Diagnostic Shifts During the Decade Following First Admission for Psychosis
Diagnostic Shifts During the Decade Following First Admission for Psychosis
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DOI：
10.1176/appi.ajp.2011.11010048
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发表时间：
2011-11-01
影响因子：
17.7
通讯作者：
Chang, Su-wei
中科院分区：
文献类型：
--
作者：
Bromet, Evelyn J.;Kotov, Roman;Chang, Su-wei
目的：诊断的变化已经在短期内进行了前瞻性研究，但诊断的长期稳定性很少得到评价。作者检查了诊断的变化超过10年的follow-up period.Method：一个队列的470例首次入院的精神障碍患者进行了系统的评估，在基线和6个月，2年，10年的后续行动。纵向最佳估计共识的诊断制定后，每个assessment.Results：在基线时，诊断分布是29.6%精神分裂症谱系障碍，21.1%双相情感障碍与精神病的功能，17.0%的抑郁症与精神病的功能，2.4%的物质引起的精神病，和27.9%的其他精神病。在第10年，分布分别变为49.8%、24.0%、11.1%、7.0%和8.1%。总体而言，50.7%的研究参与者在研究期间的某个时候改变了诊断。大多数最初被诊断为精神分裂症或双相情感障碍的参与者在第10年保留了诊断（分别为89.2%和77.8%）。然而，32.0%的参与者（N=98）最初被诊断为非精神分裂症，到第10年逐渐转变为精神分裂症。第二大变化是双相情感障碍（10.7%的患者在基线时未被诊断）。临床表现的变化解释了许多诊断变化。特别是，较差的功能和更大的负面和精神病性症状评级预测随后转移到精神分裂症。更好的功能和较低的负面和抑郁症状评级预测的转变为bipolar disorder.Conclusions：首次入院的患者与精神障碍的风险被错误分类在早期阶段的疾病过程中，包括超过2年后首次住院。应在所有随访时间点重新评估诊断。
Objective: Diagnostic shifts have been prospectively examined in the short term, but the long-term stability of diagnoses has rarely been evaluated. The authors examined diagnostic shifts over a 10-year follow-up period.Method: A cohort of 470 first-admission patients with psychotic disorders was systematically assessed at baseline and at 6-month, 2-year, and 10-year follow-ups. Longitudinal best-estimate consensus diagnoses were formulated after each assessment.Results: At baseline, the diagnostic distribution was 29.6% schizophrenia spectrum disorders, 21.1% bipolar disorder with psychotic features, 17.0% major depression with psychotic features, 2.4% substance-induced psychosis, and 27.9% other psychoses. At year 10, the distribution changed to 49.8%, 24.0%, 11.1%, 7.0%, and 8.1%, respectively. Overall, diagnoses were changed for 50.7% of study participants at some point during the study. Most participants who were initially diagnosed with schizophrenia or bipolar disorder retained the diagnosis at year 10 (89.2% and 77.8%, respectively). However, 32.0% of participants (N=98) originally given a non-schizophrenia diagnosis had gradually shifted to a schizophrenia diagnosis by year 10. The second largest shift was to bipolar disorder (10.7% of those not given this diagnosis at baseline). Changes in the clinical picture explained many diagnostic shifts. In particular, poorer functioning and greater negative and psychotic symptom ratings predicted a subsequent shift to schizophrenia. Better functioning and lower negative and depressive symptom ratings predicted the shift to bipolar disorder.Conclusions: First-admission patients With psychotic disorders run the risk of being misclassified at early stages in the illness course, including more than 2 years after first hospitalization. Diagnosis should be reassessed at all follow-up points.