前瞻性研究：双相障碍是否被过度诊断？
Prospective: Is bipolar disorder being overdiagnosed?
机构信息
Department of Psychiatry and Behavioral Sciences, George Washington University, Washington DC, USA.
The Depression & Bipolar Clinic of Colorado, Fort Collins, Colorado, USA.
出版信息
Int J Methods Psychiatr Res. 2018 Sep;27(3):e1725. doi: 10.1002/mpr.1725. Epub 2018 Jun 14.
OBJECTIVES
Many studies indicate that bipolar disorders are underdiagnosed. Yet from 2007 to 2008, a series of publications asserted that bipolar disorders were being overdiagnosed. This review examines the methods used in the studies that reported bipolar disorders were being overdiagnosed.
METHODS
A literature search for studies with original data related to overdiagnosis of bipolar disorders was performed.
RESULTS
Four studies were found indicating bipolar disorders were being overdiagnosed. The Structured Clinical Interview of the Diagnostic and Statistical Manual of Mental Disorders (SCID) was used in the diagnostic process. The studies compared the clinical diagnosis of bipolar disorder to a single SCID interview without interviewing family or reviewing old records. The studies assumed the SCID diagnosis was correct.
CONCLUSIONS
Numerous concerns were found. The SCID frequently missed diagnosis of bipolar, the definitions of bipolar disorder are so narrow and conservative that the outcomes of the studies may have been predetermined. Ultimately, the studies compared the strength of a diagnosis made by a treating psychiatrist to a SCID diagnosis collected with virtually no information from the clinician. The assumption that the SCID diagnosis is always correct and the clinician is always wrong is unsupportable. The premise that bipolar disorders are being overdiagnosed is unsupported by reasonable science.
目的
许多研究表明双相情感障碍被低估了。然而，从 2007 年到 2008 年，一系列出版物声称双相情感障碍被过度诊断。本综述检查了报告双相情感障碍被过度诊断的研究中使用的方法。
方法
对与双相情感障碍过度诊断相关的原始数据进行了文献检索。
结果
发现了四项表明双相情感障碍被过度诊断的研究。在诊断过程中使用了《精神障碍诊断与统计手册》（DSM）的结构性临床访谈（SCID）。这些研究将双相情感障碍的临床诊断与单一的 SCID 访谈进行了比较，而没有对家庭进行访谈或查阅旧记录。这些研究假设 SCID 诊断是正确的。
结论
发现了许多问题。SCID 经常漏诊双相，双相情感障碍的定义非常狭窄和保守，以至于这些研究的结果可能已经预先确定。最终，这些研究将治疗精神病医生做出的诊断的力度与几乎没有临床医生信息的 SCID 诊断进行了比较。SCID 诊断总是正确而临床医生总是错误的假设是站不住脚的。双相情感障碍被过度诊断的前提是没有合理的科学依据的。
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