综合医院心理门诊双相障碍诊断现状的调查及筛查方法

Research of diagnosis status on bipolar disorder and Method of screen out bipolar disorder in General Hospital psychological clinic service

目的探讨综合性医院医学心理科门诊患者双相障碍的诊断现状及如何提高双相障碍识别。方法 2005年7月～2009年7月以各种情绪问题为主诉至南京大学医学院附属鼓楼医院医学心理科门诊就诊的989例患者及在本院内科住院因情绪问题经心理科会诊的285例患者,共1274例,分析其中确诊双相障碍的102例患者首诊时的诊断构成和现状分析及对其中637例患者给予MDQ(中文版心境障碍问卷)测评和另637例未给予MDQ测评的患者比较其诊断率。结果双相障碍首诊时的诊断包括抑郁症、躁狂症、双相障碍、精神分裂症、广泛性焦虑、惊恐障碍、社交恐惧症、应激相关障碍、强迫症、其他疾病等。双相障碍的确诊率只有11.8%,误诊率和漏诊率达88.2%。且运用MDQ测评后诊断率明显高于未测评者(P<0.01)。结论双相障碍常被临床医生忽视,尤其被综合医院临床医生忽视,疾病特点是难确诊,目前的双相障碍的诊断现状是误诊率和漏诊率高。MDQ可以作为一种简单方便的双相情感障碍辨识工具,帮助临床医生提高确诊率。

Objective To investigate the diagnosis status on bipolar disorder in psychological clinic service in general hospital and to explore how to promote the recognition of bipolar disorder. Methods From July 2005 to July 2009, we collected 1274 patients including 989 patients from psychological department of Gu Lou hospital with emotional problems as chief complaint and 285 patients in medical department of Gu Lou hospital which were consulted by psychological doctors for their emotional problems. The diagnostic status at the first interview was analyzed in 102 patients with final diagnose as bipolar disorder. 637 patients were assessed with Chinese version of Mood Disorder Questionnaire （MDQ）. The diagnostic ratio of bipolar disorder was analyzed between 637 patients assessed with Chinese version of Mood Disorder Questionnaire （MDQ） and other 637 nonassessed patients. Results The diagnose at the first interview in 102 bipolar disorder patients included depressive disorder, mania, bipolar disorder, schizophrenia, generalized anxiety, panic disorder, social phobia, Stress disorder, obsessive-compulsive disorder, et al. Diagnostic accuracy of bipolar disorder at the first interview was 11.8%, the misdiagnosis rate and missed-diagnosis rate was 88.2%. The diagnosis rate in patients assessed with MDQ was significantly higher than the other halves （P〈0.01）. Conclusion Bipolar disorder is often ignored by clinicians in general hospitals, which resulted in the high misdiagnosis rate and missed-diagnosis rate. MDQ may be a convenient screening instrument to elevate the diagnostic accuracy of bipolar disorder.