(轻)躁狂发作伴混合特征不同自评工具识别效度比较:基于中国双相躁狂临床路径二期调研数据  

Comparison of the validity of different self-rated tools for identifying(Hypo-)manic episodes mixed features:based on Date from the Second Phase of the National Bipolar Mania Clinical Pathway Survey

作　　者：汪作为[1] 朱云程 吴创鑫 徐贵云[2] 潘苗[3] 陈致宇[4] 李晓虹 李文飞[6] 焦志安[7] 李名立[8] 张勇[9] 陈景旭[5] 陈修哲[10] 李娜[11] 孙静[12] 张建[13] 胡少华[14] 伍海姗[15] 甘照宇[16] 秦研 王育梅 马燕桃[19] 王小平[15] 方贻儒 Wang Zuowei;Zhu Yuncheng;Wu Chuangxin;Xu Guiyun;Pan Miao;Chen Zhiyu;Li Xiaohong;Li Wenfei;Jiao Zhian;Li Mingli;Zhang Yong;Chen Jingxu;Chen Xiuzhe;Li Na;Sun Jing;Zhang Jian;Hu Shaohua;Wu Haishan;Gan Zhaoyu;Qin Yan;Wang Yumei;Ma Yantao;Wang Xiaoping;Fang Yiru(Shanghai Hongkou Mental Health Center,Clinical Research Center for Mental Health,School of Medicine,Shanghai University,Shanghai 200083,China;The Affiliated Brain Hospital of Guangzhou Medical University,Guangzhou 510370,China;The Second Affiliated Hospital of Xinxiang Medical University,Xinxiang 453002,China;Hangzhou Seventh People′s Hospital,Hangzhou 310063,China;Beijing Huilongguan Hospital,Beijing 102208,China;Anhui Mental Health Center,Hefei 230022,China;Shandong Provincial Hospital,Jinan 250021,China;West China Hospital Sichuan University,Chengdou 610044,China;Tianjin Anding Hospital,Tianjin 300222,China;Shandong Mental Health Center,Jinan 250014,China;The First Affiliated Hospital of Kunming Medical College,Kunming 650032,China;Nanjing Brain Hospital,Nanjing 210024,China;Shenzhen Kang Ning Hospital,Shenzhen 518020,China;The First Affiliated Hospital Zhejiang University School of Medicine,Hangzhou 310003,China;The Second Xiangya Hospital of Central South University,Changsha 410012,China;The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Dalian Seventh People′s Hospital,Dalian 116086,China;Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China;Peking University Sixth Hospital,Beijing 100191,China;Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海市虹口区精神卫生中心、上海大学医学院精神卫生临床研究中心,上海200083 [2]广州医科大学附属脑科医院,广州510370 [3]新乡医学院第二附属医院,新乡453002 [4]杭州市第七人民医院,杭州310063 [5]北京回龙观医院,北京102208 [6]安徽省精神卫生中心,合肥230022 [7]山东省立医院,济南250021 [8]四川大学华西医院,成都610044 [9]天津市安定医院,天津300222 [10]山东省精神卫生中心,济南250014 [11]昆明医科大学第一附属医院,昆明650032 [12]南京医科大学附属脑科医院,南京210024 [13]深圳市康宁医院,深圳518020 [14]浙江大学医学院附属第一医院,杭州310003 [15]中南大学湘雅二医院,长沙410012 [16]中山大学附属第三医院,广州510630 [17]大连市第七人民医院,大连116086 [18]山东第一医科大学附属省立医院,济南250021 [19]北京大学第六医院,北京100191 [20]上海交通大学医学院附属瑞金医院,上海200025

出　　处：《中华精神科杂志》2024年第7期426-432,共7页Chinese Journal of Psychiatry

基　　金：上海市医学重点专科建设计划(ZK2019A06)。

摘　　要：目的比较简明国际神经精神访谈(轻)躁狂发作伴混合特征[Mini International Neuropsychiatric Interview(Hypo-)Manic Episode with Mixed Features-DSM-5 Module,MINI-M]问卷和临床实用抑郁发作伴混合特征量表(Clinically Useful Depression Outcome Scale Supplemented with Questions for the DSM-5 Mixed Features Specifier,CUDOS-M)抑郁分量表识别(轻)躁狂发作伴混合特征的有效性。方法在全国多中心、大样本调查中采取方便抽样方法纳入符合入组与排除标准的366例急性期(轻)躁狂发作的双相障碍患者,依据DSM-5混合特征的症状学标准进行临床诊断,采用受试者操作特征曲线(receiver operating characteristic curve,ROC)分析MINI-M问卷和CUDOS-M抑郁分量表识别混合特征的预测效度并比较二者ROC曲线下面积(area under the curve,AUC)差异性。结果MINI-M问卷和CUDOS-M抑郁分量表预测混合特征的AUC分别为0.79(95%CI=0.75~0.84)、0.81(95%CI=0.77~0.86),二者AUC差异无统计学意义(Z=-1.19,P>0.05)。依据DSM-5诊断标准,(轻)躁狂发作患者中混合特征临床诊断率为45.9%(168/366),MINI-M问卷(得分≥3分)和CUDOS-M抑郁分量表(得分≥20分)检出率分别为43.7%(160/366)和42.1%(154/366),三者具有可比性。结论(轻)躁狂发作患者中混合特征普遍存在,MINI-M问卷与CUDOS-M抑郁分量表识别混合特征的效度相当。ObjectiveA nationwide multi-center and large sample survey was conducted to compare the validity of the Mini International Neuropsychiatric Interview(Hypo-)Manic Episode with Mixed Features-DSM-5 Module(MINI-M)questionnaire and the Clinically Useful Depression Outcome Scale Supplemented with Questions for the DSM-5 Mixed Features Specifier(CUDOS-M)depression subscale in identifying mixed features in patients experiencing(hypo-)manic episodes.MethodsUsing a convenience sampling method,366 patients with bipolar disorder experiencing acute(hypo-)manic episodes who met the inclusion and exclusion criteria were recruited.The diagnosis of"with mixed features"was based on the DSM-5 criteria for mixed features.The predictive validity of the MINI-M questionnaire and the CUDOS-M depression subscale to screen mixed features was analyzed using the receiver operating characteristic(ROC)curve.Additionally,the difference in area under the ROC curve(AUC)between the two instruments was compared.ResultsThe AUC for the MINI-M questionnaire and the CUDOS-M depression subscale in screening mixed features were 0.79(95%CI=0.75-0.84)and 0.81(95%CI=0.77-0.86),respectively.There was no statistically significant difference in AUC between the two measurements(Z=-1.19,P>0.05).Among patients with acute(hypo-)manic episodes,45.9%(168/366)presented with mixed features according to the DSM-5 criteria,while the corresponding figures were 43.7%(160/366)using the MINI-M questionnaire(total score≥3)and 42.1%(154/366)using the CUDOS-M depression subscale(total score≥20).Screening results were comparable among the three measures.ConclusionMixed features are common among patients experiencing acute(hypo-)manic episodes.The MINI-M questionnaire and the CUDOS-M depression subscale demonstrate equivalent validity in identifying mixed features.

关 键 词：双相情感障碍 躁狂发作 混合特征 简明国际神经精神访谈(轻)躁狂发作伴混合特征问卷 临床实用抑郁发作伴混合特征量表 效度 

分 类 号：R749[医药卫生—神经病学与精神病学]