Weeke A
Acta Psychiatr Scand. 1984 Dec;70(6):603-13. doi: 10.1111/j.1600-0447.1984.tb01255.x.
The instability of the diagnoses in a psychiatric register causes practical problems when groups of probands with specific diagnoses are selected for further studies. A cohort of 3,062 first admissions with at least one manic-depressive admission was followed for 5-7 years. 623 had at least one admission for mania and were considered bipolar. The percentage of patients who changed their diagnoses was highest at first readmission; at each later readmission about 10% of the bipolars and 25% of the unipolars changed from manic-depressive psychosis and a similar number changed from other diagnoses to manic-depressive psychosis. Compared with the diagnostic distribution of all register cases, reactive psychoses were more frequent than expected as former diagnoses and schizophrenia as later diagnosis. Neuroses and character deviations were frequent alternative diagnoses among unipolars, not among bipolars. The consequences of different selection criteria for the composition of proband groups are discussed.
当选择具有特定诊断的先证者群体进行进一步研究时，精神病登记册中诊断的不稳定性会引发实际问题。对3062例首次入院且至少有一次躁郁症入院记录的患者进行了5至7年的随访。其中623例至少有一次躁狂发作记录，被视为双相情感障碍患者。诊断发生变化的患者比例在首次再入院时最高；在随后的每次再入院时，约10%的双相情感障碍患者和25%的单相情感障碍患者从躁郁症精神病转变而来，且有相似数量的患者从其他诊断转变为躁郁症精神病。与所有登记病例的诊断分布相比，反应性精神病作为既往诊断比预期更常见，而精神分裂症作为后续诊断更常见。神经症和性格偏差在单相情感障碍患者中是常见的替代诊断，在双相情感障碍患者中则不然。文中讨论了不同选择标准对先证者群体构成的影响。
