分裂样精神病2年后再诊断  

SCHIZOPHRENIA-LIKE PSYCHOTIC DISORDERS:TWO YEARS AFTER A FIRST DIAGNOSIS

作　　者：徐勇[1] 刘传芹[1] 于建华[1] 

机构地区：[1]青岛市精神卫生中心,山东青岛266034

出　　处：《齐鲁医学杂志》2014年第1期56-59,61,共5页Medical Journal of Qilu

摘　　要：目的探讨分裂样精神病的转归及危险因素。方法对138例入组病人分别于首次诊断、病程6个月及病程2年时进行3次随访调查。出院病人由精神科医师电话随访或根据其门诊记录进行测评,同时采用ICD-10诊断标准进行再诊断。结果病程6个月时,138例分裂样精神病转归为精神分裂症者93例(67.4%),转归为心境(情感)类障碍者11例(8.0%),转归为分裂情感类障碍者3例(2.2%),转归为器质性精神障碍者1例(0.7%);病程2年时,又有13例(14.0%)精神分裂症转归为分裂情感类障碍,4例(2.9%)分裂样精神病转归为心境(情感)类障碍。年龄<45岁、性格内向、慢性起病、起病无诱因、缺乏活力评分较高、阴性症状量表评分较高的分裂样精神病以后可能会转归为精神分裂症;慢性起病、女性、焦虑抑郁评分较高、思维逻辑评分和阳性症状量表评分较低的分裂样精神病以后可能会转归为心境(情感)类障碍;慢性起病、阴性症状量表评分较高的分裂样精神病以后可能会转归为分裂情感类障碍。结论首次诊断为分裂样精神病的病人在2年内会转归为多种疾病,过分依赖目前诊断标准可能造成误诊,追踪观察对确诊尤为关键。Objective To explore the prognosis and risk factors of schizophrenia-like psychosis. Methods This study consisted of 138patients,who were investigated on a first diagnosis,and followed six months and two years later.Discharged patients were assessed by apsychiatrist through phone calls or according to their clinic-service records,and a re-diagnosis was made by applying ICD-10. Results In 6months of the course,of 138patients,93（67.4%）of them turned to schizophrenia,11（8.0%）turned to mood（affective）disorders,three（2.2%）turned to emotional disorder and one（0.7%）turned to organic mental disorders;In 2years,13（14.0%）cases again turned to schizophrenia,and four（2.9%）turned to mood（affective）disorder. For those under 45years old,introverted,chronic onset without predisposing factors,lack of vitality,and with a higher score in negative symptoms scale were likely to develop schizophrenia later;For females of chronic onset,with a higher anxiety score and lower thinking logic and positive symptoms scale score schizophrenia-like psychotic disorders would likely to develop mood（affective）class of disorders;For those with chronic onset and higher negative symptoms scale score schizophrenia-like psychotic disorders might develop affective barrier. Conclusion The patients who are diagnosed as having schizophrenia-like psychosis at first diagnosis will turn to diverse disorders within two years,excessively depend on nowaday diagnostic criteria may lead to misdiagnosis,follow-up observation being the key for the confirmation.

关 键 词：分裂样精神病 预后 因素分析 统计学 诊断 

分 类 号：R749.5[医药卫生—神经病学与精神病学]