率各不相同。随着BP障碍持续时间标准的放宽，一致性率降低，不一致主要源于将那些被DSM诊断为单相抑郁的患者临床诊断为BP障碍。BPD的分配率略有变化，不一致主要源于临床诊断为共病BP/BPD的DSM诊断。最后，与临床医生的诊断相比，DSM高估了共病情况。至关重要的是，不采用DSM的BP持续时间标准并没有增加BPD误诊的患病率，这一发现与文献不符。
详细说明了临床诊断与DSM诊断之间不一致的发生率和原因，这有助于临床决策。
