Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong.
State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong, Hong Kong.
BMC Psychiatry. 2023 Sep 18;23(1):676. doi: 10.1186/s12888-023-05175-z.
Literature has typically associated delusional disorder with a poorer prognosis relative to schizophrenia, without considering the confounding effect of age despite the differential age of onset. This study therefore aims to investigate the diagnostic stability, clinical, functional, and neurocognitive differences of Chinese first-episode psychosis age-matched patients with delusional disorder and schizophrenia at four years.
71 delusional disorder and 71 age-matched schizophrenia patients were followed up for four years after their initial episode. Their symptoms, insight in psychosis, side effects of medication, medication compliance, functioning, and neurocognitive performance were assessed at four years.
At four years, 65% of DD patients maintained the same diagnosis, while the rest shifted to SZ. Only those without a diagnostic shift were included in the analysis. Delusional disorder patients (n = 46) experienced greater general psychopathology and poorer insight, but better attitude towards medication than schizophrenia patients (n = 71). Social and occupational functioning, quality of life, and cognitive functioning, however, were similar in delusional disorder and schizophrenia patients.
Results indicate that delusional disorder is less diagnostically stable than schizophrenia. Their outcomes in a Chinese population were largely similar at four years after removing the confounding age factor, implying that delusional disorder and schizophrenia may not be as distinct as previously thought.
文献通常将妄想障碍与精神分裂症的预后较差联系起来，而没有考虑到发病年龄的混杂效应，尽管发病年龄不同。因此，本研究旨在调查中国首发精神病年龄匹配的妄想障碍和精神分裂症患者在四年后的诊断稳定性、临床、功能和神经认知差异。
71 例妄想障碍和 71 例年龄匹配的精神分裂症患者在首次发作后随访四年。在四年时评估他们的症状、精神病的洞察力、药物副作用、药物依从性、功能和神经认知表现。
四年后，65%的 DD 患者保持相同的诊断，而其余的则转为 SZ。只有那些没有诊断转变的患者才被纳入分析。妄想障碍患者（n=46）经历了更多的一般精神病症状和较差的洞察力，但对药物的态度优于精神分裂症患者（n=71）。然而，妄想障碍和精神分裂症患者的社会和职业功能、生活质量和认知功能相似。
结果表明，妄想障碍的诊断稳定性不如精神分裂症。在中国人群中，在去除混杂的年龄因素后，他们在四年后的结果在很大程度上相似，这意味着妄想障碍和精神分裂症可能不像以前认为的那样不同。
