精神分裂症死后大脑研究中的诊断问题。

Problem of diagnosis in postmortem brain studies of schizophrenia.

作者信息

Hill C, Keks N, Roberts S, Opeskin K, Dean B, MacKinnon A, Copolov D

机构信息

National Health and Medical Research Council Network for Brain Research into Mental Disorders, Mental Health Research Institute of Victoria, Australia.

出版信息

Am J Psychiatry. 1996 Apr;153(4):533-7. doi: 10.1176/ajp.153.4.533.

DOI:10.1176/ajp.153.4.533

PMID:8599402

Abstract

OBJECTIVE

The purpose of this study was to determine 1) the reliability of diagnoses of schizophrenia at coronal autopsy and 2) the degree to which the use of different diagnostic instruments for schizophrenia would affect postmortem brain research.

METHOD

Eighty-three subjects, recorded at coronal autopsy as having had schizophrenia, were referred for neurochemistry studies. The diagnoses reported to the state coroner's office were reevaluated by a review of psychiatric case histories by clinicians using semistructured assessment and diagnostic criteria.

RESULTS

The application of DSM-III-R, Research Diagnostic Criteria (RDC), ICD-10, Schneiderian, and Feighner criteria to the diagnosis of the 83 subjects revealed that 63.9%, 48.2%, 48,2%, 43.4%, and 42.2%, respectively, met the criteria for schizophrenia. Highest concordance was between the RDC and ICD-10 systems, while lowest concordance was between the RDC and Schneider systems.

CONCLUSIONS

These data suggest that unless carefully reviewed, diagnosis may be a major confounding factor in postmortem studies of brain tissue from subjects with schizophrenia.

摘要

目的

本研究的目的是确定1）冠状位尸检时精神分裂症诊断的可靠性，以及2）使用不同的精神分裂症诊断工具对死后大脑研究的影响程度。

方法

83名在冠状位尸检时记录为患有精神分裂症的受试者被转介进行神经化学研究。临床医生通过使用半结构化评估和诊断标准回顾精神病史，对向州验尸官办公室报告的诊断进行重新评估。

结果

将《精神疾病诊断与统计手册》第三版修订版（DSM-III-R）、研究诊断标准（RDC）、《国际疾病分类》第十版（ICD-10）、施奈德标准和费格纳标准应用于这83名受试者的诊断，结果显示分别有63.9%、48.2%、48.2%、43.4%和42.2%符合精神分裂症标准。RDC和ICD-10系统之间的一致性最高，而RDC和施奈德系统之间的一致性最低。