与氯胺酮滥用相关的短期和长期心理症状清单的编制（英文）

Development of a checklist of short-term and long-term psychological symptoms associated with ketamine use

背景:氯胺酮滥用在中国日渐增多,但目前还没有一个方法可以将氯胺酮对依赖个体的心理影响作用进行分类。目的:编制能反映氯胺酮依赖人群中因该物质滥用所致的急性心理影响和长期心理影响的量表。方法:我们编制了一个初步的症状清单,共有35个条目("是"或"否"的二分法问题),内容是关于使用氯胺酮后即刻产生的主观感受以及氯胺酮滥用后感受到的长期作用。从中国广州市两个大医院招募氯胺酮依赖住院患者,共入组187例。随机选择一半的样本进行探索性因子分析(exploratory factor analysis,EFA),以精简条目并确定量表的基本结构。对另一半样本进行验证性因子分析(confirmatory factor analysis,CFA),以评估所提取因子结构的稳健性。结果:35个症状中常见的急性期症状是"身体的漂浮或盘旋感"(94%)、"在动感音乐的环境下心情更加舒畅、欣快感"(86%)、和"兴奋话多,精力充沛"(67%)。常见的慢性症状是"记忆力下降"(93%)、"性格变化"(86%)和"反应变慢"(81%)。探索性因子分析最终得到的最佳模型量表,共22个条目,构成四个因子:两个因子代表慢性症状(社交退缩和睡眠障碍),一个因子是关于急性精神病样症状的,而第四个因子整合了急性的药物所致的欣快感和长期的性欲下降。验证性因素分析显示这4个因子能解释最终22个条目量表总方差的50%,并且模型拟合良好(拟合指数,GFI=83.3%;近似误差均方根,RMSEA=0.072)。结论:四因子模型(社交退缩、睡眠障碍、精神病样症状和使用毒品时的欣快感)能较为客观地反映氯胺酮滥用相关的短期和长期心理症状。对这一22个条目的量表,今后的研究工作需要扩大样本量,以验证实该四因子结构的效度,评估量表的重测信度,并确定是否能将该量表用于氯胺酮依赖的鉴别诊断和治疗监测。

Background： Ketamine is an increasingly popular drug of abuse in China but there is currently no method for classifying the psychological effects of ketamine in individuals with ketamine dependence. Aims： Develop a scale that characterizes the acute and long-term psychological effects of ketamine use among persons with ketamine dependence. Methods： We developed a preliminary symptom checklist with 35 dichotomous （＇yes＇ or ＇no＇） items about subjective feelings immediately after ketamine use and about perceived long-term effects of ketamine use that was administered to 187 inpatients with ketamine dependence recruited from two large hospitals in Guangzhou, China. Exploratory factor analysis （EFA） was conducted on a randomly selected half of the sample to reduce the items and to identify underlying constructs. Confirmatory factor analysis （CFA） was conducted on the second half of the sample to assess the robustness of the identified factor structure. Results： Among the 35 symptoms, the most-reported acute effects were ＇floating or circling＇ （94%4 ＇euphoric when listening to rousing music＇ （86%）, and ＇feeling excited, talkative, and full of energy＇ （67%）. The most- reported long-term symptoms were ＇memory impairment＇ （93%）, ＇personality changes＇ （86%）, and ＇slowed reactions＇ （81%）. EFA resulted in a final 22-item scale best modelled by a four-factor model： two factors representing chronic symptoms （social withdrawal and sleep disturbances）, one about acute psychotic- like symptoms, and one that combined acute drug-related euphoria and longer-term decreased libido. CFA showed that these 4 factors accounted for 50% of the total variance of the final 22-item scale and that the model fit was fair （Goodness of Fit Index, GIF=83.3%; Root Mean Square Error of Approximation, RMSEA=0.072）. Conclusions： A four-factor model including social withdrawal, sleep disturbance, psychotic-like symptoms, and euphoria at the time of drug use provides a fair description of the short-term and long-term psychological symptoms associated with ketamine use. Future work on the 22-item version of the scale with larger samples is needed to confirm the validity of this 4-factor structure, to assess the scale＇s test-retest reliability, and to determine whether or not it can be useful in the differential diagnosis and monitoring of treatment of individuals with ketamine dependence.