入院诊断为急性短暂精神病性障碍患者的转归及其预测因素  

The outcomes of first admission inpatients with acute and transient psychotic disorders and their predictors

作　　者：杨贵刚[1,2] 周东丰[1] 谭云龙[2] 杨甫德[2] 李娟[2] 张东[2] 

机构地区：[1]北京大学精神卫生研究所卫生部精神卫生学重点实验室(北京大学),北京100191 [2]北京回龙观医院,北京100096

出　　处：《中国心理卫生杂志》2010年第9期661-664,共4页Chinese Mental Health Journal

基　　金：科技部973计划资助(2007CB512307);首都医学发展基金资助(2007-3058)

摘　　要：目的:调查入院诊断为急性短暂精神病性障碍(acute and transient psychotic disorders,ATPD)患者的最后转归,研究转归的预测因素。方法:采用回顾性随访研究,收集以ATPD(依据ICD-10诊断标准)序贯入院的患者112名,于首次入院诊断后1.0～4.5年内,由2名高年资精神科主治医师利用各种医疗及社区康复资料,判断患者最近的转归,探索与转归有关的预测因素。结果:(1)73.2%(82/122)的患者更改为其他诊断,主要改诊为精神分裂症65.2%(73/122);还有26.8%的患者短期患病后恢复正常,仍维持原来的诊断即ATPD;(2)将转归为精神分裂症及仍为ATPD的患者分组[2组占全部患者92.0%(103/112)]比较,发现家族史阳性患者几乎全来自精神分裂症组,精神分裂症组较ATPD组入院前病程更长[(9.8±5.8)d vs.(7.2±5.8)d,P<0.05],而病前人格方面2组均存在较高比例的内向性人格(分别为50/73和18/28);(3)对2组中测查过MMPI的患者进行分析,发现其中精神病态量表分(Pd)在精神分裂症组明显升高[(59.8±11.1)vs.(52.1±10.7),P<0.01]。结论:入院诊断为急性短暂精神病性障碍的患者大部分转归为精神分裂症,其中有精神分裂症谱系障碍阳性家族史,入院前病程偏长,MMPI精神病态量表分高者,转归为精神分裂症的可能性更大。Object： To investigate the outcomes and identify their predictors in patients who were diagnosed of acute and transient psychotic disorders （ ATPD ） at the point of first admission. Method： One hundred and twelve ftrst-admitted ATPD （ ICD-10 F23 ） patients were followed up retrospectively for 1.0 ± 4. 5 years and their recent outcomes were reevaluated by two senior in-charge psychiatrists. The relationships between the outcomes and some certain factors recorded at admission were investigated. Result： （ 1 ） 73.2% （ 82/122 ） patients changed to other diagnoses, mostly to schizophrenia [65.2% （73/122） ] . （2） The patients recently diagnosed of schizophrenia or ATPD were grouped for comparison, and it found that the schizophrenia group possessed almost all the patients with positive family history. The schizophrenia group patients had longer DUP （ duration of untreated psychosis） than the ATPD ones [ （9.8±5.8） d vs. （7.2±5.8） d, P〈0.05] .When comparing with ATPD group by MMPI （ Minnesota Multiphasic Personality Inventory） measurements, the schizophrenia group had higher Psychopathic deviate （ Pd） subtest scores [ （ 59. 8 ±11.1 ） vs. （ 52. 1 ± 10. 7 ）, P 〈 0.01 ] . Conclusion： The majority of patients diagnosed of ATPD at their first-admission have shifted to schizophrenia. And those, who have positive family histories of schizophrenia spectrum, longer DUPs, higher psychopathic deviate subtest scores of MMPI have higher possibility to change their diagnoses to schizophrenia.

关 键 词：急性短暂精神病性障碍 精神分裂症 转归 预测因素 回顾性随访 

分 类 号：R749.05[医药卫生—神经病学与精神病学]