From the Department of Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid (Drs. Cegla-Schvartzman, Ovejero, and Baca-García); University of Montpellier, Centre Hospitalier Universitaire de Nîmes, and French National Institute of Health and Medical Research (INSERM) Unit 1061, Montpellier (Dr. López-Castroman); Departments of Psychiatry, Universidad Autónoma (Madrid), Hospital Universitario Rey Juan Carlos (Móstoles), Hospital General de Villalba (Madrid), Hospital Universitario Infanta Elena (Valdemoro) (all Spain) (Dr. Baca-García); Centro de Investigación en Salud Mental (CIBERSAM), Carlos III Institute of Health, Madrid (Dr. Baca-García); Universidad Católica del Maule, Talca, Chile (Dr. Baca-García); Department of Psychiatry, Columbia University (Dr. Baca-García).
Harv Rev Psychiatry. 2019 Jan/Feb;27(1):3-14. doi: 10.1097/HRP.0000000000000187.
After participating in this activity, learners should be better able to:• Evaluate diagnostic stability in bipolar disorder• Analyze the factors contributing to diagnostic stability OBJECTIVE: Diagnostic stability is the degree to which a diagnosis remains unchanged during follow-up. It is an important measure of predictive validity in bipolar disorder (BD). In this study, we review the literature concerning diagnostic stability in BD, analyze the factors contributing to diagnostic stability, and describe the implications of diagnostic boundaries and diagnostic delay.
A comprehensive literature search of MEDLINE and EMBASE databases was conducted, including all studies published from 1980 to 2016, to evaluate the diagnostic stability of BD. Thirty-seven articles were included: 6 focusing mainly on BD, 18 on psychotic disorders, 10 on depression, and 3 on diagnostic stability in psychiatric disorders in general. Data analysis was performed in standardized fashion using a predefined form.
Despite a high variability of the methodological approaches taken, an acceptable degree of diagnostic stability was found. The most common criteria for evaluating diagnostic stability were prospective consistency and retrospective consistency. The mean prospective and retrospective consistencies were 77.4% and 67.6%, respectively. A large majority of studies were performed in Europe or in North America (67.5%), compared to 21.6% in Asia and only 10.8% in Africa, Oceania, and South America. Extreme ages, female gender, psychotic symptoms, changes to treatment, substance abuse, and family history of affective disorder have been related to diagnostic instability.
Several factors appear to have a negative impact on the diagnostic stability, but the evidence is insufficient to draw any robust conclusions. Nevertheless, despite variable prospective and retrospective consistencies, the overall diagnostic stability is good. Standardized methods need to be used to obtain more accurate assessments of stability.
参加本次活动后，学习者应能够：
评估双相情感障碍的诊断稳定性
分析导致诊断稳定性的因素
诊断稳定性是指在随访过程中诊断保持不变的程度。它是双相情感障碍（BD）预测有效性的重要衡量标准。在这项研究中，我们回顾了有关 BD 诊断稳定性的文献，分析了导致诊断稳定性的因素，并描述了诊断边界和诊断延迟的含义。
对 MEDLINE 和 EMBASE 数据库进行了全面的文献检索，包括从 1980 年到 2016 年发表的所有研究，以评估 BD 的诊断稳定性。共纳入 37 篇文章：6 篇主要关注 BD，18 篇关注精神病性障碍，10 篇关注抑郁症，3 篇关注一般精神障碍的诊断稳定性。使用预定义表格以标准化方式进行数据分析。
尽管所采用的方法学方法存在很大差异，但仍发现了可接受的诊断稳定性程度。评估诊断稳定性最常用的标准是前瞻性一致性和回顾性一致性。前瞻性和回顾性一致性的平均值分别为 77.4%和 67.6%。大多数研究在欧洲或北美进行（67.5%），而亚洲只有 21.6%，非洲、大洋洲和南美洲则只有 10.8%。极端年龄、女性性别、精神病症状、治疗改变、物质滥用和情感障碍家族史与诊断不稳定有关。
有几个因素似乎对诊断稳定性有负面影响，但证据不足以得出任何可靠的结论。然而，尽管前瞻性和回顾性一致性存在差异，但总体诊断稳定性良好。需要使用标准化方法来更准确地评估稳定性。
