Diagnostic consistency of major depression with psychosis across 10 years.
Diagnostic consistency of major depression with psychosis across 10 years.
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DOI：
10.4088/jcp.10m06774
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发表时间：
2011-09
期刊：
影响因子：
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通讯作者：
Bromet EJ
中科院分区：
文献类型：
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作者：
Ruggero CJ;Kotov R;Carlson GA;Tanenberg-Karant M;González DA;Bromet EJ
The present study investigates how consistently DSM-IV major depression (MDD) with psychosis was diagnosed by research consensus across 10 years and the association of clinical characteristics with diagnostic consistency. The sample included 146 participants, part of a larger first admission cohort (N=628) presenting with psychosis, who were diagnosed with psychotic depression at least once across 4 assessments spanning 10 years (after first admission, at 6-month, 24-month, and 10-year follow-ups). Diagnoses at each assessment were determined from semi-structured interviews, medical records, and informant reports. Fifty-five (37.7%) of the 146 were diagnosed with psychotic depression at each available assessment, 13(8.9%) switched from MDD to bipolar disorder, 24 (16.4%) switched from MDD to schizophrenia or schizoaffective disorder, and the remaining 54 (37.0%) had other patterns of diagnostic change. Only 47 (58.8%) of 80 participants diagnosed with MDD at baseline retained a mood disorder diagnosis 10 years later (36 or 45.0% had MDD and 11 or 13.8% had bipolar disorder), while 16 (30.8%) of 52 participants who ended the study with MDD were initially misdiagnosed. Those switching from MDD to bipolar disorder had better premorbid adjustment, more first degree relatives with MDD, better functioning, and fewer negative symptoms at baseline, whereas those shifting to the schizophrenia spectrum had a more insidious onset, longer initial hospital stays, worse functioning, and more negative symptoms. The diagnosis of MDD with psychosis among inpatients showed poor long-term consistency. For clinicians, results indicate that the diagnosis of MDD with psychosis based on a single assessment should be considered provisional.
