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Three clinical indicators of borderline personality disorder in anorexia nervosa: A pilot study 神经性厌食症患者边缘型人格障碍的三个临床指标:试点研究
IF 2.7 4区 医学 Q1 Arts and Humanities Pub Date : 2024-02-01 DOI: 10.1016/j.encep.2022.09.006
M. Danon , P. Duriez , P. Gorwood

Objectives

Co-occurrence of Anorexia Nervosa (AN) and borderline personality disorder (BPD) is frequent (8%–40%) and associated with specificities that impact the treatment process. Lifetime history of suicide attempt (HAS), substance use disorder (SUD) and the binge-purging subtype (B-P) might be good markers of such comorbidity. We made the hypothesis that in patients with AN, the presence of HAS, SUD and B-P have sufficient predictive power to efficiently detect an associated BPD comorbidity.

Methods

After a case report analysis on a pilot sample of 119 patients with AN, we performed a cross-sectional analysis on a confirmatory sample of 84 patients with AN in a single center specialized in eating disorders systematically assessing HAS, SUD, B-P and BPD using the Mini International Neuropsychiatric Interview for DSM-5 and the Diagnostic Interview for Borderline (DIB-R).

Results

B-P had a 100% negative predictive value, and the combination of SUD plus HAS had a 100% positive predictive value. On a quantitative level, B-P, HAS and SUD were independent explanatory factors of the DIB-R total score.

Conclusions

The main limitations were the low number of patients, the single center analyses, the potential overlapping of assessments and the fact that data were exclusively declarative. In this study, every patient with B-P, SUD and HAS had been diagnosed with BPD.

目标神经性厌食症(AN)和边缘型人格障碍(BPD)的并发率很高(8%-40%),并且与影响治疗过程的特异性有关。终生自杀未遂(HAS)史、药物使用障碍(SUD)和暴饮暴食亚型(B-P)可能是此类合并症的良好标记。我们假设,在自闭症患者中,HAS、SUD 和 B-P 的存在具有足够的预测力,可以有效地检测出相关的 BPD 合并症。方法在对119名AN患者的试验样本进行病例报告分析后,我们在一个专门研究进食障碍的中心对84名AN患者的确证样本进行了横断面分析,并使用DSM-5迷你国际神经精神访谈(Mini International Neuropsychiatric Interview for DSM-5)和边缘型诊断访谈(DIB-R)对HAS、SUD、B-P和BPD进行了系统评估。在定量层面上,B-P、HAS 和 SUD 是 DIB-R 总分的独立解释因素。结论主要局限性在于患者人数较少、单中心分析、评估可能重叠以及数据完全是陈述性的。在这项研究中,所有患有B-P、SUD和HAS的患者都被诊断为BPD。
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引用次数: 0
Othello syndrome: A case report and literature review 奥赛罗综合征1例报告及文献复习。
IF 2.7 4区 医学 Q1 Arts and Humanities Pub Date : 2024-02-01 DOI: 10.1016/j.encep.2023.08.014
Wissal Abid, Mariem Bouhamed, Salma Hentati, Rim Masmoudi, Ines Feki, Rim Sallemi, Jawaher Masmoudi
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引用次数: 0
The bifocal model: A two-level clinical model of psychiatric disorders integrating diagnostic and transdiagnostic approaches 双焦点模型:一种整合诊断和跨诊断方法的精神疾病的两级临床模型。
IF 2.7 4区 医学 Q1 Arts and Humanities Pub Date : 2024-02-01 DOI: 10.1016/j.encep.2023.06.009
Alexis Vancappel , Wissam El-Hage , François Kazour , Robert Courtois

Nowadays, two distinct conceptualizations are available to classify, label and guide the treatment of psychiatric disorders: the diagnostic approach and the transdiagnostic approach. There are pros and cons to both approaches. We propose here to link these two conceptualizations by creating a two-level clinical model that takes advantages of both approaches, named the bifocal model (BFM). This two-tier clinical model consists of a double level of analysis: the first step is to identify transdiagnostic mechanisms involved in multiple disorders and then to recognize specific mechanisms identified in a given disorder or cluster of symptoms. Such a process would bring the diagnostic and transdiagnostic approaches together and offer a more flexible way to understand mental disorders and ultimately to improve medical outcomes.

目前,有两种不同的概念可用于分类、标记和指导精神疾病的治疗:诊断方法和跨诊断方法。这两种方法各有利弊。在这里,我们建议通过创建一个利用两种方法优势的两级临床模型,将这两个概念联系起来,称为双焦点模型(BFM)。这种双层临床模型包括双重分析:第一步是确定涉及多种疾病的跨诊断机制,然后识别在给定疾病或症状群中确定的特定机制。这一过程将把诊断和跨诊断方法结合起来,提供一种更灵活的方式来理解精神障碍,并最终改善医疗结果。
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引用次数: 0
Muscle dysmorphia from an addictive perspective: Validation of the Addiction to Body Image Inventory (ABII) 从成瘾角度看肌肉畸形:身体形象成瘾量表(ABII)的验证
IF 2.7 4区 医学 Q1 Arts and Humanities Pub Date : 2024-02-01 DOI: 10.1016/j.encep.2022.10.004
M. Legendre , J. Morin , J. Cuadrado , M. Côté , G. Michel , C. Bégin

Objectives

Muscle dysmorphia (MD) is a disorder affecting mainly men and is characterized by significant dissatisfaction with muscles. The idea that MD could represent an addiction has been theoretically discussed, but no empirical data are available. Based on Foster et al. (2015) framework, the Addiction to Body Image Inventory (ABII) was developed. This study aims to validate the ABII and to evaluate its capacity to capture MD severity.

Methods

A first community sample of 466 participants was recruited and completed the ABII and questionnaires on MD and body esteem. A second sample of 47 men at risk of MD was recruited mostly in gyms and completed the ABII and questionnaires on MD, eating and psychological symptoms.

Results

With the community sample, the results showed that the ABII had a valid factorial structure, good internal consistency, and good convergent validity. With the sample of men at risk of MD, the results showed that the ABII had good convergent validity with MD and eating symptoms but not with psychological symptoms. The results of a regression model showed that the ABII explained 12% of the MD variance.

Conclusions

This study brings the first measure of addiction to body image and suggests that MD must be understood as a complex phenomenon including eating symptoms and addictive tendencies.

目的 肌肉畸形(Muscle dysmorphia,MD)是一种主要影响男性的疾病,其特征是对肌肉严重不满意。有人从理论上讨论了肌肉畸形可能代表一种成瘾的观点,但目前尚无实证数据。基于 Foster 等人(2015 年)的框架,我们开发了身体形象成瘾量表(ABII)。本研究旨在对 ABII 进行验证,并评估其捕捉 MD 严重程度的能力。在社区样本中,结果显示 ABII 具有有效的因子结构、良好的内部一致性和良好的收敛效度。对于有患多发性硬化症风险的男性样本,结果显示 ABII 与多发性硬化症和饮食症状具有良好的会聚效度,但与心理症状的会聚效度不佳。回归模型的结果显示,ABII 可以解释 12% 的 MD 变异。结论这项研究首次提出了身体形象成瘾的测量方法,并表明必须将 MD 理解为一种包括饮食症状和成瘾倾向的复杂现象。
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引用次数: 0
The body asks and the mind judges: Internal and external factors involved 身体询问,心灵判断:涉及的内部和外部因素
IF 2.7 4区 医学 Q1 Arts and Humanities Pub Date : 2024-02-01 DOI: 10.1016/j.encep.2023.06.013
Jônatas de Oliveira
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引用次数: 0
Impact du confinement sur la santé mentale des doctorants, une étude de cohorte dans une université française 禁闭对博士生心理健康的影响:法国一所大学的队列研究
IF 2.7 4区 医学 Q1 Arts and Humanities Pub Date : 2024-02-01 DOI: 10.1016/j.encep.2022.11.002
Jérémy Gaudel , Saloua Ahalli , Emmanuel Fort , Yamina Bridai , Nicole Baborier , Barbara Charbotel

Introduction

Few studies are available on the health status of doctoral students. This position at the border between university studies and a professional activity presents specific risk factors, especially in terms of psychosocial constraints. The lockdowns implemented worldwide to control the COVID-19 pandemic are potentially worsening factors.

Methods

At Lyon 1 University, a systematic medical follow-up of first year PhD students had been set up by the occupational health service in 2019. In the context of the lockdown during the COVID-19 pandemic, a telephonic interview was proposed to the same PhD students in order to assess the impact of the lockdown on working conditions and health and to provide possible assistance. During this interview, a standardized questionnaire was used to collect information about the conditions during the lockdown, doctoral work during this period and the consequences on research progress, as well as possible financial difficulties due to the lockdown. In addition, questions were asked about the perceived general health conditions and consultation with a health practitioner during this period. The Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder (GAD-7) were used to assess depression and anxiety. Questions on lifestyle during lockdown, changes in diet during the period, weight change, and changes in the quantity and quality of their sleep were also asked. Comparisons of perceived health status, the prevalence of anxiety and depression symptoms at baseline and during the follow-up survey were made by MacNemar Chi2 tests, as the data were repeated ones. The students were informed orally and in writing that their data would be entered anonymously into a computer and that they could have access to their data in accordance with the General Data Protection Regulation (GDPR). They were all informed by e-mail about the study results at the end of the study. The data collection process was registered with the National Institute for Health Data (INDS) and with the university's register under reference no. 2020/002 by the university's data protection officer in compliance with the French data protection laws (CNIL). The protocol was approved by the ethics committee of the Lyon University College of General Medicine (notification number: 2020-10-29-02).

Results

Of the 161 PhD students initially interviewed, 149 underwent a second interview. In total, 89.2% of the students assessed their health as good or very good. Regarding the answers to the GAD-7 questionnaire, 8.1% had a score equal to or higher than 10, corresponding to moderate to severe anxiety. Regarding the answers to PHQ-9, 19.6% of the PhD students had a score equal to or higher than 9 corresponding to moderate to severe depressive syndromes. The prevalence of an anxiety disorder was significantly associated with the absence of an outside private access in the pla

引言有关博士生健康状况的研究很少。博士生处于大学学习和职业活动的交界处,存在特殊的风险因素,尤其是在社会心理限制方面。里昂第一大学的职业健康服务部门于2019年对一年级博士生进行了系统的医疗跟踪。在 COVID-19 大流行期间的封锁背景下,建议对这些博士生进行电话访谈,以评估封锁对工作条件和健康的影响,并提供可能的帮助。在这次访谈中,使用了一份标准化问卷,以收集有关封锁期间的条件、这一期间的博士生工作、对研究进展的影响以及封锁可能造成的经济困难等方面的信息。此外,还询问了有关在此期间感知到的一般健康状况和向保健医生咨询的情况。患者健康问卷 (PHQ-9) 和广泛性焦虑症 (GAD-7) 被用来评估抑郁和焦虑。此外,还对封锁期间的生活方式、封锁期间的饮食变化、体重变化以及睡眠数量和质量的变化进行了提问。由于数据是重复的,因此通过 MacNemar Chi2 检验对基线和后续调查期间的健康状况、焦虑和抑郁症状的发生率进行了比较。我们以口头和书面形式告知学生,他们的数据将以匿名方式输入计算机,根据《一般数据保护条例》(GDPR),他们可以查阅自己的数据。研究结束后,他们都会通过电子邮件了解研究结果。根据法国数据保护法(CNIL)的规定,数据收集过程已在国家健康数据研究所(INDS)进行了登记,并由大学数据保护官员在大学登记处进行了登记,登记编号为2020/002。研究方案获得了里昂大学全科医学院伦理委员会的批准(通知书编号:2020-10-29-02)。89.2%的学生认为自己的健康状况良好或很好。在对 GAD-7 问卷的回答中,8.1% 的人得分等于或高于 10 分,相当于中度至重度焦虑。在 PHQ-9 问卷中,19.6% 的博士生的得分等于或高于 9 分,属于中度至重度抑郁综合征。焦虑症的发病率与以下因素有显著关联:在封锁期间,居住地没有外部私人通道(75% 对 37%)、咖啡消费量增加(33% 对 5%)、食物摄入量增加(50% 对 12%)、体重增加(50% 对 19%)和睡眠质量下降(75% 对 28%)。抑郁症状的发生率与以下因素显著相关:被关在市区(89% 对 70%)、出现经济困难(7% 对 1%)、在此期间咨询过专业医疗人员(34% 对 15%)、戒烟(14% 对 1%)、睡眠数量变化(31% 对 9%)和睡眠质量下降(59% 对 25%)以及饮食变化(66% 对 43%)。在两次调查中,90% 的参与者的 GAD-7 评分没有变化,但 6.8% 的博士生的 GAD-7 评分较高,2.7% 的博士生的 GAD-7 评分较低(P = 0.1)。15.5% 的博士生的 PHQ-9 分数有所下降,即第二次调查的分数高于第一次调查的分数,而 1.4% 的博士生的 PHQ-9 分数有所上升(P = 0.0001)。因此,他们的研究结果很难与我们的研究结果相比较;他们的 GAD-7 和 PHQ-9 评分通常与我们的研究结果相似,甚至更高。因此,我们的研究强调了禁闭对博士生心理健康的影响,这就证明有必要对这一人群进行适当的跟踪,尤其是在曾经患有精神疾病的情况下。
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引用次数: 0
Validation and bifactor structure of the French Adult ADHD Symptoms Rating Scale v1.1 (ASRS) 法国成人多动症症状评定量表 v1.1 (ASRS) 的验证与双因素结构
IF 2.7 4区 医学 Q1 Arts and Humanities Pub Date : 2024-02-01 DOI: 10.1016/j.encep.2022.11.007
H. Caci , C. Didier , D. Wynchank

Background

Three scoring methods for the widely available Adult ADHD Symptoms Rating Scale v1.1 (ASRS) have been proposed to screen for ADHD, but these three methods have rarely been compared against formal clinical diagnoses. We aimed to validate the French version of the ASRS against a clinical interview using DSM-IV and DSM-5 diagnostic algorithms.

Methods

One hundred five adults from a convenience sample were evaluated with the ASRS and the DIVA 2.0, using both DSM-IV and DSM-5 criteria. We used Confirmatory Factor Analysis to investigate the underlying structure of the ASRS. Sensitivity, specificity, and classification accuracy were compared between the rating algorithms of the ASRS.

Results

The full score method had worse predictive performance than the Screener and the 2-stage scoring method. All characteristics of the three scoring methods for the ASRS were worse when applying DSM-5 criteria. The best-fitting structure was a bi-factor model with a general ADHD factor and three specific factors.

Conclusions

ADHD was best conceived as a one-dimensional construct. The 2-stage scoring method superseded the Screener with comparable sensitivity and specificity.

背景针对广泛使用的成人多动症症状评定量表 v1.1(ASRS)提出了三种评分方法来筛查多动症,但这三种方法很少与正式的临床诊断进行比较。我们的目的是根据使用 DSM-IV 和 DSM-5 诊断算法进行的临床访谈,对法文版 ASRS 进行验证。方法我们使用 ASRS 和 DIVA 2.0 对 155 名方便抽样的成人进行了评估,同时使用了 DSM-IV 和 DSM-5 标准。我们使用确证因子分析来研究 ASRS 的基本结构。我们比较了 ASRS 各评分算法的灵敏度、特异性和分类准确性。在应用DSM-5标准时,ASRS三种评分方法的所有特征都较差。最佳拟合结构是一个双因素模型,包含一个一般多动症因素和三个特殊因素。两阶段评分法的灵敏度和特异性均优于筛查法。
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引用次数: 0
Evaluation of sleep and therapeutic education needs of military with PTSD 评估患有创伤后应激障碍的军人的睡眠和治疗教育需求
IF 2.7 4区 医学 Q1 Arts and Humanities Pub Date : 2024-02-01 DOI: 10.1016/j.encep.2023.01.004
M. Remadi , S. Dinis , L. Bernard , D. Defontaine , M. Boussaud , M. Chennaoui , E. Saguin

Sleep disorders in post-traumatic stress disorder (PTSD) are both diagnostic (nocturnal reliving) and prognostic. Poor sleep worsens the daytime symptomatology of PTSD and makes it resistant to treatment. However, no specific treatment is codified in France to treat these sleep disorders although sleep therapies (cognitive behavioural therapy for insomnia, psychoeducation and relaxation) have proven for years to be effective in treating insomnia. Therapeutic sessions can be part of a therapeutic patient education program, which is a model for the management of chronic pathologies. It allows for an improvement in a patient's quality of life and enhanced medication compliance. We therefore carried out an inventory of sleep disorders of patients with PTSD. First, we collected data by means of sleep diaries concerning the population's sleep disorders at home. Then we assessed the population's expectations and needs regarding its management of sleep, thanks to a semi-qualitative interview. The data from sleep diaries, which was consistent with the literature, showed that our patients suffered from severe sleep disorders that strongly impact their daily lives, with 87% of patients having an increased sleep onset latency, and 88% having nightmares. We observed a strong demand from patients for specific support for these symptoms, 91% expressing an interest in a TPE program targeting sleep disorders. Thanks to the data collected, the emerging themes for a future therapeutic patient education program targeting sleep disorders of soldiers with PTSD are: sleep hygiene; management of nocturnal awakenings, including nightmares; and psychotropic drugs.

创伤后应激障碍(PTSD)中的睡眠障碍既是诊断性疾病(夜间重现),也是预后性疾病。睡眠不足会加重创伤后应激障碍的日间症状,并使其对治疗产生抗药性。然而,尽管多年来睡眠疗法(失眠认知行为疗法、心理教育和放松疗法)被证明对治疗失眠有效,但法国并没有专门针对这些睡眠障碍的治疗方法。治疗课程可以是患者治疗教育计划的一部分,这是一种慢性病管理模式。它可以改善患者的生活质量,提高服药依从性。因此,我们对创伤后应激障碍患者的睡眠障碍进行了调查。首先,我们通过睡眠日记收集了患者在家睡眠障碍的相关数据。然后,我们通过半定性访谈评估了患者对睡眠管理的期望和需求。睡眠日记的数据与文献一致,显示我们的患者患有严重的睡眠障碍,这对他们的日常生活造成了严重影响,87%的患者睡眠开始潜伏期延长,88%的患者做噩梦。我们观察到,患者强烈要求针对这些症状提供特殊支持,91% 的患者表示对针对睡眠障碍的 TPE 项目感兴趣。根据收集到的数据,未来针对创伤后应激障碍士兵睡眠障碍的治疗性患者教育计划的新主题是:睡眠卫生;夜间觉醒管理,包括噩梦;精神药物。
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引用次数: 0
Somatic health according to people with severe mental disease 严重精神疾病患者的躯体健康状况
IF 2.7 4区 医学 Q1 Arts and Humanities Pub Date : 2024-02-01 DOI: 10.1016/j.encep.2022.11.003
Shirley Ba , Vincent Bianchi , Antoine Carpentier , Éric Kieffer , Laurent Lequin , Marie-Noëlle Cadou , Estelle Trinh , Laurent Lecardeur

Objectives

Patients with schizophrenia have a 15- to 20-year shorter life expectancy compared with the general population. The aim of this study was to explore these patients’ perception of their physical health.

Methods

A patient reported outcomes measure (PROM) has been developed by patients with severe mental disease. This survey had to better capture undetected, under-rated and non-prioritized physical domains by traditional routine clinical scales that are important for people who live with mental health disease. These patients have tested the applicability of this PROM with peers with severe mental disease in medical, social and community-based centers from Hauts-de-France.

Results

Two and a half years have been required to develop this PROM, to test its applicability to patients with severe mental disease and to analyze the results. The study process has been slowed by the sanitary context induced by the COVID-19 pandemic. Thirty-two questionnaires have been collected by the participants. Despite this low number of data, participants have been satisfied by the results and their experience. The results show that people with severe mental disease consider physical health as a major concern, notably pain and somatic diseases. External factors (such as accessibility to health care and medication) and internal factors (such as self-esteem, cognitive and negative symptoms, sleep, alimentation, and substance use) have been identified as barriers for physical health.

Conclusions

These results support the development of PROMs highlighting personal experience of people with severe mental disease. The data obtained thanks to these measures will allow to build programs to help them to cope with barriers for physical health.

目标 精神分裂症患者的预期寿命比普通人短 15 到 20 年。本研究旨在探讨这些患者对其身体健康的看法。方法 严重精神疾病患者开发了一种患者报告结果测量法(PROM)。这项调查必须能更好地捕捉到传统常规临床量表中未被发现、未被充分评估和未被优先考虑的身体领域,而这些领域对于精神疾病患者来说非常重要。这些患者在上法兰西地区的医疗、社会和社区中心与患有严重精神疾病的同龄人一起测试了这一 PROM 的适用性。由于 COVID-19 大流行造成的卫生环境影响,研究进程有所放缓。参与者共收集了 32 份问卷。尽管数据数量较少,但参与者对结果和他们的经历表示满意。结果表明,严重精神疾病患者认为身体健康是主要问题,尤其是疼痛和躯体疾病。外部因素(如医疗保健和药物的可及性)和内部因素(如自尊、认知症状和负面症状、睡眠、饮食和药物使用)被认为是身体健康的障碍。通过这些措施获得的数据将有助于制定方案,帮助他们应对身体健康方面的障碍。
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引用次数: 0
Development and validation of the Symptomatic Transdiagnostic Test (S2T) 症状跨诊断测试(S2T)的开发与验证
IF 2.7 4区 医学 Q1 Arts and Humanities Pub Date : 2024-02-01 DOI: 10.1016/j.encep.2022.11.004
A. Vancappel , C. Raysseguier , H. Coillot , E. Jansen , C. Bouyer , A. Mangolini , P.G. Barbe , C. Debout-Courtault , M. Pierre-le Seac’h , F. Kazour , R. Courtois , W. El-Hage

Introduction

The categorical approach in psychiatry has received many criticisms. Modern research tends to develop a transdiagnostic approach. However, transdiagnostic works lack an overall understanding and focus mainly on anxiety and depression. The aim of the present study was to develop an easy to use tool to evaluate multiple dimensions opening the way for further research in the transdiagnostic approach. This will allow researchers to quickly assess the efficacy of psychotherapeutic interventions on multiple psychopathological dimensions.

Method

First, we identified the main symptoms of psychopathology in a sample of mental healthcare workers. Second, we developed the Symptomatic Transdiagnostic Test (S2T) to assess the main symptoms of psychopathology. Third, we evaluated its psychometric properties (exploratory and confirmatory factor analysis, internal consistency) in three non-clinical samples and one clinical sample.

Results

The 66-item S2T included eleven factors referring to: i) negative thoughts and mood; ii) psycho-traumatic and maladaptive symptoms; iii) addiction symptoms; iv) disturbed eating behavior; v) disturbed perception and behavior; vi) panic and agoraphobia; vii) emotional lability; viii) dejection; ix) neurodevelopmental manifestations; x) anxiety and xi) psychic hyperactivity. We found a high internal consistency for the general scale (α = 0.96) and the subscales. We found a good concurrent validity. As expected, we found higher levels of symptoms within the clinical population as compared to the non-clinical samples, except for addiction symptoms and disrupted eating behavior. We found negative associations between the symptomatic dimensions and psychological skills.

Conclusion

The S2T is a relevant tool for clinicians and researchers to assess the psychopathological profile. The main psychopathological symptoms are negatively related to the psychological skills.

导言:精神病学中的分类方法受到了许多批评。现代研究倾向于发展一种跨诊断方法。然而,跨诊断方法的著作缺乏整体理解,主要集中在焦虑和抑郁方面。本研究旨在开发一种易于使用的工具,用于评估多个维度,为进一步研究跨诊断方法开辟道路。这将使研究人员能够快速评估心理治疗干预措施在多个心理病理学维度上的疗效。方法首先,我们在心理健康工作者样本中确定了心理病理学的主要症状。其次,我们开发了症状性跨诊断测试(S2T)来评估精神病理学的主要症状。第三,我们在三个非临床样本和一个临床样本中评估了该测验的心理测量特性(探索性和确认性因素分析、内部一致性)。结果 66 个项目的 S2T 包括 11 个因子,分别涉及:i) 负面想法和情绪;ii) 精神创伤和适应不良症状;iii) 上瘾症状;iv) 饮食行为紊乱;v) 感知和行为紊乱;vi) 恐慌和惧旷症;vii) 情绪不稳定;viii) 消沉;ix) 神经发育表现;x) 焦虑和 xi) 精神过度活跃。我们发现总量表(α = 0.96)和各分量表具有较高的内部一致性。我们还发现了良好的并发效度。正如预期的那样,我们发现与非临床样本相比,临床人群的症状水平更高,但成瘾症状和饮食行为紊乱除外。结论 S2T 是临床医生和研究人员评估精神病理学特征的相关工具。主要的精神病理症状与心理技能呈负相关。
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Encephale-Revue De Psychiatrie Clinique Biologique et Therapeutique
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