Revista de Psiquiatría y Salud Mental (English Edition)最新文献_第5页

Validation of a European Spanish-version of the Self-Evaluation of Negative Symptoms (SNS) in patients with schizophrenia 精神分裂症患者阴性症状自我评价(SNS)的欧洲西班牙文版验证

Revista de Psiquiatría y Salud Mental (English Edition)

Pub Date : 2022-01-01 DOI: 10.1016/j.rpsmen.2022.01.005

Leticia García-Álvarez , Clara Martínez-Cao , Teresa Bobes-Bascarán , Almudena Portilla , Philippe Courtet , Lorena de la Fuente-Tomás , Ángela Velasco , Leticia González-Blanco , Paula Zurrón-Madera , Eduardo Fonseca-Pedrero , Pilar A. Sáiz , María Paz García-Portilla , Julio Bobes

Introduction

Negative symptoms can be grouped into five domains: apathy/avolition, anhedonia, asociality, alogia, and affective flattening. There are few validate self-rated measures that assess these five dimensions. Therefore, this study aimed to validate the Self-Evaluation of Negative Symptoms (SNS) in Spanish patients with schizophrenia.

Material and methods

Cross-sectional, validation study in 104 outpatients with schizophrenia evaluated using the Spanish version of the following scales: Clinical Assessment Interview for Negative Symptoms (CAINS), Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression Scale for Schizophrenia (CGI-SCH), Personal and Social Performance (PSP), Motivation and Pleasure Scale – Self-Report (MAP-SR), 36-item Short-Form Health Survey (SF-36) and the Self-Evaluation of Negative Symptoms (SNS).

Results Reliability

Internal consistency (Cronbach's alpha) was 0.915. Convergent validity: The Pearson correlation coefficient between MAP-SR and SNS Total scores was 0.660 (p < 0.001). For PANSS-N, the correlation was 0.437 (p < 0.005) and with the CAINS-Total was 0.478 (p < 0.005). Divergent validity: The Pearson correlation coefficient between SNS and PSP was r = −0.372 (p ≤ 0.001), and with SF-36 Physical and Mental Summary Component scores were r = −0.213 (p = 0.066) and r = −0.144 (p = 0.219), respectively. Discriminant validity: SNS Total scores were significantly statistically different according to the severity of the negative symptomatology rated by the CGI-SCH negative scale (p < 0.001).

Conclusion

The SNS is a reliable and valid instrument to self-rate the five domains of negative symptoms in patients with schizophrenia and seems to be appropriate for use in everyday clinical practice as a complementary measure to the evaluation performed by the clinician.

阴性症状可分为五个领域:冷漠/逃避、快感缺乏、社会性、痛症和情感扁平化。很少有有效的评估这五个维度的自评措施。因此，本研究旨在验证西班牙精神分裂症患者的阴性症状自我评价(SNS)。材料与方法对104例精神分裂症门诊患者进行横断面验证研究，采用西班牙语版以下量表进行评估:阴性症状临床评估面谈(CAINS)、阳性和阴性症状量表(PANSS)、精神分裂症临床总体印象量表(ci - sch)、个人与社会表现量表(PSP)、动机与愉悦量表-自我报告(MAP-SR)、36项简短健康调查(SF-36)和阴性症状自我评价(SNS)。结果信度内部一致性(Cronbach’s alpha)为0.915。收敛效度:MAP-SR与SNS总分的Pearson相关系数为0.660 (p <0.001)。PANSS-N的相关系数为0.437 (p <0.005)， CAINS-Total为0.478 (p <0.005)。发散效度:SNS与PSP的Pearson相关系数为r = - 0.372 (p≤0.001)，与SF-36的身心总结成分得分分别为r = - 0.213 (p = 0.066)和r = - 0.144 (p = 0.219)。判别效度:SNS总分根据CGI-SCH负性量表评定的负性症状严重程度差异有统计学意义(p <0.001)。结论社交网络是一种可靠、有效的精神分裂症患者阴性症状五域自评工具，适合在日常临床实践中作为临床医生评估的补充措施使用。

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引用次数: 1

Effects of childhood trauma on facial recognition of fear in psychosis 童年创伤对精神病患者恐惧面部识别的影响

Revista de Psiquiatría y Salud Mental (English Edition)

Pub Date : 2022-01-01 DOI: 10.1016/j.rpsmen.2022.01.001

Antía Brañas , Guillermo Lahera , María Luisa Barrigón , Manuel Canal-Rivero , Miguel Ruiz-Veguilla

Introduction

Childhood trauma has been reported as a risk factor for psychosis. Different types of traumatic experiences in childhood could lead to different clinical manifestations in psychotic disorders.

Methods

We studied differences in social cognition (emotion recognition and theory of mind) and clinical symptoms in a sample of 62 patients with psychosis (less than five years of illness) and childhood trauma, analysing performance by trauma type.

Results

Psychotic patients with a history of childhood trauma other than sexual abuse were more capable of recognizing fear as a facial emotion (especially when facial stimuli were non-degraded) than participants with a history of sexual abuse or with no history of childhood trauma (P = .008). We also found that the group that had suffered sexual abuse did not show improvement in fear recognition when exposed to clearer stimuli, although this intergroup difference did not reach statistical significance (P = .064). We have not found other differences between abuse groups, neither in clinical symptoms (PANSS factors) nor in Hinting Task scores.

Conclusion

We have found differences in fear recognition among patients with psychotic disorders who have experienced different types of childhood trauma.

据报道，童年创伤是精神病的一个危险因素。不同类型的童年创伤经历可能导致不同的精神障碍临床表现。方法研究62例精神病患者(发病未满5年)和儿童期创伤患者的社会认知(情绪识别和心理理论)和临床症状的差异，并按创伤类型进行分析。结果有儿童期创伤史(非性虐待)的精神病患者比有儿童期创伤史或无儿童期创伤史的患者更能识别恐惧为面部情绪(特别是当面部刺激非退化时)(P = 0.008)。我们还发现，当暴露于更清晰的刺激时，遭受过性虐待的组在恐惧识别方面没有表现出改善，尽管这种组间差异没有达到统计学意义(P = 0.064)。我们没有发现虐待组之间的其他差异，无论是在临床症状(PANSS因素)还是在暗示任务得分方面。结论不同童年创伤类型的精神障碍患者在恐惧识别方面存在差异。

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引用次数: 2

Eating and nutritional habits in patients with schizophrenia 精神分裂症患者的饮食和营养习惯

Revista de Psiquiatría y Salud Mental (English Edition)

Pub Date : 2022-01-01 DOI: 10.1016/j.rpsmen.2022.01.003

Paula Zurrón Madera , Silvia Casaprima Suárez , Leticia García Álvarez , María Paz García-Portilla González , Raquel Junquera Fernández , María Teresa Lluch Canut

Background

There are few studies that relate eating and nutritional habits to the severity of the disease and demographic profile in patients with schizophrenia.

Objective

To describe eating and nutritional habits and their relationship with the severity of the disease in patients with schizophrenia.

Method

Cross-sectional descriptive study. Sample: 31 patients with schizophrenia (ICD-10) under outpatient treatment. Inclusion criteria: age 18–65 years, clinically stable and, written informed consent. Assessment: Demographic, clinical characteristics (CGI-SCH, length of illness, BMI, abdominal perimeter), ad hoc questionnaire (eating, nutritional, and physical activity).

Results

Mean age 43.13(SD = 7.85) years, males 61.3%. Mean severity of illness was 3.94(SD = 1.06), mean duration of the illness 18.42(SD = 8.27) years. 74.2% used to eatweekly fat meat and 64.5% less than 3−4 servings of fish, 77.4% less than 3 servings of fruit per day, and 51.6% drink less than 1 L of water. 83.9% used to drink coffee daily, 2.81(SD = 2.02) cups per day. Patients showed lower levels of Vitamin A, D, E, K1, C, folic acid, and magnesium. 93.5% did not fulfill the WHO recommendations on physical activity. Only retinol (r = −0.602, P = .039) and vitamin K1 (r = −0.693, P = .012) in women were related to the severity of illness.

Conclusions

Outpatients with schizophrenia do not follow WHO recommendations on healthy diets, neither physical activity. Both clinical severity of the illness and marital status and cohabitation were associated with poor eating habits and nutrients deficit. These data should be taken into account by the nursing staff when implementing specific care in routine clinical practice.

很少有研究将饮食和营养习惯与精神分裂症患者的疾病严重程度和人口统计学特征联系起来。目的探讨精神分裂症患者的饮食营养习惯及其与病情严重程度的关系。方法横断面描述性研究。样本:31例门诊精神分裂症患者(ICD-10)。纳入标准:年龄18-65岁，临床稳定，书面知情同意。评估:人口统计学、临床特征(CGI-SCH、病程、BMI、腹围)、特别问卷调查(饮食、营养和身体活动)。结果平均年龄43.13岁(SD = 7.85)岁，男性61.3%。平均病情严重程度为3.94(SD = 1.06)，平均病程为18.42(SD = 8.27)年。74.2%的人每周吃肥肉，64.5%的人每天吃不到3 - 4份鱼，77.4%的人每天吃不到3份水果，51.6%的人每天喝不到1 升的水。83.9%的人每天喝咖啡，每天2.81杯(SD = 2.02)。患者的维生素A、D、E、K1、C、叶酸和镁水平较低。93.5%的人没有达到世卫组织关于身体活动的建议。只有视黄醇(r = −0.602,P = .039)和维生素K1 (r = −0.693,P = .012)与女性疾病的严重程度有关。结论精神分裂症门诊患者没有遵循世卫组织建议的健康饮食和身体活动。疾病的临床严重程度、婚姻状况和同居与不良饮食习惯和营养缺乏有关。护理人员在日常临床实践中实施具体护理时应考虑到这些数据。

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引用次数: 0

Schizophrenia incidence in Spain: More questions than facts 西班牙精神分裂症发病率:问题多于事实

Revista de Psiquiatría y Salud Mental (English Edition)

Pub Date : 2022-01-01 DOI: 10.1016/j.rpsmen.2022.01.004

Víctor Romero-Pardo , Franco Mascayano , Ezra S. Susser , Gonzalo Martínez-Alés

引用次数: 0

Validation of a European Spanish adaptation of the Apathy Evaluation Scale-self-rated version (AES-S) in patients with schizophrenia 精神分裂症患者冷漠评估量表自评版(AES-S)的欧洲西班牙改编的验证

Revista de Psiquiatría y Salud Mental (English Edition)

Pub Date : 2022-01-01 DOI: 10.1016/j.rpsmen.2020.04.007

Clara Martínez-Cao , Leticia García-Álvarez , Teresa Bobes-Bascarán , Lorena de la Fuente-Tomás , Emilio Fernández-Egea , Ángela Velasco , Leticia González-Blanco , Paula Zurrón-Madera , Eduardo Fonseca-Pedrero , Pilar A. Sáiz-Martínez , María Paz García-Portilla , Julio Bobes

Introduction

Apathy is a negative symptom of schizophrenia and is associated with poor real world functioning. Therefore, it is important to have validated psychometric instruments to assess this symptom. This is the first study to validate the Spanish adaptation of the self-rated version of the Apathy Assessment Scale (AES-S) in patients with schizophrenia.

Materials and methods

Naturalistic, cross-sectional, validation study in 104 patients with schizophrenia evaluated using the following scales: Clinical Global Impression-Severity (CGI-S), Personal and Social Performance (PSP), Clinical Assessment Interview for Negative Symptoms (CAINS), Self-report of Negative Symptoms (SNS), Motivation and Pleasure Scale-Self-Report (MAP-SR), Calgary Depression Scale for Schizophrenia (CDSS), and Apathy Evaluation Scale-self-rated version (AES-S).

Results

Reliability: Internal consistency (Cronbach's alpha) was 0.908. Convergent validity: The Pearson correlation coefficient between AES-S and CAINS-MAP total scores was −0.483 (p < 0.001). For SNS, total and avolition subscale scores were −0.803 and −0.639 (p < 0.001), respectively. With the MAP-SR, the correlation coefficient was −0.727 (p < 0.001). Divergent validity: The Pearson correlation coefficient between AES-S and PSP total scores was 0.504 (p < 0.001). Furthermore, with the CDSS, the correlation coefficient was −0.431 (p < 0.001). Discriminant validity: The AES-S discriminated between different levels of illness severity according to CGI-S scores. Factor analysis: A three-component solution explained 57.32% of the variance. Pearson correlations between coefficients were 1–2 = 0.265, 1–3 = 0.464, and 2–3 = 0.060.

Conclusion

The Spanish AES-S is a reliable and valid instrument for assessing apathy in Spanish patients with schizophrenia. It seems to be appropriate for use in everyday clinical practice as a means of monitoring apathy in these patients.

冷漠是精神分裂症的一种阴性症状，与现实生活功能低下有关。因此，重要的是要有有效的心理测量工具来评估这种症状。这是第一个验证西班牙语自评版冷漠评估量表(AES-S)在精神分裂症患者中的适应性的研究。材料与方法对104例精神分裂症患者进行自然、横断面、验证性研究，采用以下量表进行评估:临床总体印象-严重程度(ci -s)、个人与社会表现(PSP)、阴性症状临床评估访谈(CAINS)、阴性症状自述(SNS)、动机与愉悦量表-自述(MAP-SR)、精神分裂症卡尔加里抑郁量表(CDSS)和冷漠评估量表-自评版(AES-S)。结果信度:内部一致性(Cronbach’s alpha)为0.908。收敛效度:AES-S总分与CAINS-MAP总分的Pearson相关系数为- 0.483 (p <0.001)。SNS的总分和自愿分分别为- 0.803分和- 0.639分(p <分别为0.001)。MAP-SR的相关系数为- 0.727 (p <0.001)。发散效度:AES-S与PSP总分的Pearson相关系数为0.504 (p <0.001)。此外，与CDSS相关系数为- 0.431 (p <0.001)。区分效度:AES-S根据CGI-S评分区分不同程度的疾病严重程度。因子分析:三组分解决方案解释了57.32%的方差。系数间Pearson相关性为1-2 = 0.265,1-3 = 0.464,2-3 = 0.060。结论西班牙AES-S量表是一种可靠、有效的评估西班牙精神分裂症患者冷漠程度的工具。它似乎适合在日常临床实践中使用，作为监测这些患者冷漠的手段。

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引用次数: 1

Early versus late risk factors for deficit and nondeficit schizophrenia 缺乏性和非缺乏性精神分裂症的早期和晚期危险因素

Revista de Psiquiatría y Salud Mental (English Edition)

Pub Date : 2022-01-01 DOI: 10.1016/j.rpsmen.2022.01.006

Setareh Alabaf , Brian Kirkpatrick , Shanquan Chen , Rudolf N. Cardinal , Emilio Fernandez-Egea

Aim

We examined whether timing of known risk factors for schizophrenia may influence the development of schizophrenia with primary negative symptoms.

Method

This cross-sectional single-centre study in England used a clinical cohort of 167 clozapine-treated schizophrenia patients. Deficit and nondeficit schizophrenia models were used as clinical proxies of patients with and without primary negative symptoms respectively. Patients were assessed using the Schedule for the Deficit Syndrome. We examined previously replicated risk factors (family history of psychosis, advanced paternal age, male gender, birth weight <3000 g, summer birth, cannabis use, exposure to physical or sexual abuse and/or bullying) as well as other traumatic events for deficit and nondeficit schizophrenia.

Results

We found a distinct risk factor pattern for the two groups. Compared to the nondeficit group, patients with deficit schizophrenia reported a significantly lower prevalence of cannabis use (p = 0.005) at the time of first-episode psychosis (FEP), physical or sexual abuse (p = 0.033) prior to FEP, less exposure to crime-related traumatic events (p = 0.012) and significantly associated with summer birth (p = 0.017). The groups did not differ in terms of family history of psychosis, advanced paternal age, male gender, or low birth weight. To account for multiple comparisons, a confirmatory analysis was performed using logistic regression which yielded similar results except that summer birth no longer reached statistical significance.

Conclusion

Our results suggest the timing of the insult may influence the symptom presentation, with insults later in life (cannabis or traumatic events) being associated with psychotic presentation and less with primary negative symptoms.

我们研究了已知的精神分裂症危险因素的时间是否会影响原发阴性症状的精神分裂症的发展。方法在英国进行的一项横断面单中心研究纳入了167例氯氮平治疗的精神分裂症患者的临床队列。以有原发性阴性症状和无原发性阴性症状的精神分裂症患者分别采用缺陷型和非缺陷型精神分裂症模型作为临床指标。采用缺陷综合征量表对患者进行评估。我们检查了先前重复的风险因素(精神病家族史、父亲高龄、男性、出生体重(3000克)、夏季出生、大麻使用、遭受身体或性虐待和/或欺凌)以及其他创伤性事件对缺陷和非缺陷精神分裂症的影响。结果我们发现两组患者有明显的危险因素模式。与非缺陷组相比，缺陷精神分裂症患者在首次精神病发作(FEP)时使用大麻的患病率(p = 0.005)，在FEP之前遭受身体或性虐待(p = 0.033)，较少接触与犯罪相关的创伤事件(p = 0.012)，并与夏季出生显著相关(p = 0.017)。两组在精神病家族史、父亲年龄、男性性别或低出生体重方面没有差异。为了解释多重比较，使用逻辑回归进行了验证性分析，除了夏季出生不再达到统计显著性外，结果相似。结论:我们的研究结果表明，侮辱的时间可能会影响症状的表现，晚年的侮辱(大麻或创伤事件)与精神病症状的表现有关，而与原发性阴性症状的关系较小。

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引用次数: 1

Defining negative symptoms remission in schizophrenia using the Brief Negative Symptom Scale 用简短阴性症状量表定义精神分裂症的阴性症状缓解

Revista de Psiquiatría y Salud Mental (English Edition)

Pub Date : 2022-01-01 DOI: 10.1016/j.rpsmen.2022.01.007

Gurpreet Rekhi , Mei San Ang , Yiong Huak Chan , Emilio Fernandez-Egea , Brian Kirkpatrick , Jimmy Lee

Introduction

This study aimed to propose criteria for negative symptoms remission (NSR) in schizophrenia using the Brief Negative Symptom Scale (BNSS).

Material and methods

274 participants were assessed on the Positive and Negative Syndrome Scale (PANSS), BNSS and Social and Occupational Functioning Assessment Scale (SOFAS). Two criteria for NSR on the BNSS were proposed – NSR based on the BNSS domains scores (NSR_{BNSS_DOMAINS}) and NSR based on 5 key items of the BNSS (NSR_{BNSS_5ITEMS})_. A SOFAS score of 61 and above was considered as functional remission (FR). Logistic regressions were run to examine the association between FR and NSR. Receiver operating characteristic (ROC) curve analysis was performed for the NSR criteria on FR. Kappa agreement statistic was used to evaluate the agreement between the two NSR criteria.

Results

Eighty-nine (32.5%) participants fulfilled NSR_{BNSS_DOMAINS} criterion whereas 70 (25.6%) participants fulfilled NSR_{BNSS_5ITEMS} criterion. The two NSR criteria had substantial agreement (Kappa statistic = 0.797) with each other. Sixty-one (25.3%) participants were in FR. FR was significantly associated with NSR, irrespective of the criterion used. To predict FR, the Area Under the Curve for NSR_{BNSS_DOMAINS} and NSR_{BNSS_5ITEMS} were 0.761 (CI: 0.696–0.826, p < 0.001) and 0.723 (CI: 0.656–0.790, p < 0.001), respectively. Hence, both NSR criteria demonstrated a fair ability to discriminate between functional remitters and non-remitters.

Conclusions

Depending on the setting and needs, clinicians and researchers might employ either the full BNSS or an abbreviated 5-item BNSS scale to identify NSR in schizophrenia. More research is needed to further examine the validity of these criteria in schizophrenia.

本研究旨在使用简短阴性症状量表(BNSS)提出精神分裂症阴性症状缓解(NSR)的标准。材料与方法对274名被试进行Positive and Negative Syndrome Scale (PANSS)、BNSS和Social and Occupational Functioning Assessment Scale (SOFAS)评估。提出了基于BNSS域分数的NSR (NSRBNSS_DOMAINS)和基于BNSS 5个关键条目的NSR (NSRBNSS_5ITEMS)两个NSR标准。SOFAS评分61分及以上为功能缓解(FR)。Logistic回归检验FR和NSR之间的关系。采用受试者工作特征(ROC)曲线分析FR的NSR标准，采用Kappa一致性统计评价两个NSR标准之间的一致性。结果89例(32.5%)被试满足NSRBNSS_DOMAINS标准，70例(25.6%)被试满足NSRBNSS_5ITEMS标准。两种“噪音感应强”标准之间存在显著的一致性(Kappa统计量= 0.797)。61名(25.3%)参与者发生FR。无论使用何种标准，FR与NSR显著相关。预测FR时，NSRBNSS_DOMAINS和NSRBNSS_5ITEMS的曲线下面积为0.761 (CI: 0.696-0.826, p <0.001)和0.723 (CI: 0.656-0.790, p <分别为0.001)。因此，两个NSR标准都显示出区分功能性缓解者和非缓解者的公平能力。结论根据环境和需要，临床医生和研究人员可以采用完整的BNSS量表或简化的5项BNSS量表来识别精神分裂症患者的NSR。需要更多的研究来进一步检验这些标准在精神分裂症中的有效性。

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引用次数: 1

United Nations Convention on the Rights of Persons with Disabilities: The effects of the debate 联合国残疾人权利公约:辩论的效果

Revista de Psiquiatría y Salud Mental (English Edition)

Pub Date : 2021-10-01 DOI: 10.1016/j.rpsmen.2021.02.003

Julián Gómez Peñalver, Carmen Fernández de Henestrosa Serra, José Luis Ayuso-Mateos

引用次数: 1

Exploring the factor structure of the mini-ICF-APP in an inpatient clinical sample, according to the psychiatric diagnosis 根据精神病学诊断，探讨住院患者临床样本中mini-ICF-APP的因子结构

Revista de Psiquiatría y Salud Mental (English Edition)

Pub Date : 2021-10-01 DOI: 10.1016/j.rpsmen.2021.11.002

Stephan T. Egger , Godehard Weniger , Julio Bobes , Erich Seifritz , Stefan Vetter

Introduction

Psychosocial functioning is a key factor determining prognosis, severity, impairment and quality of life in people who have a mental disorder. The mini-ICF-APP was developed to provide a standardised classification of functioning and disability. However, despite its gaining popularity little is known about its structure and performance. This paper examines the structure of the mini-ICF-APP using factor analysis techniques.

Materials and methods

In a clinical sample of 3178 patients, with psychiatric diagnoses from several ICD-10 categories, we analysed internal consistency, item inter-correlations and the factorial structure of the data, with reference to ICD-10 diagnostic categories; Neurocognitive Disorders; Alcohol Use Disorders; Substance Use Disorders; Schizophrenia and Psychotic Disorders; Bipolar Disorder; Major Depressive Disorder; Anxiety Disorders; Personality Disorders; and Neurodevelopmental Disorders.

Results

We found good internal consistency and item inter-correlations (Cronbach alpha = 0.92) for the mini-ICF-APP. We were able to identify pivotal domains (flexibility, assertiveness and intimate relationships), which demonstrate sub-threshold influences on other domains. The factor analysis yielded a one-factor model as ideal for the whole sample and for all diagnostic categories. For some diagnostic categories the data suggested a two or three-factor model, however, with poorer fit indices.

Conclusions

The factor structure of the mini-ICF-APP appears to modify according to the main diagnosis. However, a one-factor model demonstrates better fit regardless of diagnostic category. Consequently, we consider the mini-ICF-APP to be a trans-diagnostic measurement instrument for the assessment and grading of psychosocial functioning. The use of the mini-ICF-APP sum score seems to best reflect the degree of impairment in an individual, even taking into account that affected domains may lead to sub-threshold effects on other domains.

心理社会功能是决定精神障碍患者预后、严重程度、损害和生活质量的关键因素。mini-ICF-APP的开发是为了提供功能和残疾的标准化分类。然而，尽管它越来越受欢迎，但人们对它的结构和性能知之甚少。本文利用因子分析技术考察了mini-ICF-APP的结构。参考ICD-10的诊断分类，我们分析了3178例临床样本的内部一致性、项目相互相关性和数据的析因结构;神经认知障碍;酒精使用障碍;物质使用障碍;精神分裂症和精神障碍;双相情感障碍;重度抑郁症;焦虑障碍;人格障碍;以及神经发育障碍。结果mini-ICF-APP具有良好的内部一致性和项目间相关性(Cronbach alpha = 0.92)。我们能够确定关键领域(灵活性、自信和亲密关系)，这些领域对其他领域的影响低于阈值。因子分析产生了一个单因素模型作为理想的整个样本和所有诊断类别。然而，对于某些诊断类别，数据显示是两个或三个因素的模型，拟合指数较差。结论mini-ICF-APP的因子结构随着主要诊断的不同而发生改变。然而，无论诊断类别如何，单因素模型都具有更好的拟合性。因此，我们认为mini-ICF-APP是一种跨诊断的测量工具，用于评估和评定心理社会功能。即使考虑到受影响的域可能导致其他域的亚阈值效应，使用mini-ICF-APP总评分似乎也能最好地反映个体的损伤程度。

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引用次数: 0

Sensitivity and specificity of DSM-5 diagnostic criteria for autism spectrum disorder in a child and adolescent sample 儿童和青少年自闭症谱系障碍的DSM-5诊断标准的敏感性和特异性

Revista de Psiquiatría y Salud Mental (English Edition)

Pub Date : 2021-10-01 DOI: 10.1016/j.rpsmen.2019.10.005

Ana Blázquez Hinojosa , Luisa Lázaro Garcia , Olga Puig Navarro , Eva Varela Bondelle , Rosa Calvo Escalona

Background

Controversy exists regarding the DSM-5 criteria for autism spectrum disorders (ASD). Given the mixed results that have been reported, our main aim was to determine DSM-5 sensitivity and specificity in a child and adolescent Spanish sample. As secondary goals, we assessed the diagnostic stability of DSM-IV-TR in DSM-5, and clinical differences between children diagnosed with an ASD or a social (pragmatic) communication disorder (SPCD).

Methods

This study was carried out in 2017, reviewing the medical records of patients evaluated in our service. Items from a parent report measure of ASD symptoms (Autism Diagnostic Interview-Revised) were matched to DSM-5 criteria and used to assess the sensitivity and specificity of the DSM-5 criteria and current DSM-IV criteria when compared with clinical diagnoses.

Results

DSM-5 sensitivity ranged from .69 to 1.00, and was higher in females. By age, the DSM-5 and DSM-IV-TR criteria showed similar sensitivity. In the case of intellectual quotient, DSM-5 criteria sensitivity was lower for those in the “low-functioning” category. DSM-5 specificity ranged from .64 to .73, while DSM-5 specificity was similar for all phenotypic subgroups. With respect to stability, 83.3% of autism disorder cases retained a diagnosis of ASD using the DSM-5 criteria. With regard to differences between ASD and SPCD, we found that patients diagnosed with ASD received more pharmacological treatment than those diagnosed with SPCD.

Conclusions

Further research is required to confirm our results. Studies focusing on the SPCD phenotype will be necessary to determine outcome differences with ASD and the most effective diagnostic and therapeutic tools.

关于自闭症谱系障碍(ASD)的DSM-5标准存在争议。鉴于已报道的混合结果，我们的主要目的是确定DSM-5在儿童和青少年西班牙样本中的敏感性和特异性。作为次要目标，我们评估了DSM-IV-TR在DSM-5中的诊断稳定性，以及诊断为ASD或社会(实用)沟通障碍(SPCD)的儿童之间的临床差异。方法本研究于2017年开展，回顾我院所评估患者的病历。来自ASD症状的家长报告测量项目(自闭症诊断访谈-修订版)与DSM-5标准相匹配，并用于评估DSM-5标准和现行DSM-IV标准与临床诊断相比的敏感性和特异性。结果dsm -5的敏感性在0.69 ~ 1.00之间，女性较高。按年龄划分，DSM-5和DSM-IV-TR标准的敏感性相似。在智商的情况下，DSM-5标准对“低功能”类别的人的敏感度较低。DSM-5的特异性范围从0.64到0.73，而DSM-5的特异性在所有表型亚组中相似。在稳定性方面，83.3%的自闭症病例保留了使用DSM-5标准诊断的ASD。关于ASD和SPCD之间的差异，我们发现ASD患者比SPCD患者接受更多的药物治疗。结论需要进一步的研究来证实我们的结果。研究集中在SPCD表型将是必要的，以确定与ASD的结果差异和最有效的诊断和治疗工具。

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