EPIDEMIOLOGY OF NEWLY DIAGNOSED PSYCHOTIC DISORDERS

描述(改编自申请人的摘要)：本建议书是 MH44801的竞争性更新(新诊断的流行病学 精神障碍)，一项对首次入院患者的流行病学研究 取自纽约州萨福克县的所有住院设施。这个 目标是完成后续评估和共识诊断 并对诊断结果的稳定性进行分析。 疾病的早期病程、诊断特征的差异 并用4年的课程，用一个修正的漏洞模型来解释 治疗经历的过程和结果，不同的效果 48个月的随访，以及特殊群体中的自然障碍史 (认知功能低下；HIV+；早期缺陷综合征；短暂精神病； 患有精神病情感障碍的青少年)。多个指标 功能，以及一套全面的预测指标，包括在内。这个 设计需要基线评估(通常在卸货前)和 6个月、24个月和48个月后进行面对面跟踪，每隔一段时间进行简短联系 3个月至24个月，此后每6个月。共识 在基线、6个月和24个月评估后制定诊断； 诊断不明确或诊断变化的受访者在调查结束后再次接受审查 为期48个月的面试。重要的其他面谈和辅助医疗 信息也是纵向获得的。 1989-1995年间，733名受访者接受了基线访谈(答复 比率=72%)。在1989-92年间参与该研究的471名患者中，有355人 同意基线面试(75.4%)。我们保留了94.5%的合格 6个月的受访者和24个月的合格受访者中的89.3% (包括94.8%的6个月受访者)。 在实地工作和DSM-III-R和DSM-IV方面做出了相当大的努力 过去几年的诊断性配方。面试官是 精神科社会工作者，数据收集包括精神科， 心理社会和神经心理评估。项目精神病学家 制定诊断的人员包括高级教员和受雇的研究员 专门为这项研究而设计的。此外，我们还进行了初步的分析 受访者在最初的几年里参加了这项研究。这 产生了一些关于以下问题的方法和实质性出版物 诊断问题(前6个月的稳定性；诊断不清楚； 短暂的精神病；出院与研究诊断)，情感障碍， 早期病程的预测因素，受访者在基线上的差异 在面谈期间出现全部精神病症状或部分精神病症状或没有精神病症状，以及 阴性症状。使用这个第一阶段的样本，我们目前 完成一系列关于24个月课程体验、诊断的论文 转移，以及特殊亚群的特征。 在续期期间，我们还计划跟踪样品以 为未来的研究做好准备。

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.