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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 To understand the clinical features of childhood and adolescent affective disorder and schizophrenia. Methods A total of 64 first-episode cases of children and adolescents diagnosed with DSM-Ⅲ affective disorder and schizophrenia in our hospital from 1984 to 1999 were collected, ranging in age from 5 to 17 years. Baseline assessment was performed at enrollment and then followed up for long periods. To the end of follow-up, the two groups of diseases were analyzed. Results 58 cases (91%) were followed up with an average follow-up time of 12.4 years. Thirty-six children diagnosed as having affective disorders in adolescence were enrolled, 92% were diagnosed as affective disorders and 8% were diagnosed as schizophrenia by the end of adult follow-up. Among them, 22 cases were diagnosed as schizophrenia in adolescence, At the end of follow-up, 32% were diagnosed with affective disorder and 68% were diagnosed with schizophrenia. Children with adolescent mood disorders diagnosed as schizophrenia in adulthood were significantly higher than schizophrenia patients diagnosed as affective disorders (χ2 = 22.852, P <0.001). Childhood psychiatric disorders to adulthood diagnostic consistency is low (Kappa = 0.62). Childhood and adolescent onset of affective disorders compared with schizophrenia, age of onset is low, the number of attacks less, good social relations and better social function. Symptomatic mental symptoms and schizophrenia and more overlap, but the schizophrenia appear higher frequency of emotional uncoordinated, distracted, delusional relationship, emotional slowness, being aware of flu and other symptoms, in patients with emotional disorders has never existed. Conclusions Emotional disorders in children and adolescents have many similarities with schizophrenia in psychology and are the important causes of misdiagnosis. However, some of the core symptoms of schizophrenia in children and adolescents may be symptomatic indicators of differential diagnosis between the two.