论文部分内容阅读
目的 探讨32项轻躁狂症状清单(HCL-32)和心境障碍问卷(MDQ)筛查双相障碍或抑郁症自杀风险的可行性.方法 使用简明国际神经精神障碍访谈(MINI-SCID)评价1478例双相障碍或抑郁症患者的临床特征,依据MINI-SCID对自杀意念进行自杀风险分级.采用logistic回归分析HCL-32和MDQ用来筛查双相障碍及抑郁症患者自杀风险的可行性,筛选与自杀风险相关的条目.结果 1478例患者中,692例(46.8％)无自杀风险,271例(18.3％)为低自杀风险,284例(19.2％)为中自杀风险,231例(15.6％)为高自杀风险.不同自杀风险患者的HCL-32和MDQ评分比较差异均有统计学意义(P＜0.01);双相障碍Ⅰ型中不同自杀风险患者的HCL-32评分比较差异有统计学意义(P＜0.01),抑郁症不同自杀风险患者的MDQ评分比较差异有统计学意义(P＜0.01);双相障碍Ⅱ型中不同自杀风险患者的HCL-32和MDQ评分比较差异均无统计学意义(P＞0.05).logistic回归分析显示,HCL-32量表中的1(需要的睡眠比平时少)、29(喝咖啡比平时多)、31(喝酒比平时多)、32(比平时服用更多的药物)项(OR分值别为1.382、1.623、1.817、1.354,95％可信区间分别为1.124～ 1.698,1.116～2.359,1.242～2.658,0.960 ～1.909),MDQ中2(容易发脾气,经常大声指责别人,或与别人争吵、吵架)、4(比平时睡的少,而且不想睡)、13(花钱太多,使自己或家庭陷入困境)项(OR分值别为1.265、1.330、2.382,95％可信区间分别为1.006 ～1.590,1.066 ～1.660,1.721～3.297)均进入自杀风险相关因素模型.HCL-32和MDQ评估双相障碍Ⅰ型自杀风险相关操作特征曲线下面积分别为0.66、0.62.结论 HCL-32与MDQ筛选双相障碍Ⅰ型自杀意念相关危险因素尚可,但对于双相障碍Ⅱ型及抑郁障碍效果不佳.“,”Objective To evaluate the feasibility of screening for suicidal risk with the Hypomania Checklist (HCL-32) and Mood Disorder Questionnaire (MDQ) among patients of bipolar disorder or depression.Methods This was the re-analysis of data from Bipolar Screening Investigation Project.1487 consecutive subjects with bipolar disorder or depression were screened for suicidal ideation using the Chinese version of the HCL-32 and the MDQ,and diagnostically interviewed with the MINI-SCID by physician.According to the MINI-SCID screening for suicide risk,four risk groups were divided.The correlated items of suicide risk were screened in the HCL-32 and MDQ.Results In the 1478 screened patients,ones with non-,low-,middle-or high-suicide risk were 692 (46.8％),271 (18.3％),284 (19.2％) or 231 (15.6％) respectively.The scores of HCL-32 and MDQ in the four groups were significantly different (P ＜ 0.01).The score of HCL-32 was different in the four groups of suicide risk among the patients with bipolar Ⅰ disorder (P ＜ 0.01),and so was the score of MDQ among the patients with unipolar depression (P ＜ 0.01).No difference of HCL-32 and MDQ score were found in the four groups with bipolar [[disorder (P ＞ 0.05).With logistic regression analysis,factors of suicidal risk were screened with the 1 th,29th,31th and 32th items of HCL-32,i.e.,a decreased need for sleep,increased demand of coffee,alcohol and drugs.The other was with 2th,4th and 13th items of MDQ,i.e.,tend to lose temper and wrangle,decreased need for sleep,extravagancy.The comparison with the MDQ and HCL-32 performance showed that both screening tools might show passable effects in bipolar disorder with the area under ROC (0.66,0.62).Conclusion The results indicate passable accuracy of HCL-32 and MDQ as a screening instrument for suicide risk with bipolar Ⅰ disorder,but with a high rate of false negatives of identification for suicide risk in bipolar disorder Ⅱ.