Kendler K S, Gallagher T J, Abelson J M, Kessler R C
Department of Psychiatry, Medical College of Virginia/Virginia Commonwealth University, Richmond, USA.
Arch Gen Psychiatry. 1996 Nov;53(11):1022-31. doi: 10.1001/archpsyc.1996.01830110060007.
We seek to estimate lifetime prevalence and demographic correlates of nonaffective psychosis in the US population assessed by a computer-analyzed structured interview and a senior clinician.
In the National Comorbidity Survey, a probability subsample of 5877 respondents were administered a screen for psychotic symptoms. Based on the response to this screening, detailed follow-up interviews were conducted by mental health professionals (n = 454). The initial screen and clinical reinterview were reviewed by a senior clinician. Results are presented for narrowly (schizophrenia or schizophreniform disorder) and broadly (all nonaffective psychoses) defined psychotic illness.
One or more psychosis screening questions were endorsed by 28.4% of individuals. By computer algorithm, lifetime prevalences of narrowly and broadly defined psychotic illness were 1.3% and 2.2%, respectively. Of those assigned a narrow diagnosis by the computer, the senior clinician assigned narrow and broad diagnoses to 10% and 37%, respectively. By clinician diagnosis, lifetime prevalence rates of narrowly and broadly defined psychosis were 0.2% and 0.7%, respectively. A clinician diagnosis of nonaffective psychosis was significantly associated with low income; unemployment a marital status of single, divorced, or separated; and urban residence Clinician confirmation of a computer diagnosis was predicted by hospitalization, neuroleptic treatment, duration of illness, enduring impairment, and thought disorder.
Lifetime prevalence estimates of psychosis in community samples are strongly influenced by methods of assessment and diagnosis. Although results using computer algorithms were similar in the National Comorbidity Survey and Epidemiologic Catchment Area studies, diagnoses so obtained agreed poorly with clinical diagnoses. Accurate assessment of psychotic illness in epidemiologic samples may require collection of extensive contextual information for clinician review.
我们旨在通过计算机分析的结构化访谈和资深临床医生评估，估算美国人群中非情感性精神病的终生患病率及其人口统计学相关因素。
在全国共病调查中，对5877名受访者的概率子样本进行了精神病症状筛查。根据该筛查的结果，心理健康专业人员（n = 454）进行了详细的随访访谈。资深临床医生对初始筛查和临床复查进行了审核。结果呈现了狭义（精神分裂症或精神分裂症样障碍）和广义（所有非情感性精神病）定义的精神病性疾病情况。
28.4%的个体认可了一个或多个精神病筛查问题。通过计算机算法，狭义和广义定义的精神病性疾病的终生患病率分别为1.3%和2.2%。在计算机给出狭义诊断的人群中，资深临床医生给出狭义和广义诊断的比例分别为10%和37%。根据临床医生诊断，狭义和广义定义的精神病的终生患病率分别为0.2%和0.7%。临床医生诊断的非情感性精神病与低收入、失业、单身、离婚或分居的婚姻状况以及城市居住显著相关。住院治疗、使用抗精神病药物治疗、病程、持续性损害和思维障碍可预测临床医生对计算机诊断的确认。
社区样本中精神病的终生患病率估计值受评估和诊断方法的强烈影响。尽管全国共病调查和流行病学集水区研究中使用计算机算法的结果相似，但如此获得的诊断与临床诊断的一致性较差。在流行病学样本中准确评估精神病性疾病可能需要收集广泛的背景信息以供临床医生审核。
