儿童个性特征测定在心因性非癫痫性发作鉴别诊断中的应用

摘要

目的 探讨儿童个性特征评估在心因性非癫痫性发作(PNES)、癫痫(EP)和健康对照(NC)之间鉴别诊断中的应用.方法 选取本中心心理专科和神经内科收诊的106例PNES患儿、138例EP患儿和139例儿童保健科健康体检的NC儿童作为研究对象.采用艾森克个性问卷(EPQ)和Piers-Harris儿童自我意识量表(PHCSS)对各组儿童进行评估,并进行比较分析.结果 PNES组患儿的个性缺陷程度明显高于EP组和NC组儿童,尤其焦虑(6.34±2.58)、合群(6.06±2.64)、幸福与满足(4.60±2.34)三个自我意识分量表评分明显低于EP组和NC组儿童,TP(59.23±8.22)和TN(56.16±8.27)两个艾森克个性问卷分量表评分明显高于EP组和NC组儿童,差异有统计学意义(P＜0.05).焦虑分量表在鉴别诊断PNES组和NC组儿童时表现出了良好的判别能力,灵敏度和特异度分别为74.1％和72.6％,ROC曲线下面积达0.825.TP分量表在鉴别诊断PNES组和EP组儿童时表现出了较好的判别能力,灵敏度和特异度分别为52.8％和97.1％,ROC曲线下面积达0.789.结论 PNES患儿自我意识水平明显低于EP组和NC组患儿,个性多偏神经质和精神质,建议根据其心理特点和性格特征进行鉴别诊断和干预.%Objective To examine the ability of the assessment of personality to differentiate patients with psychogenic non-epileptic seizures (PNES) from normal controls (NC) and epileptic seizures (ES).Methods Patients were recruited from mental health department of our center.In all,106 children with PNES and 138 children with EP completed questionnaires including Eysenck Personality Questionnaire (EPQ) and Piers-Harris Children's Self-concept Scale (PHCSS).Both questionnaires were also completed by 139 healthy volunteers from children health care clinic.The results of three groups were compared to determine the diagnostic accuracy of the assessment of personality.Results Subjects with PNES reported significantly greater degree of personality abnormality than ES and NC,such as lower anxiety (6.34±2.58),gregarious (6.06±2.64),happiness and satisfaction (4.60±2.34) subscale of HPCSS,and higher TP (59.23±8.22) and TN (56.16±8.27) of EPQ (all P＜0.05).The anxiety subscale of HPCSS showed a sensitivity of 74.1％,a specificity of 72.6％,and an area under the curve (AUC) of 0.825 for diagnosing PNES from NC.TP subscale of EPQ showed a sensitivity of 52.8％,a specificity of 97.1％,and an AUC of 0.789 for diagnosing PNES from ES.Conclusions Maladaptive personality is common in children with PNES.Greater attention should be paid to personality disorders in the differentiation of PNES and ES,and the provision of effective treatment.