心境障碍问卷和32项轻躁狂症状清单对综合医院精神科门诊诊断抑郁症患者中双相障碍的筛查价值

摘要

Objective To compare the psychometric properties of the Chinese Mood Disorder Questionnaire (MDQ) and the Chinese Hypomania Checklist-32 (HCL-32),and determine the better approach for screening bipolar disorder (BD) among outpatients diagnosed as major depressive disorder (MDD)in general hospital.Methods A total of 1010 outpatients diagnosed as MDD were consecutively examined in 3 general hospitals.The patients' socio-demographic and clinical characteristics were recorded using a standardized protocol and data collection procedure.The MDQ and HCL-32 was self-completed by patients to identify symptoms characteristic of BD.DSM-Ⅳ diagnoses were established using the SCID-I/P (Structured Clinical Interview for DSM-Ⅳ axis Ⅰ disorders,Research Version for patients).Results 417 of the 1010 patients (41.3％) satisfied DSM-Ⅳ criteria for BD.In ROC curve the optimal cut-off of the HCL-32 was 11 symptoms for differentiating BD from MDD,its corresponding sensitivity,specificity,positive predictive value and negative predictive value was 0.80,0.85,0.79 and 0.84.The optimal cut-off of the MDQ was 4 symptoms,its corresponding sensitivity,specificity,positive predictive value and negative predictive value was 0.46,0.96,0.89,0.72 ; and with omission of the impairment criterion,it was 4 affirmative responses,the sensitivity and specificity was 0.76 and 0.93.Conclusions The study shows the HCL-32 is the better approach for detecting previously unrecognised bipolar disorder among outpatients diagnosed as major depressive disorder in general hospital.%目的 评估比较中文版心境障碍问卷(MDQ)与32项轻躁狂症状清单(HCL-32)筛查综合医院精神科门诊诊断的抑郁症患者中双相障碍的价值.方法 2008年11月至2009年12月采用中文版MDQ与HCL-32对来自国内3家三级综合医院的1010例精神科门诊诊断抑郁症的患者进行测评,记录其一般资料和临床特征,并由对测评结果不知情的精神科专家以《美国精神障碍诊断与统计手册(第4版)》轴Ⅰ障碍定式检查-病人研究版(SCID-I/P)为诊断标准,对患者做出明确诊断.结果 1010例患者中417例(41.3％)符合双相障碍诊断.经ROC曲线法,HCL-32对于双相障碍与抑郁症的最佳划界分为11分,相应敏感度、特异度为0.80、0.85,阳性预测值为0.79,阴性预测值为0.84；MDQ对于双相障碍与抑郁症的最佳划界分为4分,相应敏感度、特异度为0.46、0.96,阳性预测值为0.89,阴性预测值为0.72；若去除功能损害因子,MDQ对于双相障碍与抑郁症的最佳划界分为4分,相应敏感度、特异度为0.76、0.93.结论 中文版HCL-32较MDQ对诊断双相障碍有更好的灵敏度,也有较好的特异度,适合作为门诊筛查抑郁症患者中双相障碍的辅助工具.