Predicting Diagnostic Change Among Patients Diagnosed With First-Episode DSM-IV-TR Major Depressive Disorder With Psychotic Features
Predicting Diagnostic Change Among Patients Diagnosed With First-Episode DSM-IV-TR Major Depressive Disorder With Psychotic Features
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DOI：
10.4088/jcp.12m08328
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发表时间：
2013-07-01
影响因子：
5.3
通讯作者：
Tohen, Mauricio
中科院分区：
文献类型：
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作者：
Salvatore, Paola;Baldessarini, Ross J.;Tohen, Mauricio
目的：在年轻人中，从伴有精神病特征的重度抑郁症（MDD）发作开始的纵向研究很少;因此，在本研究中，纳入了广泛年龄范围的受试者。由于精神病性MDD可能是不稳定的诊断，我们系统地评估这些患者从第一次发病前瞻性，以确定预测以后的诊断变化。在这项前瞻性自然主义研究中，我们招募了1989年至2003年在马萨诸塞州和意大利精神病住院单位的DSM-IV-TR精神病性MDD患者，并从第一次住院开始对他们进行随访，以比较人口统计学、前因、和首次发作的临床特征与后来的诊断变化的关联，基于使用DSM-III-R患者版结构化临床访谈的访谈。结果：平均值（SD）在4.0以内（2.7）岁，107例年龄为34.6岁的受试者的诊断（16.2）岁（范围、10-82岁）的患者中，29.9%的患者发生了第一次精神病性MDD发作，转为DSM-IV-TR双相情感障碍情感性精神障碍占11.2%。与精神病性MDD稳定诊断相关的因素有躯体痛苦（χ 2 =13.8，P
Objective: Longitudinal studies beginning from onset of major depressive disorder (MDD) with psychotic features in young adults are rare; therefore, in this study, subjects across a wide age range were included. Since psychotic MDD may be unstable diagnostically, we systematically evaluated such patients prospectively from first episode to ascertain predictors of later diagnostic change.Method: In this prospective naturalistic study, we recruited patients with DSM-IV-TR psychotic MDD from 1989 through 2003 at psychiatric inpatient units in Massachusetts and Italy and followed them from first hospitalization to compare demographic, antecedent, and first-episode clinical characteristics for associations with later changes of diagnosis based on interviews using the Structured Clinical Interview for DSM-III-R, Patient Version.Results: Within a mean (SD) of 4.0 (2.7) years, diagnoses among 107 subjects aged 34.6 (16.2) years (range, 10-82 years) who were experiencing a first lifetime DSM-IV-TR psychotic MDD episode changed in 29.9% to DSM-IV-TR bipolar disorder (18.7%) or schizoaffective disorder (11.2%). Factors associated with stable diagnoses of psychotic MDD included ontological anguish (chi(2)=13.8, P