Department of Psychiatry, Jiménez Díaz Foundation, Madrid, Spain.
Department of Psychiatry, Jiménez Díaz Foundation, Madrid, Spain; Department of Psychiatry, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain.
Psychiatry Res. 2019 Sep;279:306-314. doi: 10.1016/j.psychres.2019.04.020. Epub 2019 May 2.
The objective is to systematically review previous literature on the diagnostic stability of schizophrenia, particularly to investigate prospective and retrospective consistency. We carried out a systematic literature search in PubMed and other minor sources from 1980 to July 2017. Specifically, prospective and retrospective consistency were examined. Thirty-nine studies were included, 5 focused on schizophrenia, 23 on psychotic episodes and 11 on psychiatric disorders in general. Samples sizes range from 60 to 10 058 subjects (total N = 39 965). The majority of studies (n = 26, 66.67%) were performed in Europe and North America and they had a prospective design (n = 27, 69.23%), with a median follow-up of 3 years. Prospective and retrospective consistency means were 84.29% and 67.15% respectively. Diagnostic change was also frequently measured (n = 12, mean 31.28%). The factors more commonly associated with diagnostic stability were: male sex, older age at the study inception, older age at onset, late stages of illness, family history of mental illness, poorer functioning and longer length of stay. Schizophrenia was found to have high diagnostic stability over time, although research on this topic is mainly focused in first psychotic episodes. More standardized methods are needed to further research diagnostic stability of schizophrenia over time and its determinants.
系统回顾既往关于精神分裂症诊断稳定性的文献，特别调查前瞻性和回顾性一致性。我们在 1980 年至 2017 年 7 月期间，在 PubMed 和其他次要来源进行了系统文献检索。具体而言，我们检查了前瞻性和回顾性一致性。共纳入 39 项研究，其中 5 项聚焦精神分裂症，23 项聚焦精神病发作，11 项聚焦一般精神障碍。样本量范围为 60 至 10058 例（总 N=39965）。大多数研究（n=26，66.67%）来自欧洲和北美，采用前瞻性设计（n=27，69.23%），中位随访时间为 3 年。前瞻性和回顾性一致性的平均值分别为 84.29%和 67.15%。诊断改变也经常被测量（n=12，平均值 31.28%）。与诊断稳定性更相关的因素有：男性、研究起始时年龄较大、发病年龄较大、疾病晚期、精神疾病家族史、功能较差和住院时间较长。精神分裂症随着时间推移具有较高的诊断稳定性，尽管该主题的研究主要集中在首发精神病发作。需要更标准化的方法来进一步研究精神分裂症随时间推移的诊断稳定性及其决定因素。
