与基于结构化访谈的研究诊断相比，国家健康登记处中严重精神障碍诊断的质量。
The quality of severe mental disorder diagnoses in a national health registry as compared to research diagnoses based on structured interview.
作者信息
Nesvåg Ragnar, Jönsson Erik G, Bakken Inger Johanne, Knudsen Gun Peggy, Bjella Thomas D, Reichborn-Kjennerud Ted, Melle Ingrid, Andreassen Ole A
机构信息
Norwegian Institute of Public Health, P.O. Box 4044, Nydalen, N-0403, Oslo, Norway.
Norwegian Center for Mental Health Research (NORMENT), Oslo University Hospital & University of Oslo, P.O. Box 4956, Nydalen, N-0424, Oslo, Norway.
出版信息
BMC Psychiatry. 2017 Mar 14;17(1):93. doi: 10.1186/s12888-017-1256-8.
BACKGROUND
Utilization of diagnostic information from national patient registries rests on the quality of the registered diagnoses. We aimed to investigate the agreement and consistency of diagnoses of psychotic and bipolar disorders in the Norwegian Patient Registry (NPR) compared to structured interview-based diagnoses given as part of a clinical research project.
METHODS
Diagnostic data from NPR were obtained for the period 01.01.2008-31.12.2013 for all patients who had been included in the Thematically Organized Psychosis (TOP) study between 18.10.2002 and 01.09.2014 with a Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnosis of schizophrenia (n = 537), delusional disorder (n = 48), schizoaffective disorder (n = 118) or bipolar disorder (n = 408). Diagnostic agreement between the primary DSM-IV diagnosis in TOP and the International Classification of Diseases, 10th revision (ICD-10) diagnoses in NPR was evaluated using Cohen's unweighted nominal kappa (κ). Diagnostic consistency was calculated as the proportion of all registered severe mental disorder diagnoses in NPR that were equivalent to the primary diagnosis given in the TOP study.
RESULTS
The proportion of patients registered with the equivalent ICD-10 diagnosis as the primary DSM-IV diagnosis given in TOP was 84.2% for the schizophrenia group, 68.8% for the delusional disorder group, 76.3% for the schizoaffective disorder group, and 78.4% for the bipolar disorder group. Diagnostic agreement was good for schizophrenia (κ = 0.74) and bipolar disorder (κ = 0.72), fair for schizoaffective disorder (κ = 0.63), and poor for delusional disorder (κ = 0.39). Among patients with DSM-IV schizophrenia, 4.7% were diagnosed with ICD-10 bipolar disorder, and among patients with DSM-IV bipolar disorder, 2.5% were diagnosed with ICD-10 schizophrenia. Diagnostic consistency was 84.9% for schizophrenia, 59.1% for delusional disorder, 65.9% for schizoaffective disorder, and 91.0% for bipolar disorder.
CONCLUSIONS
When compared to research-based diagnoses, clinical diagnoses of schizophrenia and bipolar disorder in the NPR are accurate and consistent, with minimal diagnostic overlap between the two disorders.
背景
来自国家患者登记处的诊断信息的利用取决于登记诊断的质量。我们旨在调查挪威患者登记处（NPR）中精神分裂症和双相情感障碍诊断与作为临床研究项目一部分给出的基于结构化访谈的诊断之间的一致性和稳定性。
方法
获取了2008年1月1日至2013年12月31日期间所有在2002年10月18日至2014年9月1日期间被纳入主题性组织精神病（TOP）研究的患者的NPR诊断数据，这些患者根据《精神疾病诊断与统计手册》第四版（DSM-IV）被诊断为精神分裂症（n = 537）、妄想性障碍（n = 48）、精神分裂情感性障碍（n = 118）或双相情感障碍（n = 408）。使用科恩未加权名义kappa（κ）评估TOP中的主要DSM-IV诊断与NPR中的《国际疾病分类》第十版（ICD-10）诊断之间的诊断一致性。诊断稳定性计算为NPR中所有登记的严重精神障碍诊断中与TOP研究中给出的主要诊断等效的比例。
结果
在精神分裂症组中，登记有与TOP中给出的主要DSM-IV诊断等效的ICD-10诊断的患者比例为84.2%，妄想性障碍组为68.8%，精神分裂情感性障碍组为76.3%，双相情感障碍组为78.4%。精神分裂症（κ = 0.74）和双相情感障碍（κ = 0.72）的诊断一致性良好，精神分裂情感性障碍（κ = 0.63）一般，妄想性障碍（κ = 0.39）较差。在DSM-IV精神分裂症患者中，4.7%被诊断为ICD-10双相情感障碍，在DSM-IV双相情感障碍患者中，2.5%被诊断为ICD-10精神分裂症。精神分裂症的诊断稳定性为84.9%，妄想性障碍为59.1%，精神分裂情感性障碍为65.9%，双相情感障碍为91.0%。
结论
与基于研究的诊断相比，NPR中精神分裂症和双相情感障碍的临床诊断准确且一致，两种障碍之间的诊断重叠最小。
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