Department of Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
Department of Psychiatry, Centre Hospitalier Universitaire de Nîmes.
J Clin Psychiatry. 2021 Sep 14;82(6):20m13764. doi: 10.4088/JCP.20m13764.
Diagnostic stability is the degree to which a diagnosis remains unchanged during time. Our main objective was to evaluate the diagnostic stability of bipolar disorder (BD) in psychiatric outpatient consultations and determine the socio-demographic variables influencing its stability. The Cumulative Register of Cases of the Community of Madrid provided data on all outpatient visits conducted at Madrid's Community Mental Healthcare Centers between 1980-2009. Diagnoses were made according to / criteria. Two indices were measured: temporal consistency (maintenance of the diagnosis over time) and diagnostic constancy (presence of BD diagnosis in at least 75% of visits). κ coefficient measured the agreement between diagnoses in the first and last evaluations (prospective and retrospective consistency). 14,557 patients were diagnosed with BD for at least 1 evaluation and had at least 10 visits and 1 year of follow-up. At first evaluation, 3,988 patients were diagnosed with BD (prospective consistency 50.8%), and at last evaluation 5,396 patients were diagnosed with BD (retrospective consistency 37.5%). A total of 2,026 patients were diagnosed with BD at their first and last evaluations (prospective consistency 18.3%). This longitudinal study conducted in community mental health centers reflects common diagnostic practices in outpatient settings over a 30-year period (130,000 patient-years). Delay of > 10 years was found to achieve diagnostic stability. Frequent diagnostic shifts were found in relation to BD, the most common being with other affective disorders. Anxiety was also a common misdiagnosis. Greater stability was associated with having been diagnosed after hospitalization, having an age at onset > 25 years, and having an age at diagnosis < 24 years.
诊断稳定性是指在一段时间内诊断保持不变的程度。我们的主要目的是评估精神科门诊咨询中双相情感障碍（BD）的诊断稳定性，并确定影响其稳定性的社会人口学变量。马德里社区的病例累积登记册提供了 1980-2009 年期间马德里社区精神保健中心所有门诊就诊的数据。诊断是根据 / 标准进行的。测量了两个指数：时间一致性（随着时间的推移保持诊断）和诊断恒定性（至少 75%的就诊中有 BD 诊断）。κ 系数衡量了首次和最后评估（前瞻性和回顾性一致性）中诊断的一致性。有 14557 名患者至少接受了一次评估，至少有 10 次就诊和 1 年的随访，被诊断为 BD。首次评估时，有 3988 名患者被诊断为 BD（前瞻性一致性为 50.8%），最后评估时，有 5396 名患者被诊断为 BD（回顾性一致性为 37.5%）。共有 2026 名患者在首次和最后评估中被诊断为 BD（前瞻性一致性为 18.3%）。这项在社区心理健康中心进行的纵向研究反映了 30 年来门诊环境中常见的诊断实践（130000 患者年）。发现需要超过 10 年的时间才能达到诊断稳定性。与 BD 相关的诊断变化频繁，最常见的是与其他情感障碍。焦虑也是常见的误诊。更大的稳定性与住院后诊断、发病年龄 >25 岁和诊断年龄 <24 岁有关。
