通过跨诊断的临床特征来描述严重精神疾病的发展轨迹
Juan F De la Hoz1, Alejandro Arias2, Susan K Service1
1Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
概括
电子健康记录揭示了严重精神疾病 (SMI) 的共同特征和诊断转移,跨越精神分裂症,双相情感障碍和抑郁症. 大多数患者经历了诊断变化,但在六年内经常达到稳定.
科学领域:
- 精神病学是一个精神病学.
- 医疗信息学 医疗信息学
- 流行病学 流行病学
背景情况:
- 电子健康记录 (EHR) 在低收入和中等收入国家 (LMICs) 越来越容易获得.
- 电子健康记录为研究严重精神疾病 (SMI) 和其跨诊断特征提供了宝贵的资源.
- 了解SMI轨迹对于改善资源有限的环境中的患者护理至关重要.
研究的目的:
- 使用来自LMIC机构的EHR数据来描述SMI的跨诊断特征.
- 分析精神分裂症,双相情感障碍和严重抑郁症患者的诊断轨迹和切换模式.
- 确定影响严重精神疾病诊断稳定的因素.
主要方法:
- 在哥伦比亚的一家专门的精神卫生机构,从2005年至2022年使用电子健康记录的回顾性队列研究.
- 包括22447名被诊断患有精神分裂症,双相情感障碍或严重抑郁症的患者.
- 使用混合效应物流回归分析诊断代码,临床笔记,自杀倾向,精神病,诊断切换和并发症的分析.
主要成果:
- 在所有三种严重精神疾病诊断中都观察到高频率的自杀倾向和精神病症.
- 64%的患者随着时间的推移得到了多重诊断,其中19%的患者转换了主要诊断.
- 妄想,先前的诊断切换和治疗时间是诊断切换的重要预测因素.
结论:
- 综合的EHR数据揭示了严重精神疾病的跨诊断模式.
- 可以识别疾病轨迹的预测因素,有助于理解SMI.
- 基于EHR的工具对LMICs的研究和精密精神病学有很大的潜力.
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