Diagnostic change 10 years after a first episode of psychosis
Diagnostic change 10 years after a first episode of psychosis
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DOI：
10.1017/s0033291715000720
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发表时间：
2015-10-01
影响因子：
6.9
通讯作者：
Doody, G. A.
中科院分区：
文献类型：
--
作者：
Heslin, M.;Lomas, B.;Doody, G. A.
背景。随着时间的推移，缺乏基于病因的疾病分类导致了精神病学诊断的不稳定。本研究旨在使用 10 年后随访的精神病病例发病样本数据来检查精神病诊断的诊断稳定性，并检查与诊断变化相关的基线变量。数据来自 AESOP 和 AESOP-10 研究，分别是对来自两个地点的首发精神病病例的人群队列的发病率和随访研究。使用 ICD-10 和 DSM-IV-TR 进行诊断。使用前瞻性和回顾性一致性检查诊断变化。使用逻辑回归和似然比检验检查与变化相关的基线变量。结果。与 DSM-IV-TR (55.3%) 相比，具有相同基线和终生 ICD-10 诊断的病例 (59.6%) 略多，但前瞻性和回顾性一致性相似。精神分裂症、精神病性双相情感障碍和药物引起的精神病比其他诊断更具前瞻性一致性。大量在基线时有其他诊断的病例（ICD-10，n = 61；DSM-IV-TR，n = 76）在 10 岁时被归类为患有精神分裂症。许多变量与精神分裂症的变化相关，但很少与诊断的总体变化相关。结论。除精神分裂症以外的诊断应被视为可能是临时的。
Background. A lack of an aetiologically based nosology classification has contributed to instability in psychiatric diagnoses over time. This study aimed to examine the diagnostic stability of psychosis diagnoses using data from an incidence sample of psychosis cases, followed up after 10 years and to examine those baseline variables which were associated with diagnostic change.Method. Data were examined from the AESOP and AESOP-10 studies, an incidence and follow-up study, respectively, of a population-based cohort of first-episode psychosis cases from two sites. Diagnosis was assigned using ICD-10 and DSM-IV-TR. Diagnostic change was examined using prospective and retrospective consistency. Baseline variables associated with change were examined using logistic regression and likelihood ratio tests.Results. Slightly more (59.6%) cases had the same baseline and lifetime ICD-10 diagnosis compared with DSM-IV-TR (55.3%), but prospective and retrospective consistency was similar. Schizophrenia, psychotic bipolar disorder and drug-induced psychosis were more prospectively consistent than other diagnoses. A substantial number of cases with other diagnoses at baseline (ICD-10, n = 61; DSM-IV-TR, n = 76) were classified as having schizophrenia at 10 years. Many variables were associated with change to schizophrenia but few with overall change in diagnosis.Conclusions. Diagnoses other than schizophrenia should to be regarded as potentially provisional.