Reliability and validity of the DSM-IV diagnostic category of schizoaffective disorder: Preliminary data
Reliability and validity of the DSM-IV diagnostic category of schizoaffective disorder: Preliminary data
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DOI：
10.1016/s0165-0327(99)00059-2
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发表时间：
2000-01-01
影响因子：
6.6
通讯作者：
Bucci, P
中科院分区：
文献类型：
--
作者：
Maj, M;Pirozzi, R;Bucci, P
背景：人们对精神分裂情感障碍的DSM-IV标准的可靠性和有效性表示担忧，但到目前为止还没有系统的研究发表。方法：采用国际综合诊断访谈法，对150例由两名精神科医生独立访谈的患者进行精神分裂症-情感障碍、躁狂发作和重度抑郁发作的科恩卡帕评分。采用Strauss-Carpenter结果量表，将DSM-IV一致诊断为分裂情感性障碍的患者与DSM-IV精神分裂症和精神分裂样障碍患者的两年结果进行比较。结果：诊断精神分裂情感性障碍的科恩kappa为0.22，诊断躁狂发作的科恩kappa为0.71，诊断重度抑郁发作的科恩kappa为0.82。精神分裂情感性患者的预后明显好于精神分裂症患者，但比精神分裂样障碍患者的预后差。结论：DSM-IV精神分裂情感障碍诊断标准的评分间信度不理想。与精神分裂症相比，DSM-IV分裂情感性障碍的更好结果似乎更多地取决于精神分裂症的定义，而不是分裂情感性障碍的定义中包含的六个月病程和功能损害标准，而不是两种情况的不同症状模式。局限性：满足精神分裂情感障碍DSM-IV标准的患者样本量很小。临床相关性：该研究表明，目前有问题的分裂情感障碍诊断的临床意义可能是适度的。(C) 2000 Elsevier Science B.V.版权所有
Background: Concerns have been expressed about the reliability and validity of the DSM-IV criteria for schizoaffective disorder, but no systematic study has been published up to now. Methods: The Cohen's kappa for the individual items of the DSM-IV definition of schizoaffective disorder, manic episode and major depressive episode was evaluated in 150 patients independently interviewed by two psychiatrists using the Composite international Diagnostic Interview. The two-year outcome of patients with a consensus DSM-IV diagnosis of schizoaffective disorder was compared to that of patients with DSM-IV schizophrenia and schizophreniform disorder, using the Strauss-Carpenter Outcome Scale. Results: The Cohen's kappa was 0.22 for the diagnosis of schizoaffective disorder, 0.71 for that of manic episode, and 0.82 for that of major depressive episode. Schizoaffective patients had a significantly better outcome than those with schizophrenia but a worse outcome than those with schizophreniform disorder. Conclusions: The inter-rater reliability of the DSM-IV criteria for schizoaffective disorder is not satisfactory. The better outcome of DSM-IV schizoaffective disorder compared with schizophrenia seems to depend more on the inclusion, in the definition of schizophrenia but not in that of schizoaffective disorder, of the six-month duration and functional impairment criteria than on the different symptomatological patterns of the two conditions. Limitation: The size of the sample of patients fulfilling DSM-IV criteria for schizoaffective disorder was small. Clinical relevance: The study suggests that the clinical implications of the currently problematic diagnosis of schizoaffective disorder may be modest. (C) 2000 Elsevier Science B.V. All rights reserved.