Reliability of psychiatric diagnosis in postmortem research
Reliability of psychiatric diagnosis in postmortem research
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DOI：
10.1016/j.biopsych.2004.10.016
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发表时间：
2005-01-01
影响因子：
10.6
通讯作者：
Kleinman, JE
中科院分区：
文献类型：
--
作者：
Deep-Soboslay, A;Akil, M;Kleinman, JE
背景：人脑死后研究是确定精神疾病病理生理学中涉及的细胞、分子和遗传途径的重要方法。尸检研究的一个关键组成部分是用于确定研究队列的精神病学诊断的可靠性。寻找可靠的方法来评估受试者死后的终生精神疾病诊断是非常具有挑战性的。方法：比较了两种常用的方法：精神病历回顾和死后家庭访谈。我们假设，这两种方法对精神分裂症患者的诊断符合率比情绪障碍患者更高。采用DSM-IV结构化临床访谈法对37例患者的精神科病历进行了回顾，并对其家属进行了访谈。结果：比较两种方法得出的诊断结果，总的kappa系数为。67.精神分裂症队列的Kappa系数为.94，重度抑郁症队列的Kappa系数为.68，双相情感障碍队列的Kappa系数为.58。因此，尽管使用这两种方法中的一种来确定精神分裂症的死后诊断可能已经足够，但要达到对情绪障碍的准确死后诊断的最佳方法更难确定，需要进一步研究。
Background: Postmortem human brain research is an important approach for identifying the cellular, molecular, and genetic pathways involved in the pathophysiology of psychiatric disorders. One critical component in postmortem research is the reliability of psychiatric diagnoses used to define study cohorts. Finding reliable methods for assessing lifetime psychiatric diagnoses in subjects after death is extremely challenging.Methods: Two commonly used approaches were compared: psychiatric record reviews and Postmortem family interviews. We hypothesized that these two methods would lead to more diagnostic agreement for subjects with schizophrenia than those with mood disorders. For 37 cases, psychiatric records were reviewed retrospectively using the Diagnostic Evaluation After Death, and family members were interviewed using the Structured Clinical Interview for DSM-IVResults: Comparison of diagnoses derived from these two approaches generated an overall kappa coefficient of. 67. Kappa coefficients for the schizophrenia cohort were .94, .68 for the major depressive disorder cohort, and .58 for the bipolar disorder cohort.Conclusions. Thus, although it may be sufficient to establish the postmortem diagnosis of schizophrenia using one of the two methods, the best method for reaching an accurate postmortem diagnosis for mood disorders is more difficult to determine and requires further study.