Holm Minna, Suokas Kimmo, Liukko Emmi, Lindgren Maija, Näätänen Petri, Kärkkäinen Jukka, Salokangas Raimo K R, Suvisaari Jaana
Finnish Institute for Health and Welfare, Equality Unit, Helsinki, Finland.
Finnish Psychiatric Association, Helsinki, Finland.
Schizophrenia (Heidelb). 2024 Feb 19;10(1):20. doi: 10.1038/s41537-024-00444-6.
The Finnish Quality of Psychosis Care Register assesses nonaffective psychosis (NAP) care, acknowledging treatment outside specialized psychiatric services. This approach, while providing a holistic view, raises concerns about diagnostic inaccuracies. Here, we studied situations where the register-based diagnosis might be inaccurate, and whether the first episode can be reliably identified using a 14-year wash-out period. People with first register-based NAP (ICD-10 F20-F29) between years 2010 and 2018 and without NAP diagnoses in 1996-2009 were identified from the Care Register for Health Care. A diagnosis of NAP was deemed unreliable before age 7, when dementia preceded NAP diagnosis, and when a NAP diagnosis had been assigned at admission or during psychiatric hospitalization but was not confirmed by discharge diagnosis. Despite a 14-year follow-back the first register diagnosis may miss the first treatment episode in older patients. Register-based studies on psychotic disorders should pay attention to exclusion criteria and to the definition of treatment onset.
芬兰精神病护理质量登记册评估非情感性精神病（NAP）护理情况，认可在专门精神病服务机构之外的治疗。这种方法虽能提供全面视角，但引发了对诊断不准确的担忧。在此，我们研究了基于登记册的诊断可能不准确的情况，以及是否可通过14年的洗脱期可靠地识别首次发作。从医疗保健护理登记册中识别出2010年至2018年间首次基于登记册诊断为NAP（国际疾病分类第十版F20 - F29）且在1996 - 2009年期间无NAP诊断的患者。在7岁之前、痴呆先于NAP诊断以及在入院时或精神科住院期间被诊断为NAP但出院诊断未确认时，NAP诊断被视为不可靠。尽管进行了14年的追溯，首次登记诊断可能会遗漏老年患者的首次治疗发作。基于登记册的精神病障碍研究应关注排除标准和治疗起始的定义。
