Widing Line, Simonsen Carmen, Flaaten Camilla B, Haatveit Beathe, Vik Ruth Kristine, Wold Kristin F, Åsbø Gina, Ueland Torill, Melle Ingrid
NORMENT, Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, Oslo University Hospital and University of Oslo, Oslo, Norway.
Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
Front Psychiatry. 2020 Nov 12;11:580444. doi: 10.3389/fpsyt.2020.580444. eCollection 2020.
Approximately 10% of patients with psychotic disorders receive the diagnosis Psychotic disorder not otherwise specified" (PNOS). However, there is a lack of knowledge about the clinical presentations captured by this diagnosis in the mental health services. Therefore, we examined the symptom profiles of participants with PNOS compared to participants with bipolar disorder (BD) and schizophrenia spectrum disorder (SZ) diagnoses. We here included 1,221 participants from the Thematically Organized Psychosis-study at Oslo University Hospital; 792 with SZ, 283 with BD, and 146 with PNOS, assessed with SCID-I for DSM-IV. The participants with PNOS were categorized into subgroups based on SCID information. The GAF, PANSS, Alcohol Use Disorders Identification Test (AUDIT), and Drug Use Disorders Identification Test (DUDIT) were used to assess function, clinical symptoms, and substance use. In the PNOS group, 44% did not meet the criteria for any specific psychotic disorder, 35.5% had contradictory information making a specific diagnosis difficult, and 20.5% had inadequate information to make a specific diagnosis. The most frequent reason for a PNOS diagnosis was difficulty ruling out a substance-induced psychotic disorder ( = 41, 28%). Participants with PNOS were younger and more often first-episode than participants with BD and SZ. They were intermediate between BD and SZ for GAF scores (BD>PNOS>SZ) and PANSS scores (BD<PNOS<SZ) and more often scored above the clinical cut-off for substance misuse as measured by the AUDIT (BD = PNOS<SZ), DUDIT (BD = SZ<PNOS) and for the combination of both these measures. A PNOS diagnosis is more common in first-episode than in multi-episode patients. The diagnosis captures a heterogeneous group of psychotic syndromes, with a severity of symptoms and functional loss that is intermediate between BD and SZ.
约10%的精神障碍患者被诊断为“未特定的精神障碍”（PNOS）。然而，心理健康服务领域对这一诊断所涵盖的临床表现缺乏了解。因此，我们对比了被诊断为PNOS的参与者与被诊断为双相情感障碍（BD）和精神分裂症谱系障碍（SZ）的参与者的症状概况。我们纳入了来自奥斯陆大学医院主题性精神病研究的1221名参与者；792名被诊断为SZ，283名被诊断为BD，146名被诊断为PNOS，采用DSM-IV的SCID-I进行评估。根据SCID信息，将PNOS组的参与者分为亚组。使用总体功能评估量表（GAF）、阳性和阴性症状量表（PANSS）、酒精使用障碍识别测试（AUDIT）以及药物使用障碍识别测试（DUDIT）来评估功能、临床症状和物质使用情况。在PNOS组中，44%不符合任何特定精神障碍的标准，35.5%存在相互矛盾的信息，难以做出特定诊断，20.5%的信息不足，无法做出特定诊断。PNOS诊断最常见的原因是难以排除物质所致精神障碍（n = 41，28%）。与BD和SZ组的参与者相比，PNOS组的参与者更年轻，且更多为首发患者。在GAF评分（BD>PNOS>SZ）和PANSS评分（BD<PNOS<SZ）方面，他们处于BD和SZ之间，并且在通过AUDIT（BD = PNOS<SZ）、DUDIT（BD = SZ<PNOS）以及这两种测量方法的组合所衡量的物质滥用临床临界值以上的得分更为常见。PNOS诊断在首发患者中比在多发作患者中更为常见。该诊断涵盖了一组异质性的精神综合征，其症状严重程度和功能丧失程度介于BD和SZ之间。
