EPIDEMIOLOGY OF NEWLY DIAGNOSED PSYCHOTIC DISORDERS

描述（改编自申请人摘要）：本提案是一项 MH 44801的竞争性更新（新诊断的 精神障碍），一项首次入院患者的流行病学研究 从纽约萨福克郡的所有住院机构抽取。 的 目的是完成后续评估和共识诊断， 并对队列中的诊断稳定性进行分析， 病程早期，疾病特征的诊断差异 和4年的课程，修改后的脆弱性模型的实用性，以解释 过程和结果，治疗经验的不同影响， 48-随访1个月，特殊人群疾病的自然史 (poor认知功能; HIV +;早期缺陷综合征;短暂性精神病; 患有精神情感障碍的青年）。 多项指标 功能和一套全面的预测指标。 的 设计需要基线评估（通常在出院前）， 6个月、24个月和48个月后进行面对面随访，每隔一个月进行一次简短联系。 3个月至24个月，此后每6个月一次。 共识 在基线、6个月和24个月评估后制定诊断; 诊断不明确或变化的受访者在 48-月面试 重要的其他面谈和辅助医疗 还纵向获得了信息。 从1989年至1995年，733名受访者接受了采访，在基线（响应 率=72%）。 在1989年至1992年的471名患者中， 同意基线访谈（75.4%）。 我们保留了94.5%的合格 在6个月时，合格受访者中有89.3%在24个月时 （包括94.8%的6个月受访者）。 在现场工作和DSM-III-R和DSM-IV方面投入了大量精力 在过去的几年里，诊断配方。 面试官是 精神科社会工作者，数据收集包括精神科， 社会心理和神经心理评估。 项目精神病学家 制定诊断的人包括高级教员和雇用的研究员 特别是研究。 此外，我们还进行了初步分析， 在最初的几年里，受访者参加了这项研究。 这 产生了一些方法和实质性出版物， 诊断问题（前6个月的稳定性;诊断不明确; 短暂精神病;出院与研究诊断），情感障碍， 早期过程的预测因素，受访者之间的基线差异， 在访谈期间显示完全与部分精神病症状或无精神病症状， 阴性症状。 利用第一阶段的样本，我们目前 完成一套关于24个月课程经验的论文， 变化和特殊亚群的特征。 在续约期间，我们还计划跟踪样品， 为将来的研究做准备。

DESCRIPTION (Adapted from applicant's abstract): This proposal is a competitive renewal of MH44801 (The Epidemiology of Newly Diagnosed Psychotic Disorders), an epidemiologic study of first-admission patients drawn from all of the inpatient facilities in Suffolk County, New York. The aims are to complete the follow-up assessments and consensus diagnoses of the cohort and to conduct analyses on the stability of diagnosis in the early course of illness, diagnostic differences in illness characteristics and 4-year course, the utility of a modified vulnerability model to explain course and outcome, differential effects of treatment experiences over the 48-month follow-up, and the natural history of disorder in special groups (poor cognitive functioning; HIV +; early deficit syndrome; brief psychoses; youth with psychotic affective disorders). Multiple indicators of functioning, and a comprehensive set of predictors, are included. The design entailed baseline assessments (usually before discharge) and face-to-face follow-up 6, 24-, and 48-months later with brief contact every 3 months through 24-months and every 6 months thereafter. Consensus diagnoses were formulated after the baseline, 6- and 24-month assessments; respondents with unclear or shifting diagnoses were reviewed again after the 48-month interview. Significant other interviews and ancillary medical information were also obtained longitudinally. From 1989-1995, 733 respondents were interviewed at baseline (response rate=72%). Of the 471 patients referred to the study from 1989-92, 355 agreed to a baseline interview (75.4%). We retained 94.5% of qualified respondents at 6-months, and 89.3% of qualified respondents at 24-months (including 94.8% of 6-month respondents). Considerable effort has gone into the field work and DSM-III-R and DSM-IV diagnostic formulations over the past several years. The interviewers are psychiatric social workers, and the data collection includes psychiatric, psychosocial, and neuropsychological assessments. Project psychiatrists formulating the diagnoses include senior faculty as well as fellows hired specifically for the study. In addition, we conducted preliminary analyses with respondents enrolled in the study during the first few years. This resulted in a number of methodological and substantive publications on diagnostic issues (stability during the first 6 months; unclear diagnoses; brief psychoses; discharge vs. research diagnosis), affective disorders, predictors of early course, differences at baseline between respondents who revealed full vs. partial or no psychotic symptoms during the interview, and negative symptoms. Using this first-phase sample, we are currently completing a set of papers on the 24-month course experience, diagnostic shifts, and the characteristics of special sub-populations. During the renewal period, we also plan to keep track of the sample to prepare for future research.