Comparison of psychotic bipolar disorder, schizoaffective disorder, and schizophrenia: an international, multisite study
Comparison of psychotic bipolar disorder, schizoaffective disorder, and schizophrenia: an international, multisite study
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DOI：
10.1111/acps.12447
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发表时间：
2016-01-01
影响因子：
6.7
通讯作者：
Baldessarini, R. J.
中科院分区：
文献类型：
--
作者：
Tondo, L.;Vazquez, G. H.;Baldessarini, R. J.
目的：对分裂情感性障碍(SA)、伴精神病性特征的双相I型障碍(BDP)和精神分裂症(SZ)之间的病因学差异仍未解决。方法：通过12项社会人口学和临床测量，对来自8个国际合作地点的2269名具有DSM-IV-TR诊断特征的患者(1435个BDP，463个SZ，371个SA)进行比较。结果：在双因素比较中，SA在11/12个特征(除发病应激源外)始终介于BDP和SZ之间，SZ和BDP在所有12个因素上都存在差异。SA和SZ在9/12个因子上与BDP和SZ不同：SA和BDP在教育和自杀意念或行为方面相似；SA和SZ在教育、起病应激源和物质滥用方面相似。对10个分类因素的诊断对的Meta分析比较表明，SZ和BDP的SA差异相似。多变量模型显示BDP与SZ(8个因素)、SA与SZ(5个)、BDP与SA(3个)之间存在显著的独立差异。所有诊断的测量方差都是相似的。结论：SA始终介于BDP和SZ之间。这三个诊断组的排名是：BDP>；SA>；SZ与较低的发病率或残疾相关。这一发现与Kraepelian的二元分类不一致，尽管三个DSM-IV诊断小组之间的相当大的重叠表明，如果他们代表不同的疾病，边界不确定。
Objective: Nosological distinctions among schizoaffective disorder (SA), bipolar I disorder with psychotic features (BDp), and schizophrenia (SZ) remain unresolved.Method: We compared 2269 subjects with psychotic features in DSM-IV-TR diagnoses (1435 BDp, 463 SZ, 371 SA) from 8 collaborating international sites, by 12 sociodemographic and clinical measures, all between diagnostic pairs.Results: In bivariate comparisons, SA was consistently intermediate between BDp and SZ for 11/12 features (except onset stressors), and SZ vs. BDp differed in all 12 factors. SA differed from both BDp and SZ in 9/12 factors: SA and BDp were similar in education and suicidal ideation or acts; SA and SZ were similar in education, onset stressors, and substance abuse. Meta-analytic comparisons of diagnostic pairs for 10 categorical factors indicated similar differences of SA from both SZ and BDp. Multivariate modeling indicated significantly independent differences between BDp and SZ (8 factors), SA vs. SZ (5), and BDp vs. SA (3). Measurement variance was similar for all diagnoses.Conclusion: SA was consistently intermediate between BDp and SZ. The three diagnostic groups ranked: BDp > SA > SZ related to lesser morbidity or disability. The findings are not consistent with a dyadic Kraepelinian categorization, although the considerable overlap among the three DSM-IV diagnostic groups indicates uncertain boundaries if they represent distinct disorders.