(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

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.