Cano-Ruiz Paloma, Sanmartin-Salinas Patricia, Gómez-Peinado Alicia, Calero-Mora Cecilia, Gutiérrez-Rojas Luis
Mental Health Unit, Almansa General Hospital, Albacete, Spain.
Department of Biology, Biochemical and Molecular Biology, University of Alcalá, Alcalá de Henares, Madrid, Spain.
Actas Esp Psiquiatr. 2020 Jan;48(1):28-35. Epub 2020 Jan 1.
Stability of a diagnosis over time represents the best evidence to validate psychiatric diagnoses and helps to predict the course of a disorder. The diagnosis of bipolar disorder shows large variability over time and only a few numbers of investigations have evaluated the impact of the diagnostic stability vs the change.
A systematic review was made through a literature search in Pubmed, Medline and Web of Science of the articles published in the last 10 years (2008- 2018). We used the following key words; "stability diagnosis", AND "bipolar disorders", AND "mood disorders". We selected those studies conducted in patients who presented affective and/or psychotic clinic where the stability of the diagnosis was studied over time.
The initial search showed a total of 140 articles, 13 of which met inclusion criteria. In this review we have found that, compared to other mental disorders, Bipolar Disorder has in its favor a greater construct validity and longterm stability.
Initial phases of Bipolar Disorder constitute a real diagnostic and therapeutic challenge. Despite this, it is considered, added to schizophrenia as one of the most stable diagnostic categories (60% of patients who receive this initial diagnosis remain it during time). The absence of reliable and valid instruments for diagnosis is considered as a limitation so it would be convenient that in the next classifications of mental disorders they continue striving so that the nosological entities have greater construct validity possible.
诊断随时间的稳定性是验证精神科诊断的最佳证据，并有助于预测疾病的病程。双相情感障碍的诊断随时间变化差异很大，仅有少数研究评估了诊断稳定性与变化的影响。
通过在PubMed、Medline和Web of Science中检索过去10年（2008 - 2018年）发表的文章进行系统综述。我们使用了以下关键词：“稳定性诊断”、“双相情感障碍”、“心境障碍”。我们选择了那些在出现情感和/或精神病性症状的患者中进行的研究，这些研究对诊断的稳定性进行了长期研究。
初步检索共显示140篇文章，其中13篇符合纳入标准。在本综述中我们发现，与其他精神障碍相比，双相情感障碍具有更高的结构效度和长期稳定性。
双相情感障碍的初始阶段构成了真正的诊断和治疗挑战。尽管如此，它与精神分裂症一起被认为是最稳定的诊断类别之一（60%接受初始诊断的患者在此期间保持该诊断）。缺乏可靠有效的诊断工具被视为一个限制因素，因此在未来的精神障碍分类中，继续努力使疾病实体具有尽可能高的结构效度将是很方便的。
