Widing Line, Simonsen Carmen, Bjella Thomas, Engen Magnus Johan, Flaaten Camilla Bärthel, Gardsjord Erlend, Haatveit Beathe, Haug Elisabeth, Lyngstad Siv Hege, Svendsen Ingrid Hartveit, Vik Ruth Kristine, Wold Kristin Fjelnseth, Åsbø Gina, Ueland Torill, Melle Ingrid
NORMENT, Norwegian Centre for Mental Disorders Research, Division of Mental Health and Addiction, 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.
Schizophr Bull Open. 2023 Feb 16;4(1):sgad005. doi: 10.1093/schizbullopen/sgad005. eCollection 2023 Jan.
The Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV diagnostic category "Psychotic disorder not otherwise specified" (PNOS) is seldom investigated, and we lack knowledge about long-term outcomes. We examined long-term symptom severity, global functioning, remission/recovery rates, and diagnostic stability after the first treatment for PNOS.
Participants with first-treatment PNOS ( = 32) were reassessed with structured interviews after 7 to 10 years. The sample also included narrow schizophrenia spectrum disorders (SSD, = 94) and psychotic bipolar disorders (PBD, = 54). Symptomatic remission was defined based on the Remission in Schizophrenia Working Group criteria. Clinical recovery was defined as meeting the criteria for symptomatic remission and having adequate functioning for the last 12 months.
Participants with baseline PNOS or PBD had lower symptom severity and better global functioning at follow-up than those with SSD. More participants with PNOS and PBD were in symptomatic remission and clinical recovery compared to participants with SSD. Seventeen (53%) PNOS participants retained the diagnosis, while 15 participants were diagnosed with either SSD (22%), affective disorders (19%), or substance-induced psychotic disorders (6%). Those rediagnosed with SSD did not differ from the other PNOS participants regarding baseline clinical characteristics.
Long-term outcomes are more favorable in PNOS and PBD than in SSD. Our findings confirm diagnostic instability but also stability for a subgroup of participants with PNOS. However, it is challenging to predict diagnostic outcomes of PNOS based on clinical characteristics at first treatment.
《精神疾病诊断与统计手册》（DSM）-IV中的诊断类别“未另行规定的精神病性障碍”（PNOS）很少被研究，我们对其长期预后缺乏了解。我们研究了首次治疗PNOS后的长期症状严重程度、整体功能、缓解/康复率以及诊断稳定性。
首次治疗PNOS的参与者（n = 32）在7至10年后通过结构化访谈进行重新评估。样本还包括狭义精神分裂症谱系障碍（SSD，n = 94）和精神病性双相障碍（PBD，n = 54）。症状缓解根据精神分裂症缓解工作组标准定义。临床康复定义为符合症状缓解标准且在过去12个月内功能良好。
基线为PNOS或PBD的参与者在随访时的症状严重程度低于SSD参与者，整体功能更好。与SSD参与者相比，更多的PNOS和PBD参与者实现了症状缓解和临床康复。17名（53%）PNOS参与者维持原诊断，而15名参与者被诊断为SSD（22%）、情感障碍（19%）或物质所致精神病性障碍（6%）。重新诊断为SSD的参与者在基线临床特征方面与其他PNOS参与者无差异。
PNOS和PBD的长期预后比SSD更有利。我们的研究结果证实了诊断的不稳定性，但也有一部分PNOS参与者诊断稳定。然而，根据首次治疗时的临床特征预测PNOS的诊断结果具有挑战性。
