儿童及少年期首发精神障碍患者的随访  

Follow-up study of mental disorders in childrenhood and early adolescence

作　　者：徐文炜[1] 陶伟谷[1] 苏旭江[1] 

机构地区：[1]无锡市精神卫生中心,214151

出　　处：《上海精神医学》2006年第2期72-75,共4页Shanghai Archives of Psychiatry

摘　　要：目的了解儿童及少年期情感障碍和精神分裂症的临床特征。方法收集1984年至1999年之间在本院就诊患者中符合DSM-Ⅲ情感障碍和精神分裂症诊断的儿童及少年期首次发作病例64例,年龄5～17岁。入组时进行基线评定,然后长期随访。至随访结束,对两组疾病进行对照分析。结果58例(91%)完成随访,平均随访时间12.4年。儿童少年期入组诊断为情感障碍者36例,至成年随访结束时,92%诊断为情感障碍,8%诊断为精神分裂症;儿童少年期入组诊断为精神分裂症者22例,至成年随访结束时,32%诊断为情感障碍,68%诊断为精神分裂症。儿童少年期情感障碍患者在成年期诊断为精神分裂症者明显高于精神分裂症患者修改诊断为情感障碍(χ2=22.852,P<0.001)。儿童少年期精神障碍至成年期的诊断一致性较低(Kappa=0.62)。儿童及少年期发作的情感障碍与精神分裂症比较,起病年龄低、发作次数少、社会关系良好和较好的社会功能。情感障碍的精神症状多与精神分裂症重叠,但精神分裂症出现频率较高的情感不协调、注意力分散、关系妄想、情感迟钝、被洞悉感等症状,在情感障碍患者中始终未存在。结论儿童及少年期的情感障碍在症状学上与精神分裂症有许多相似之处,是导致误诊的重要原因。但儿童少年期精神分裂症存在的一些核心症状可能是两者鉴别诊断的症状学指标。Objective： The goal of the study was to explore characteristics of affective disorders and schizophrenia in childhood and early adolescence. Methods： Clinical characteristics and outcomes of child - and adolescent - onset affective disorders with those of schizophrenia were compared by long - time follower - up. 64 consecutive patients with first - episode child - or adolescent - onset psychosis （ age at onset from 5 to 17） between 1984 and 1999 were followed up. The semi - structured examination was fulfilled with PSE - 9. Consensus best - estimate DSM - Ⅲ diagnoses were made at follow - up, and course and outcome were assessed blind to first - episode diagnosis. Results： An average of 12.4 years after first contact forty - seven （91% ） of 58 patients were successfully followed - up. There were 36 patients with affective disorder and 22 patients with schizophrenia in children and early adolescent. Eight percent of first episode diagnoses of affective disorders were change to schizophrenia and 32% of first episode diagnoses of schizophrenia were change to affective disorder at end of followed -up. Meanwhile, 92% of first episode diagnoses of affective disorders and 68% of first episode diagnoses of schizophrenia maintain former diagnosis. There is significantly statistic on difference of diagnosis between two disorders （X^2 = 22. 852,P 〈 0. 001 ）. Compared with schizophrenia, the age - onset was lower, the times of onset was fewer, social relationship and social function was better in patients with affeetive disorders. Meanwhile, the symptoms of affective disorders in Children - or adolescent - onset were overlapped with schizophrenia. Conclusion：There are many similar on symptomatology between affective disorders and schizophrenia. It may be an important factor for misdiagnosis. But the core symptoms of schizophrenia are important symptomatology indictions for differential diagnosis between affective disorders and schizophrenia.

关 键 词：精神障碍 儿童 少年 随访 

分 类 号：R749.94[医药卫生—神经病学与精神病学]