孤独症近期预后状况的研究

目的 研究儿童孤独症的近期预后状况。方法 对61例孤独症患儿进行3－6年的追访,收集智商、社会适应商、症状变化、临床病史等资料,使用SAS统计软件做描述性统计分析。结果 在61例孤独症患儿中,智力有缺损者为37例（76％）,6例（12％）处于边缘状态,仅有6例（12％）智商超过85分;社会适应能力有缺损者为42例（88％）,4例（8％）属于边缘状态,仅2例（4％）达到正常水平。有20％－50％的患儿孤独症症状持续存在,5％－12％的患儿症状呈不同程度的加重。结论 提示儿童孤独症总体近期预后较差。     

儿童孤独症康复治疗的研究进展

儿童孤独症起病早,以语言障碍、社会交往（人际关系）障碍、兴趣狭窄及行为重复刻板为主要临床表现,多数伴有智能落后。由于孤独症是一种全面的发育障碍,其不仅严重影响患者的生存质量,还给患者家庭带来沉重的心理和经济负担。由于孤独症致病因素众多,目前尚无特异的治愈手段,如何有效治疗孤独症仍是世界难题。多年来国内外学者探索性的治疗成果提示积极的康复治疗能有效提高孤独症儿童的生活质量。现将近年来康复治疗取得的进展综述如下。     

儿童孤独症的脑扩散张量成像研究

目的 研究孤独症儿童脑扩散张量成像的异常.方法 对24例孤独症儿童(孤独症组)和10名正常儿童(正常对照组)进行脑扩散张量成像扫描,测量并比较两组的双侧胼胝体膝部、压部和双侧内囊后肢表观扩散系数(ADC值)和各向异性分数(FA值),分析孤独症儿童各被检测部位ADC值、FA值与孤独症治疗评估量表(ATEC)得分的相关性.结果 (1)孤独症组双侧内囊后肢[左右侧分别为(6.8±0.3)×10-9 mm2/s和(6.7±0.4)×10-9 mm2/s]、左侧胼胝体膝部[(8.0±0.5)×10-9 mm2/s]ADC值高于对照组[分别为(6.6±0.2)×10-9 mm2/s,(6.6±0.4)×10-9 mm2/s,(7.4±0.5)×10-9 mm2/s;P＜0.05～0.01];孤独症组右侧胼胝体压部(0.73±0.14)FA值低于正常对照组(0.84±0.07;P＜0.05),孤独症组右侧胼胝体膝部(0.75±0.07)FA值高于正常对照组(0.68±0.17;P＜0.05).(2)孤独症组右侧胼胝体压部ADC值与ATEC健康/行为评分呈正相关(r=0.490),右侧胼胝体压部FA值与ATEC说话/语言评分呈负相关(r=-0.453),右胼胝体膝部FA值与社交评分呈正相关(r=0.427),均P＜0.05.(3)孤独症组内囊后肢、胼胝体膝部FA值左右侧的差异有统计学意义(P＜0.05).结论 孤独症儿童胼胝体神经纤维连接存在异常.     

中国精神障碍分类与诊断标准第3版孤独症诊断标准的临床研究

目的 比较中国精神障碍分类与诊断标准第3版（CCMD-3）与中国精神疾病分类方案与诊断标准第2版修订本（CCMD-2-R）和国际疾病分类第10版（ICD-10）儿童孤独症诊断标准的一致性及症状出现率。方法 采用临床面谈和定式工具收集病史和评估症状，先依据CCMD-2-R对117例患儿进行初次诊断，然后按照CCDM-3和ICD-10进行再诊断。结果 （1）CCMD-3与ICD-10诊断的一致率为100.0%（Kappa值=1.000),CCMD-2-R与ICD-10的一致率为95.8%（Kappa值=0.915)。（2）孤独症组在三种诊断标准中8项相同症状的出现率为79.4%-100.0%。14项不同相同症状的出现率为27.0%-98.4%;CCMD-3,CCMD-2-R和ICD-10中出现率≤50%的症状分别有2项，3项和1项，结论CCMD-3较CCMD-2-R与ICD-10诊断一致性高，但少数症状出现率仍偏低。     

分离体验量表中文版信度和效度的初步研究

目的:探讨对住院精神障碍患者分离体验量表第二版(DES-II)中文版评定的信度和效度。方法:404例住院精神障碍患者进行分离体验量表的评定。6周后在初筛病例中随机抽取样本数20%进行量表重测。将DES-II量表初筛评定结果按得分高低随机排序并分组抽样:0～10分第一组抽取样本数的10%;10～20分第二组抽取30%;20～40分第三组抽取50%;40分以上第四组抽取100%。抽取99例样本进行DDIS量表评定,其中完成量表并符合分析要求量表80例,验证DES-II中文版和DDIS分量表的相关效度。结果:DES量表各项目与总分间的相关系数在0.566～0.728之间;DES-II中文版评定量表的Cronbach’s的α系数为0.957;量表奇偶分半系数分别是0.843、0.883。6周后重测量表相关系数为0.617;DES得分分组的一致性Kappa值为0.549。DES量表因子分析结果表明,量表为单一因子的一维量表。对DDIS量表除外躯体性主诉和物质滥用之外所有的13个分量表和DES量表进行关联效度分析,DDIS分量表和DES得分相关系数在0.306～0.720之间,DDIS分量表得分相加的和DES因子分的相关系数为0.994。结论:分离体验量表DES-II中文版信度和效度较好,DES和DDIS各分量表的相关性较高。DES量表可以作为临床筛查的有效工具,具有临床和科研应用价值。     

孤独症患儿脑单光子发射计算机体层摄影术的研究

目的 研究孤独症患儿的脑血流和细胞功能.方法 采用单光子发射计算机体层摄影术,对31例符合中国精神疾病分类方案与诊断标准第2版修订本中孤独症的诊断标准的患儿(研究组)和20名排除神经精神科疾病、患躯体疾病的非孤独症儿童(对照组)进行脑影像分析.结果 (1)视觉定性分析,研究组中有27例存在36个放射性分布减低区,其中以左侧额叶(13个)和双侧颞叶(左右侧分别为6个和8个)皮质较多见.(2)放射性计数分析,研究组左侧额叶(84±34)和海马(62±23)低于右侧[分别为(88±32)和(67±26)],差异有非常显著性(P<0.01);对照组各部位左右侧比较,差异均无显著性.结论 孤独症儿童左侧额叶、海马及双侧颞叶存在局部血流灌注降低和细胞功能障碍.     

老年抑郁量表和普通健康问卷(简本)信度和效度的研究

目的测量老年抑郁量表简本（ＧＤＳ１５）和普通健康问卷简本（ＧＨＱ１２）的信度和效度。方法以≥７０岁的老年人为对象,通过问卷和个别面谈进行调查。结果ＧＤＳ１５和ＧＨＱ１２均有良好的信度（Ｃｒｏｎｂａｃｈα分别＝０．８２和０．７５）;可体现性别和婚姻状况对心理健康的影响,两个量表与社会经济因素及自评健康状况有显著相关（尤其是ＧＤＳ１５）。结论两个量表均可作为评估对老年人提供社会支持、经济援助及增强体质成效的工具,ＧＤＳ１５具有较高的灵敏度。     

孤独症患儿生物学父母的认知功能研究

目的 比较孤独症父母和健康对照的认知功能,探索孤独症核心家系中神经心理的改变.方法 选用11个效能可靠的神经心理测验,通过与正常对照的比较,来探索孤独症父母的认知损害.结果 孤独症父母在数字符号、木块图、Stroop CW、言语流畅性测验的重复数、WCST的持续错误数、WCST的非持续错误数、坚持性反应数和概括力水平百分数、Hanoi塔的执行时间、Hanoi塔的总分和总分/执行时间测验上与正常对照组有明显差异.结论 孤独症父母存在一定程度的认知功能损害,特别是构建功能、注意和执行功能方面,这些神经心理指标可能是孤独症遗传的表型标记.     

宾夕法尼亚酒精渴求量表(PACS)的信度及效度研究

目的对宾夕法尼亚酒精渴求量表的信度和效度进行测试。方法选取200例符合ICD-10中酒依赖综合症的诊断标准的患者,进行宾夕法尼亚酒精渴求量表评测,对所获资料进行因素分析和信度及效度检验。结果①Cronbach’sα系数为0．97;分半信度为0．88,表明本量表具有较好的信度。②因素分析显示单一主成分87．82％;与VAS的相容效度0．89;量表总分与各项目分内部相关系数r在0．77—0．92,表明量表具有较好的效度。结论宾夕法尼亚酒精渴求量表具有较好的信度和效度,是一种较好的对酒精渴求度的评测工具,适合我国临床应用。     

自我效能量表的信度及效度研究

目的评价自我效能量表(SES)的信度和效度.方法由专业医生对45例心身科门诊心理咨询者评定SES和症状自评量表(SCL-90),一周后重测SES.对量表的内部一致性、重测信度及平行效度进行分析.结果SES的Cronbach'sα系数为0.7984,重测后各项目的相关系数均在0.672～0.932之间.SES的总分与SCL-90总分间的相关系数为0.454,且半数以上的项目与SCL-90总分呈明显相关.结论SES具有较好的信度和效度.     

Detecting panic disorder in medical and psychosomatic outpatients: comparative validation of the Hospital Anxiety and Depression Scale, the Patient Health Questionnaire, a screening question, and physicians' diagnosis

OBJECTIVES: To compare the validity of detecting panic disorder using the Hospital Anxiety and Depression Scale (HADS), the Patient Health Questionnaire (PHQ), a screening question, and physicians' diagnosis, and to test whether modified evaluation algorithms improve the operating characteristics of these questionnaires. Additionally, patient and physician acceptability of the screening questionnaires was investigated. METHODS: The total sample of 499 patients comprised 348 medical outpatients and 151 psychosomatic outpatients. The Structured Clinical Interview for DSM-IV (SCID) was the criterion standard for the presence of a panic disorder. Sensitivity, specificity, predictive values, and overall accuracy were compared for the different measures. The conditional test characteristics were calculated based on the observed prevalence of panic disorder in the medical and psychosomatic subsample, respectively. RESULTS: Panic disorder was diagnosed in 4.3% of the medical outpatients and in 19.2% of the psychosomatic outpatients. The HADS, PHQ, and screening question achieved good operating characteristics. In contrast, physicians detected only 15% of cases with panic disorder. Modified evaluation algorithms of the questionnaires lead to an improvement of test characteristics. Of all measures, the PHQ had the best operating characteristics. The use of screening questionnaires was accepted by 96% of the patients and 97% of the physicians. CONCLUSIONS: The questionnaires as well as the screening question performed well in detecting panic disorder. Thus, the integration of these highly accepted measures into clinical evaluation is suggested. Recommendations for the selection of specific evaluation algorithms are given.     

The validity of the Hospital Anxiety and Depression Scale. An updated literature review

OBJECTIVE: To review the literature of the validity of the Hospital Anxiety and Depression Scale (HADS). METHOD: A review of the 747 identified papers that used HADS was performed to address the following questions: (I) How are the factor structure, discriminant validity and the internal consistency of HADS? (II) How does HADS perform as a case finder for anxiety disorders and depression? (III) How does HADS agree with other self-rating instruments used to rate anxiety and depression? RESULTS: Most factor analyses demonstrated a two-factor solution in good accordance with the HADS subscales for Anxiety (HADS-A) and Depression (HADS-D), respectively. The correlations between the two subscales varied from.40 to.74 (mean.56). Cronbach's alpha for HADS-A varied from.68 to.93 (mean.83) and for HADS-D from.67 to.90 (mean.82). In most studies an optimal balance between sensitivity and specificity was achieved when caseness was defined by a score of 8 or above on both HADS-A and HADS-D. The sensitivity and specificity for both HADS-A and HADS-D of approximately 0.80 were very similar to the sensitivity and specificity achieved by the General Health Questionnaire (GHQ). Correlations between HADS and other commonly used questionnaires were in the range.49 to.83. CONCLUSIONS: HADS was found to perform well in assessing the symptom severity and caseness of anxiety disorders and depression in both somatic, psychiatric and primary care patients and in the general population.     

Detecting and monitoring depression with a two-item questionnaire (PHQ-2)

OBJECTIVE: This study evaluates the two-item Patient Health Questionnaire (PHQ-2) as a measure for diagnosing and monitoring depression. METHODS: We assessed construct validity in a cross-sectional sample of 1619 medical outpatients (mean age 43+/-14 years, 64% female) by comparing the PHQ-2 to four longer self-report questionnaires. Criterion validity was established in a subsample of 520 participants with reference to the Structured Clinical Interview for DSM-IV (SCID). Sensitivity to change was investigated in a prospective study of 167 patients who completed the SCID both at baseline and the 1-year follow-up. RESULTS: With reference to the SCID, the PHQ-2 had a sensitivity of 87% and a specificity of 78% for major depressive disorder and a sensitivity of 79% and a specificity of 86% for any depressive disorder. Its diagnostic performance was comparable with that of longer depression scales. PHQ-2 change scores accurately reflected improved, unchanged, and deteriorated depression outcomes. CONCLUSION: The PHQ-2 performed favorably with respect to a standard diagnostic interview, as well as established depression scales and proved sensitive to change. Thus, the PHQ-2 appears promising as a brief multipurpose measure for detecting depression, grading its severity, and monitoring outcomes over time.     

记忆改变测试量表中文版的信效度

目的 初步探讨记忆改变测试量表(M@T)中文版在我国老年人群中应用的信度、效度和可行性.方法 以横断面调查测试的形式测查220名某社区老年人,其中明确诊断为轻度认知功能损害(MCI)患者39例、阿尔茨海默病(AD)患者20例,认知正常者161名,用内部一致性、内容效度、标准效度、主成分和因子分析、影响因素等对测试结果进行评价.结果 M@T筛查量表克朗巴赫α系数(Cronbach α)为0.818.各项目得分与总分相关系数为0.5～0.9;MMSE与M@T相关系数为0.933.因子分析提取5个公因子,能解释总方差的69.449%,且各项目在相应因子上有较满意的因子载荷量(≥0.4).不同认知水平组M@T得分[认知正常组(39.0±3.7)分、MCI组(29.0±3.7)分、AD组(16.9±3.7)分]差异有统计学意义(F=498.419,P<0.05).不同性别、年龄、职业、文化程度人群的M@T得分差异无统计学意义.结论 中文版M@T具有较好的信效度和可行性,基本不受性别、年龄、职业、文化程度等因素的影响.

Abstract：

Objectives To study the reliability,validity and feasibility of the Chinese version of memory alteration test(M@T).Methods Cross-sectional survey with a convenience sample was employed to interview 220 elderly people over 60 years old,39 patients with mild cognitive impairment(MCI),20 with Alzheimer's disease(AD),and 161 normal cognitive elderly.The survey was,then evaluated with internal consistency,content validity,criterion validity,principal component/factor analysis and influencing factors.Results A Cronbach's α coefficient of 0.818 was obtained in M@T. The correlation coefficients which were the score of the subtest and the total were 0.5-0.9.The correlation coefficient of the scores of the Mini.mental State Examination(MMSE)and the M@T Was 0.933.The 5 factors were extracted with the factor analysis,which could explain the total variance of 69.449%,and the corresponding factors of the proieets have a satisfied amount of factor loading(≥0.4).There were significant diffeFences in the score of M@T among the different cognitive level groups with good discriminant validity(cognitive normal group:39.0±3.7,MCI group:29.0±3.7,AD group:16.9±3.7;F=498.419,P<0.05).There were no significant differences in the score of M@T among the different gender,age,occupation and education level groups.Conclusions The Chinese version of M@T has good reliability and validity and feasibility.The score of the M@T is not affected by gender,age,occupation,education level and other factors.     

The Autism Observation Scale for Infants: Scale Development and Reliability Data

The Autism Observation Scale for Infants (AOSI) was developed to detect and monitor early signs of autism as they emerge in high-risk infants (all with an older sibling with an autistic spectrum disorder). Here we describe the scale and its development, and provide preliminary data on its reliability. Inter-rater reliability both for total scores and total number of endorsed items is good to excellent at 6, 12 and 18 months; reliability is more modest for individual items, particularly in 6-month-olds. Test-retest reliability of the AOSI at 12 months of age is within acceptable limits. Evidence that the AOSI provides reliable data is the first critical step towards evaluating its efficacy in distinguishing high-risk infants who develop ASD.     

Trends in Autism Prevalence: Diagnostic Substitution Revisited

There has been little evidence to support the hypothesis that diagnostic substitution may contribute to increases in the administrative prevalence of autism. We examined trends in assignment of special education codes to British Columbia (BC) school children who had an autism code in at least 1 year between 1996 and 2004, inclusive. The proportion of children with an autism code increased from 12.3/10,000 in 1996 to 43.1/10,000 in 2004; 51.9% of this increase was attributable to children switching from another special education classification to autism (16.0/10,000). Taking into account the reverse situation (children with an autism code switching to another special education category (5.9/10.000)), diagnostic substitution accounted for at least one-third of the increase in autism prevalence over the study period.     

Using the Autism Diagnostic Interview-Revised and the Autism Diagnostic Observation Schedule-Generic for the Diagnosis of Autism Spectrum Disorders in a Greek Sample with a Wide Range of Intellectual Abilities

We studied the interrelationship between the Autism Diagnostic Observation Schedule-Generic (ADOS-G), the Autism Diagnostic Interview-Revised (ADI-R) and DSM-IV clinical diagnosis, in a Greek sample of 77 children and adolescents, referred for the assessment of a possible pervasive developmental disorder (PDD) and presenting a wide range of cognitive abilities. The agreement of the ADOS-G and the ADI-R with the clinical diagnosis was estimated as satisfactory and moderate, respectively, while both instruments presented with excellent sensitivity for the diagnosis of autistic disorder along with satisfactory specificity. ADOS-G/ADI-R agreement was estimated as fair. Our results confirm the discriminant validity of ADI-R and ADOS-G in diagnosing pervasive developmental disorders in children and adolescents with a wide range of intellectual abilities.     

Diagnostic utility of the autism diagnostic observation schedule in a clinical sample of adolescents and adults

BackgroundThe Autism Diagnostic Observation Schedule (ADOS) Module 4 was investigated in an independent clinical sample of highfunctioning adolescent and adult males and females with suspected autism spectrum disorder. Special attention was paid to the performance of the ADOS in the subgroups autism spectrum disorders (ASD), personality disorders and disorders with onset usually occurring in childhood and adolescence.MethodThe recently revised algorithm and severity scores for Module 4 were used to analyze predictive values compared to the original algorithm in a sample of N = 356, 21% females, age range 12–68 yrs.ResultsBoth algorithms have good sensitivity and specificity, with slightly better results for the revised algorithm. Diagnostic accuracy is lower for females, older individuals, and individuals with personality disorders or higher intellectual abilities.ConclusionThe revised algorithm has good utility when used as part of a comprehensive assessment procedure conducted by an experienced examiner and including information on developmental history.     

Discriminant validity of the 12-item version of the general health questionnaire in a Swedish case-control study

Background: The 12-item version of the General Health Questionnaire (GHQ-12) is widely used as a proxy for Affective Disorders in public health surveys, although the cut-off points for distress vary considerably between studies. The agreement between the GHQ-12 score and having a clinical disorder in the study population is usually unknown.

Aims: This study aimed to assess the criterion validity and to determine the sensitivity and specificity of the GHQ-12 in the Swedish population.

Methods: This study used 556 patient cases surveyed in specialized psychiatric care outpatient age- and sex-matched with 556 controls from the Stockholm Health Survey. Criterion validity for two scoring methods of GHQ-12 was tested using Receiver Operating Characteristics (ROC) analyses with Area Under the Curve (AUC) as a measure of agreement. Reference standard was (1) specialized psychiatric care and (2) current depression, anxiety or adjustment disorder.

Results: Both the Likert and Standard GHQ-12 scoring method discriminated excellently between individuals using specialized psychiatric services and healthy controls (Likert index AUC?=?0.86, GHQ index AUC?=?0.83), and between individuals with current disorder from healthy controls (Likert index AUC?=?0.90, GHQ index AUC?=?0.88). The best cut-off point for the GHQ index was ≥4 (sensitivity?=?81.7 and specificity?=?85.4), and for the Likert index ≥14 (sensitivity?=?85.5 and specificity?=?83.2).

Conclusions: The GHQ-12 has excellent discriminant validity and is well suited as a non-specific measure of affective disorders in public mental health surveys.