两种自评问卷筛查综合医院诊断抑郁障碍患者的既往躁狂症状

目的 探索两种躁狂症状问卷在综合医院门诊ICD-10诊断的抑郁障碍是否筛查出既往有躁狂症状,及两个问卷识别躁狂症状的差异及其与临床特征的关系.方法 连续评估同济大学附属同济医院精神科门诊符合ICD-10诊断的抑郁障碍102例,调查工具包括自编问卷、中文版心境障碍调查问卷(Chinese version mood disorder questionnaire,CV-MDQ)、中文版32项轻躁狂症状清单(Chinese version 32 items hypomania check list,CV-HCL-32),CV-MDQ≥7分为既往躁狂症状阳性,CV-HCL-32≥14分为既往轻躁狂症状阳性.结果 1.内部一致性检验显示,CV.MDQ的Cronbach's α值为0.808,P<0.01,CV-HCL32的Cronbach's α值为0.916,P<0.01.2.11例患者(10.8%)在CV-MDQ报告躁狂症状阳性,14例(13.7%)在CV-HCL-32报告躁狂症状阳性,两问卷判别躁狂或轻躁狂的一致性有显著差异(Kappa=0.227,P<0.05).3.CV-HCL-32阳性组的首发年龄、总病程、本次病程、复发次数的中位数(35.0岁,60.0月,12.0月,2.5次)与阴性组(50.5岁,22.0月,6.0月,1.0次)差异具有显著性(Z=-2.065,-2.102,-2.180,-2.168,均P<0.05),年龄、性别、文化程度差异无显著性(P>0.05);CV-MDQ阳性组与阴性组间差异无显著性(P>0.05).结论 CV-MDQ和CV-HCL-32可在综合医院门诊ICD诊断为抑郁障碍患者中检出一定比例既往有躁狂或轻躁狂症状,但CV-HCL-32是否较CV-MDQ更适用于筛查双相Ⅱ型障碍值得探索.

Abstract：

Objective To explore the prevalence of self reposed mania/hypomania symptoms of depressive disorders and the difference between the two self-rating symptoms questionnaires in setting of psychiatric clinic of a general hospital.Methods 102 outpatients who were diagnosed with depressive disorders by ICD-10 in department of psychiatry of Tongji Hospital of Tongji University were continuously investigated and fulfilled the Chinese Version mood disorder questionnaire(CV-MDQ)and the Chinese Version 32 items hypomania check list(CVHCL-32).The positive mania symptoms were elevated with at least seven positive mania items reported by the CVMDQ.The positive hypomania symptoms were elevated with at least fourteen positive hypomania items reported by the CV-HCL-32.Results The internal consistency(Cronbach alpha)of the CV-MDQ was 0.808(95% CI=0.767～0.845,P<0.01).The internal consistency(Cmnbach alpha) of the CV-HCL-32 was 0.916(95% CI=0.898～0.930,P<0.01).11 patients(10.8%) reported positive mania symptoms by the CV-MDQ.14 patients (13.7%)had been reported positive hypomania symptoms through the CV-HCL-32.The ability of discriminating mania or hypomania between the two scales was significantly different(Kappa=0.227,P<0.05).Compared to the patients who were reported negative hypomania symptoms by the CV-HCL-32.the 11 patients with positive hypomania symptoms by the CV-HCL-32 had much earlier age in first episode(35.0 vs 50.5,z=-2.065,P<0.05),much longer months in total disease course(60.0 vs 22.0,z=-2.102,P<0.05)and present episode (12.0 vs 6.0,z=-2.180,P<0.05),and much higher frequency of relapse(2.5 vs 1.0,z=-2.168,P<0.05),but no significant differences at age,gender and education.No significant differences appeared between CV-MDQ positive and negative group.Conclusion Mania or hypomania symptoms may be screened by CV-MDQ and CV-HCL-32 from the outpatients with depressive disorders who are diagnosed by ICD-10 in general hospital.whether CV-HCL-32 is superior to CV-MDQ when screening bipolar Ⅱ disorder is worthly further study.

Screening reported mania symptoms by two self-rating questionnaires from outpatients with depressive disorders in a general hospital

Objective To explore the prevalence of self reposed mania/hypomania symptoms of depressive disorders and the difference between the two self-rating symptoms questionnaires in setting of psychiatric clinic of a general hospital.Methods 102 outpatients who were diagnosed with depressive disorders by ICD-10 in department of psychiatry of Tongji Hospital of Tongji University were continuously investigated and fulfilled the Chinese Version mood disorder questionnaire(CV-MDQ)and the Chinese Version 32 items hypomania check list(CVHCL-32).The positive mania symptoms were elevated with at least seven positive mania items reported by the CVMDQ.The positive hypomania symptoms were elevated with at least fourteen positive hypomania items reported by the CV-HCL-32.Results The internal consistency(Cronbach alpha)of the CV-MDQ was 0.808(95% CI=0.767～0.845,P<0.01).The internal consistency(Cmnbach alpha) of the CV-HCL-32 was 0.916(95% CI=0.898～0.930,P<0.01).11 patients(10.8%) reported positive mania symptoms by the CV-MDQ.14 patients (13.7%)had been reported positive hypomania symptoms through the CV-HCL-32.The ability of discriminating mania or hypomania between the two scales was significantly different(Kappa=0.227,P<0.05).Compared to the patients who were reported negative hypomania symptoms by the CV-HCL-32.the 11 patients with positive hypomania symptoms by the CV-HCL-32 had much earlier age in first episode(35.0 vs 50.5,z=-2.065,P<0.05),much longer months in total disease course(60.0 vs 22.0,z=-2.102,P<0.05)and present episode (12.0 vs 6.0,z=-2.180,P<0.05),and much higher frequency of relapse(2.5 vs 1.0,z=-2.168,P<0.05),but no significant differences at age,gender and education.No significant differences appeared between CV-MDQ positive and negative group.Conclusion Mania or hypomania symptoms may be screened by CV-MDQ and CV-HCL-32 from the outpatients with depressive disorders who are diagnosed by ICD-10 in general hospital.whether CV-HCL-32 is superior to CV-MDQ when screening bipolar Ⅱ disorder is worthly further study.