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首页> 外文期刊>The journal of clinical psychiatry >Predicting diagnostic change among patients diagnosed with first-episode DSM-IV-TR major depressive disorder with psychotic features
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Predicting diagnostic change among patients diagnosed with first-episode DSM-IV-TR major depressive disorder with psychotic features

机译：预测患有精神病特征的第一集集DSM-IV-TR重大抑郁症患者的诊断变化

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Objective: Longitudinal studies beginning from onset of major depressive disorder (MDD) with psychotic features in young adults are rare; therefore, in this study, subjects across a wide age range were included. Since psychotic MDD may be unstable diagnostically, we systematically evaluated such patients prospectively from first episode to ascertain predictors of later diagnostic change. Method: In this prospective naturalistic study, we recruited patients with DSM-/V-TR psychotic MDD from 1989 through 2003 at psychiatric inpatient units in Massachusetts and Italy and followed them from first hospitalization to compare demographic, antecedent, and first-episode clinical characteristics for associations with later changes of diagnosis based on interviews using the Structured Clinical Interview for DSM-///-R, Patient Version. Results: Within a mean (SD) of4.0 (2.7) years, diagnoses among 107 subjects aged 34.6 (16.2) years (range, 10 82 years) who were experiencing a first lifetime DSM-/V-TR psychotic MDD episode changed in 29.9% to DSM-/V-TR bipolar disorder (1 8.7%) or schizoaffective disorder (11 .2%). Factors associated with stable diagnoses of psychotic MDD included ontological anguish (x2=13.8, P.000 1), nihilistic delusions (x2=4.47, P=.034), and weight loss (x 2=4.69, P.030) at initial syndromal presentation. Factors preceding diagnoses of bipolar disorder included antecedent impulsivity (x 2=9.10, P.003), lCD-JO mixed states at intake (x 2=19.4, P.0001), and previous hypomanic symptoms (x 2=13.7, P.002). Factors predicting later schizoaffective diagnoses included mood incongruent delusions (x2=9.17, P.002) and somatosensory hallucinations (x2=9.53, P.033) at intake, previous functional decline (x2=8.13, P.008), initial Schneiderian first rank symptoms (x2=10.6, P.005), and meeting criteria for lCD-JO schizoaffective disorder at intake (x2=24.9, P.0001). Conclusions: Among patients who initially met DSM-IV-TR criteria for first- episode psychotic MDD, early indications of features typically associated with bipolar disorder or with nonaffective psychoses, respectively, strongly predicted later diagnostic change to bipolar disorder or schizoaffective disorders.The findings support the value of psychopathological details in improving diagnostic and prognostic criteria for complex illnesses.
机译：目的：从重大抑郁症（MDD）开始的纵向研究与年轻成年人的精神病特征是罕见的;因此，在这项研究中，包括宽度范围的受试者。由于精神病医疗MDD可以诊断出来不稳定，我们系统地从第一集地评估了这些患者，以确定后来诊断变化的预测因子。方法：在这项潜在的自然主义研究中，我们从1989年至2003年招募了DSM-/ V-TR精神病MDD患者，在马萨诸塞州和意大利的精神病住院单位，并从第一次住院时间进行了比较人口，前进和第一集集临床特征基于采访DSM - // - R，患者版本的结构临床访谈的访谈基于访谈的诊断变化的关联。结果：在4.0（2.7）年的平均（SD）内，在34.6（16.2）年（范围，10 82年）的107名科目之间进行诊断，他们正在经历第一个终身DSM-/ V-TR精神病医疗MDD集中的变化29.9％至DSM-/ V-TR双极障碍（1,8.7％）或SchizoAfferceive疾病（11.2％）。与精神病的稳定诊断相关的因素包括本体痛苦（x2 = 13.8，p＆ .0001），虚无化妄想（x2 = 4.47，p = .034）和减重（x 2 = 4.69，p <.030）在初始综合征介绍。双极性障碍诊断的因素包括前一种冲动（x 2 = 9.10，p＆ .003），LCD-jo混合状态在进气时（x 2 = 19.4，p＆ .0001）和以前的奇异症状（x 2 = 13.7， P＆ .002）。预测以后的SchizoAfferive诊断的因素包括情绪不一致的妄想（x2 = 9.17，p＆ .002）和躯体感应型幻觉（x2 = 9.53，p＆ 033），以前的功能下降（x2 = 8.13，p＆ .008），初始Schneiderian第一排名症状（X2 = 10.6，P＆ .005），并在摄入时的LCD-JO SchizoAfcerceive病症的符合标准（X2 = 24.9，P＆ .0001）。结论：初始达到精神病学MDD的DSM-IV-TR标准的患者中，分别与双相障碍或非面向心脏病有关的特征的早期迹象，强烈预测对双相情感障碍或SchizoAfferive疾病的诊断变化。结果支持精神病理细节的价值，以改善复杂疾病的诊断和预后标准。

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    SalvatoreP.; BaldessariniR.J.; KhalsaH.-M.K.; AmoreM.; DiVittorioC.; FerraroG.; MagginiC.; TohenM.;

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    Department of Psychiatry Harvard Medical School Belmont MA United States International;

    Department of Psychiatry Harvard Medical School Belmont MA United States International;

    Department of Psychiatry Harvard Medical School Belmont MA United States International;

    Psychiatric Clinic University of Genoa Genoa Italy;

    Section of Psychiatry Department of Neuroscience University of Parma Parma Italy;

    Section of Psychiatry Department of Neuroscience University of Parma Parma Italy;

    Section of Psychiatry Department of Neuroscience University of Parma Parma Italy;

    Department of Psychiatry Harvard Medical School Belmont MA United States International;

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  • 正文语种 eng
  • 中图分类 精神病学;
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