精神分裂症与心境障碍交替发作47例临床分析

Clinical analysis of 47 patients with alternative episode between schizophrenia and mood disorder

目的:探讨精神分裂症和心境障碍交替发作这一特殊病例群体的演变规律和可能的诊断归属问题。方法:在15年间住院3次或以上,诊断为精神分裂症或心境障碍的638例病历中筛选出有精神分裂症和心境障碍诊断变更的81例,按中国精神障碍分类与诊断标准第3版分别再诊断,符合要求者作为研究组,共47例(7.4%)。结果:精神分裂症→心境障碍组36例,最后诊断为精神分裂症14例(38.9%),诊断为心境障碍22例(61.1%);心境障碍→精神分裂症组11例,最后诊断为心境障碍7例(63.6%),精神分裂症4例(36.4%);心境障碍→精神分裂症组的最后诊断与初次诊断的一致率显著高于精神分裂症→心境障碍组(P<0.05)。结论:本类型精神障碍在现象学层面是一个独立的疾病单元,其生物学特性以及临床特征可能与心境障碍存在更大关联,有待大样本前瞻性研究。建议在精神疾病分类方案与诊断标准中有其正式的归属。

Objective： To explore the evolution rule and the possible diagnosis category for the group of special patients who had alternative episodes between schizophrenia and mood disorder. Method：81 patients, having diagnostic alteration between schizophrenia and mood disorder, were screened out from 638 patients who were diagnosed with schizophrenia or mood disorder in the past 15 years with three times or more hospitalization. The 81 patients were re-diagnosed according to Chinese Classification and Diagnostic Criteria of Mental Disorder-Third Edition and 47 patients （7.4%） of them met with the standard above, and therefore enrolled as study group. Results： In subgroup of 36 patients diagnosed shifting from schizophrenia to mood disorder, 14 patients （38.9%） and 22 patients （61.1% ） were finally diagnosed with schizophrenia and mood disorder, respectively. In subgroup of 11 patients diagnosed shifting from mood disorder to schizophrenia,7 patients （63,6%） and 4 patients （36.4%） were finally diagnosed with mood disorder and schizophrenia, respectively. Compared with subgroup diagnosing shifting from schizophrenia to mood disorder, final diagnoses in subgroup diagnosing shifting from mood disorder to schizophrenia significantly higher accorded with their primary diagnosis （ P 〈 0.05）. Conclusion： This type of mental disorder perhaps belongs to an independent disease unit in phenomenolagieal surface. It maybe has more correlations with mood disorder, biologically and clinically, which need to be further approved by perspective research with more samples. It suggests that this type of mental disorder belongs to a disease unit in classification and diagnostic criteria of mental disorder.