Diagnosing schizophrenia in the initial prodromal phase
Diagnosing schizophrenia in the initial prodromal phase
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DOI：
10.1001/archpsyc.58.2.158
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发表时间：
2001-02-01
影响因子：
--
通讯作者：
Schultze-Lutter, F
中科院分区：
文献类型：
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作者：
Klosterkötter, J;Hellmich, M;Schultze-Lutter, F
背景：在精神分裂症研究中，在首次精神病发作前早期发现最初的前驱症状是一个主要的课题。因此，初步前驱症状的预测准确性是前瞻性的。方法：选取1987 ~ 1991年间因诊断问题而转诊至德国精神科大学门诊部的患者为研究对象，采用波恩基本症状评估量表和第九版状态检查对其进行检查，以发现早期精神分裂症。在1995年至1998年期间，385名没有表现出精神分裂症特征症状的患者中，110名有前驱症状，50名没有最初的前驱症状，用同样的仪器进行了随访和重新检查，以确定是否过渡到精神分裂症。结果：平均随访9.6年。160例患者中有79例（49.4%）转变为精神分裂症。无前驱症状排除后续精神分裂症的概率为96%（敏感性：0.98，假阴性预测：1.3%），而前驱症状的存在预测精神分裂症的概率为70%（特异性：0.59，假阳性预测：20%）。某些障碍，如思维干扰、接受性语言障碍或视觉扭曲，预测精神分裂症的概率甚至高达91%（特异性：0.85-0.91；假阳性预测：1.9%-7.5%）。结论：波恩基本症状评估量表对精神分裂症的早期诊断有较好的应用价值。因此，它可能对疾病的预测有用，特别是如果它被进一步细化以选择那些具有特别高的预测准确性的项目。
Background: In schizophrenia research, early detection in the initial prodrome before first psychotic episodes is a major topic. Therefore, the prognostic accuracy of initial prodromal symptoms was examined prospectively.Methods: The study sample was composed of patients referred to outpatient departments of German psychiatric university departments, because of diagnostic problems, between 1987 and 1991, They were examined with the Bonn Scale for the Assessment of Basic Symptoms and the Ninth Version of the Present State Examination to detect an incipient schizophrenic disorder. Of 385 patients showing no schizophrenia-characteristic symptoms, between 1995 and 1998, 110 with and 50 without initial prodromal symptoms were followed up and reexamined with the same instruments for a transition to schizophrenia.Results: During a mean follow-up period of 9.6 years. 79 (49.4%) of the 160 patients had transited to schizophrenia. The absence of prodromal symptoms excluded a subsequent schizophrenia with a probability of 96% (sensitivity: 0.98, false-negative predictions: 1.3%), whereas their presence predicted schizophrenia with a probability of 70% (specificity: 0.59; false-positive predictions: 20%). Certain disturbances, such as thought interference, disturbances of receptive language, or visual distortions, predicted schizophrenia, even with a probability up to 91% (specificity: 0.85-0.91; false-positive predictions: 1.9%-7.5%).Conclusions: The Bonn Scale for the Assessment of Basic Symptoms operationalization of prodromal symptoms performed well in the early detection of schizophrenia. It therefore might be useful for the prediction of the disorder, especially if it is further refined to select those items with particularly high prognostic accuracy.