三种诊断定义对抑郁发作患者中双相障碍的识别效能  

Recognition potency of three diagnostic definitions of bipolar disorder in patients with current depressive episode

作　　者：朱玥[1] 马燕桃[1] 魏镜[2] 于欣[1] 

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]北京协和医院,北京100730

出　　处：《中国心理卫生杂志》2011年第8期588-593,共6页Chinese Mental Health Journal

基　　金：北京大学医学部“985工程”二期建设项目精神病与精神卫生学研究平台(985-2-027-39)

摘　　要：目的:比较不同诊断定义对当前抑郁发作患者中双相障碍(BD)的识别效能,并考察有助提高BD识别的临床指标。方法:对符合精神障碍诊断与统计手册第4版(DSM-IV)抑郁发作诊断标准的成年患者共95例,实施盲法、横断面筛查。由两位主治以上水平的精神科医生依据疾病和有关健康问题的国际统计分类第10次修订本心境障碍诊断标准做出临床已知诊断,并以此为参照标准,评价DSM-IV、双极性及轻躁狂症状清单(HCL-32)三种诊断定义对BD(包括双相I型及II型)的识别效能;并比较双极性定义筛查BD阳性及阴性患者的临床特征。结果:临床已知诊断中BD比例为21%,DSM-IV、双极性及HCL-32对目前抑郁发作患者中BD的识别率分别为8%、48%及61%。三种诊断定义对BD的筛检灵敏度分别为30%、85%及85%,筛检特异度分别为97%、63%及41%,准确度(粗一致率)分别为83%、67%及51%。抑郁患者若伴有不典型抑郁、企图自杀≥2次及既往情感发作≥4次等特征时,双极性定义诊断BD的机率增加。结论:抑郁发作患者中存在相对高比例的BD。双极性定义具有较好的诊断灵敏度,兼有中等特异度及准确度,有助提高BD的识别率。Objective： To compare recognition potency of three diagnostic definitions for bipolar disorder （BD） in patients with current depressive episode, and to explore possible clinical indicators of BD. Methods： A to- tal of 95 adult patients with current depressive episode who met the diagnostic criteria for depression episode in Di- agnostic and Statistical Manual of Mental Disorders Fourth Edition （DSM-IV） were recruited. Clinical diagnosis was made by two qualified psychiatrists according to the International statistical Classification of Diseases and Re- lated Health Problems 10th Revision （ICD-10） and was regarded as reference standard with comparison. The BD recognition potency of the DSM- IV, the bipolarity criteria and the 32-item Hypomania Checklist （HCL-32） were evaluated. Clinical features between patients who were screened as positive and negative according to bipolarity definition were compared as well. Results： The frequency of BD were 8%, 48% and 61% according to DSM-IV, bipolarity criteria and HCL-32 respectively. Using ICD-10 diagnosis as reference standard, the sensitivity for the three definitions was 30%, 85% and 85% respectively, while the specificity was 97%, 63% and 41%, and the accuracy （gross consistency rate） was 83%, 67% and 51% respectively. Clinical feature such as atypical depression, total number of suicidal attempts ≥2 and previous mood episodes ≥4 increased the probability of BD diagnosis when using bipolarity criteria. Conclusion： A relatively high proportion of bipolar disorder may be prevalent in patients with current depressive episode. Bipolarity definition may have good diagnostic sensitivity, moderate specificity and accuracy, which may incerease the recognition rate of BD.

关 键 词：双相障碍 抑郁 识别 双极性 轻躁狂症状清单(HCL-32) 横断面研究 

分 类 号：R749.404[医药卫生—神经病学与精神病学]