精神病症状维度评定量表中文版的效度和信度

目的:评价精神病症状维度评定量表(CRDPSS)中文版的效度和信度。方法:选取精神疾病患者86例,其中精神分裂症48例,心境障碍38例。以阳性和阴性症状量表(PANSS)、汉密尔顿抑郁量表(HAMD-17)、杨氏躁狂评定量表(YMRS)为校标工具。选取其中5例患者由9名精神科医师共同完成检查后独立评分,评估评定者一致性信度;选取40例在首次测评1周后重测。结果:主成分分析得出阴性症状与认知缺损、幻觉妄想、情感症状、言行紊乱4个主成份因子,可解释总方差的76.4%;CRDPSS总分与PANSS总分呈正相关(r=0.65,P0.01);CRDPSS对非情感性精神障碍和情感性精神障碍的正确分类率为93.8%。CRDPSS的评定者一致性信度(ICC)为0.88,重测一致性度(ICC)为0.94;总量表内部一致性Cronbach α系数为0.66,各主成分因子内的α系数为0.56～0.87。结论:精神病症状维度评定量表有较好效度和信度,适用于临床精神症状的评估。     

阳性和阴性症状量表(PANSS,中文版)的信、效度研究

目的:以阳性和阴性症状量表(PANSS)中文版为基础,进一步分析其心理测量特质,并简要介绍临床应用.方法:选取105例诊断符合国际疾病分类手册第10版(ICD-10)中精神分裂症标准的患者进行PANSS评定,对原始评定结果进行因子分析、信度分析.结果:因子分析提出5个因子,分别是:阴性症状、阳性症状、兴奋敌对、焦虑抑郁、认知缺损;信度分析显示量表的标准化Cronbach α值为0.8707,5个维度的Cronbach α值在0.7434-0.9044间,项目间具有内在的一致性.结论:PANSS中文版有较好的信、效度,适用于精神分裂症症状的量化评估.     

中文版注意缺陷多动障碍SNAP-Ⅳ评定量表-父母版的信效度

目的:引进中文版注意缺陷多动障碍SNAP-Ⅳ评定量表-父母版(Chinese version of Swanson Nolan and Pelham,VersionⅣScale-parent form,SNAP-Ⅳ)并检验其信效度.方法:对31名符合美国精神障碍诊断与统计手册第4版诊断标准的注意缺陷多动障碍(ADHD)门诊患儿和231名正常儿童进行中文版注意缺陷多动障碍SNAP-Ⅳ评定量表父母版、中文版Conners父母用症状问卷(PSQ)及中文版Achenbach儿童行为量表(CBCL)评估,以检验校标效度.对27名受试者(ADHD组3人,正常组24人)1周内再次进行中文版注意缺陷多动障碍SNAP-Ⅳ评定量表父母版评估,以检验重测信度.结果:中文版注意缺陷多动障碍SNAP-Ⅳ评定量表父母版全量表内部一致性信度Cronbachα系数为0.95,注意力不集中、多动冲动、对立违抗3个分量表Cronbach α系数分别为0.90、0.89、0.88.重测信度组内相关系数(ICC)为0.68,3个分量表的重测信度ICC分别为0.75、0.76、0.24.中文版注意缺陷多动障碍SNAP-Ⅳ评定量表父母版与PSQ及CBCL对应各因子得分之间相关系数分别介于0.29～0.73、0.30～0.74,验证性因子分析显示中文版注意缺陷多动障碍SNAP-Ⅳ评定量表父母版的3因子及4因子模型均合理.中文版注意缺陷多动障碍SNAP-Ⅳ评定量表父母版诊断ADHD敏感度为0.87,特异度为0.79.结论:中文版注意缺陷多动障碍SNAP-Ⅳ评定量表父母版具有良好的信度与效度.     

中文版修订躯体快感缺失量表的信度和效度

目的对中文版修订躯体快感缺失量表(RPAS-C)的信度和效度作初步分析。方法采用RPAS-C对202名精神分裂症患者及311名正常人进行评估,2周后随机抽取其中100名精神分裂症患者和74名正常人进行重测。以多伦多述情障碍量表(TAS-20)总分和阳性与阴性症状量表(PANSS)的阴性症状分为校标,计算校标关联效度。结果总样本RPAS-C的Cronbach'sα系数为0.850,分半信度为0.796,重测信度为0.909,患者组与正常组的Cronbach'sα系数、分半信度和重测信度趋于一致;患者组RPAS-C得分高于正常组,差异具有统计学意义(P0.01);总样本、患者组和正常组RPAS-C得分与述情障碍总分间的相关系数分别为0.316、0.422和0.237,患者组RPAS-C得分与PANSS阴性症状分的相关系数为0.448,具有显著统计学意义(均P0.01)。结论 RPAS-C具有较好的信度和效度,可用于中国精神分裂症患者人群和正常人群躯体快感缺失的评估。     

卡尔加里精神分裂症抑郁量表(中文版)信效度初步分析

目的: 考察卡尔加里精神分裂症抑郁量表(中文版)(Calgary Depression Scale for Schizophrenia,CDSS-C)的信度及效度. 方法: 采用张鸿燕翻译的卡尔加里精神分裂症抑郁量表对100名住院精神分裂症患者进行测试,并同时测定汉密顿抑郁量表(Hamilton Depression Scale ,HAMD-24)、阳性阴性症状量表(Positive and Negative Syndrome Scale ,PANSS)、治疗中出现的症状量表(Treatment Emergent Symptom Scale ,TESS). 结果: ①CDSS-C全量表的 Cronbach α系数为0.798~0.810,Spearman-Brown分半信度分别为0.694~0.727,重测信度为0.638~0.831;②CDSS-C的9个条目被确定为2个因子:抑郁体验因子和自我评价因子;③CDSS-C量表总分与HAMD-24和PANSS-G6的相关系数分别为0.76、0.70;④CDSS-C判断抑郁的划界分为≥6分. 结论: 卡尔加里精神分裂症抑郁量表(中文版)具有良好的信度及效度,可以有效地识别精神分裂症的抑郁症状.     

中文版精神病高危症状量表的信度和效度

目的:检验中文版精神病高危症状量表(SOPS)的信度和效度。方法:经原著者同意,汉化英文版精神病高危综合征定式访谈(SIPS)工具,该工具包括精神病高危症状量表(SOPS)。应用中文版SIPS在心理咨询中心筛选出104例精神病高危综合征(PRS)个体,对其进行SOPS评分。用组内相关法(ICC)计算评估者间一致性信度;Cronbachα系数计算内部一致性信度;计算单项与总和的Spearman相关系数;应用探索性因子分析检测SOPS的结构效度;应用Pearson相关分析探讨SOPS与阳性及阴性症状量表(PANSS)的同时效度;半年后对PRS个体随访,观察向精神病性障碍的转化率,评估预测效度。结果:中文版SOPS评定者间一致性系数为0.96;Cronbachα系数为0.71;各条目与总分的相关系数在0.19到0.66之间(P0.05);探索性因子分析得到3个因子,解释总方差的43.9%,除了P3夸大观念、P4知觉异常/幻觉,其余项目的因子载荷均高于0.4;同时效度分析,SOPS总分与PANSS总分显著相关(r=0.63,P0.01);半年后随访发现PRS个体向精神病性障碍的转化率为5.8%。结论:中文版SOPS评估精神病高危症状具有良好的信度和效度,可以用于评估及研究我国的精神病高危患者。     

异常行为量表中文版在儿童孤独症群体中的信效度

目的:引进并探讨异常行为量表(Aberrant Behavior Checklist,ABC)在我国儿童孤独症群体的适用性。方法:对206例孤独症儿童(1.5~14.0岁)进行ABC评定,其中49例患儿由父母分别填写ABC,30例患儿于2~4周后由同一位家长再次评定,以检验评定者信度和重测信度;根据适用年龄范围对部分患儿评定儿童孤独症评定量表、孤独症行为评定量表、Conner父母评定量表及Achenbach儿童行为量表,经比较检验ABC的校标效度;对ABC结构模型进行验证性因素分析以检验结构效度。结果:ABC中文版各因子的评定者信度(ICC)在0.820~0.898之间(P<0.001),重测信度(ICC)0.873~0.944(P<0.001),各因子及总量表的内部一致性系数为0.748~0.951;ABC中文版各因子与儿童孤独症评定量表、孤独症行为评定量表、Conner父母评定量表及Achenbach儿童行为量表的相应因子间呈正相关(r=0.27~0.67,均P<0.01);验证性因素分析检验了结构的有效性(χ2/df=1.91,RMSEA=0.060,GFI=0.704,NFI=0.62,CFI=0.77)。结论:异常行为量表中文版的信、效度较好,适用于儿童孤独症的量化评估,但仍需进一步修订完善。     

社交技能评定目录中文版在精神障碍患者中应用的信效度

目的:验证社交技能评定目录(SSC)中文版在我国精神障碍患者社交技能评估中的信效度。方法:选择按美国精神障碍诊断和统计手册第4版(DSM-IV)诊断为精神分裂症、情感障碍及其他精神障碍的患者共200名(病例组)及正常对照30名(正常组),请3名精神科专业人员用SSC进行评估,并对其中30名患者同时评定世界卫生组织残疾评定量表-II(WHO-DAS-II)和自我意识量表的社交焦虑分量表(SAS)。结果:SSC中文版的重测信度为0.93~0.99,评定者一致性0.92,内部一致性0.81~0.94;SSC中文版得分与WHO-DAS-II和SAS得分呈正相关(r=0.37~0.72,P<0.05),但区分效度有待进一步验证;探索性因素分析将SSC中文版聚合为3因子模型,验证性因素分析显示该模型结构大致合理(除近似均方根误差外)。精神分裂症组SCC中文版各因子评分均高于对照组,情感障碍组的交谈和冲突处理能力评分高于对照组(P<0.001)。结论:社交技能评定目录用于我国18岁以上精神障碍患者的社交技能评估的信效度良好,但区分效度和结构效度有待进一步验证。     

世界卫生组织残疾评定量表第2版中文版在精神残疾评定中的信效度检验

目的:检验世界卫生组织残疾评定量表第2版中文版(WHO-DASⅡ)在精神残疾评定中的信度和效度,以探讨其在精神疾病患者中的适用性.方法:对218例精神残疾者进行WHO-DASⅡ评定,采用相关分析和Cronbach α系数检验量表内部一致性信度;应用探索和验证性因素分析检验量表结构效度;以不同精神疾病的得分差异检验量表的实证效度.结果:总量表内部一致性Cronbach α系数为0.93,6个分量表α系数在0.69～0.94之间;评定者一致性为0.93.除分量表6外其余5个分量表内部各条目间、6个分量表之间以及分量表与总分之间均呈正相关(r =0.17 ～0.91,P＜0.05).探索性因素分析显示,6个因子累积解释的总方差为63.68％,所有因子特征根均大于1;但各因子包含题项均与原量表不一致;验证性因素分析显示原量表结构与样本的拟合度较差(x2/df=4.24,P＜0.001、GFI=0.57、NFI=0.58、CFI =0.64、RMSEA =0.12).器质性精神障碍组的总分和理解与交流、身体移动、自我照料3个分量表得分均高于情感性精神障碍组和精神分裂症组(P＜0.05).结论:世界卫生组织残疾评定量表第2版中文版具有较好的内部一致性信度和实证效度,但结构效度不理想,有待进一步探索和验证.     

中文版布罗塞特暴力风险评估量表测评儿童青少年严重精神障碍患者的效度和信度

目的:检验中文版布罗塞特暴力风险评估量表(BVC)在我国儿童青少年精神障碍患者中的效度信度。方法:临床精神科工作的6名专家对中文版BVC量表的内容效度评定。选取346例符合DSM-IV精神分裂症、双相I型障碍躁狂发作诊断标准的4～16岁患者,中文版BVC量表每8h评估一次,用Achenbach儿童行为量表(CBCL)攻击性因子检验同时效度,根据暴力行为出现的真实结果检验量表的预测效度;应用Cronbach α系数检验量表的内部一致性信度。结果:中文版BVC量表的内容效度为0.91,总分与CBCL攻击性因子得分之间呈中度正相关(r=0.32,P0.01)。ROC曲线下面积为0.93(P0.01),临界点为2时,工具灵敏度为83.7%,特异度为89.0%。量表的内部一致性信度Cronbach α系数为0.90,题总相关系数r=0.60～0.80(P0.01)。结论:中文版BVC量表测评儿童青少年严重精神障碍患者的同时效度、预测效度和信度符合测量学基本要求。     

Depersonalization as a mediator in the relationship between self-focused attention and auditory hallucinations

The purpose of this work was to study the potentially mediating role of certain dissociative factors, such as depersonalization, between self-focused attention and auditory hallucinations. A total of 59 patients diagnosed with schizophrenic disorder completed a self-focused attention scale ( M. F. Scheier & C. S. Carver, 1985 ), the Cambridge Depersonalization Scale (M. Sierra & G. E. Berrios, 2000), and the hallucination and delusion items on the Positive and Negative Syndrome Scale (S. R. Kay, L. A. Opler, & J. P. Lindenmayer, 1988). The results showed that self-focused attention correlated positively with auditory hallucinations, with delusions, and with depersonalization. It was also demonstrated that depersonalization has a mediating role between self-focused attention and auditory hallucinations but not delusions. In the discussion, the importance of dissociative processes in understanding the formation and maintenance of auditory hallucinations is suggested.     

低频重复经颅磁刺激治疗精神分裂症患者的顽固性幻听

目的:探讨左背外侧前额叶低频重复经颅磁刺激(rTMS)治疗精神分裂症患者顽固性幻听的临床疗效。方法:本研究为随机双盲对照研究。根据美国精神障碍诊断统计手册第4版(DSM-Ⅳ)的诊断标准,选取122例伴顽固性幻听的精神分裂症患者按2∶1随机分为治疗组(n=88)和对照组(n=34)。治疗组共接受6周的rTMS治疗,对照组接受伪刺激治疗。采用阳性和阴性症状量表(PANSS)、幻听量表(AHRS)、临床疗效总印象量表(CGI)评定临床症状,采用UKU副作用量表评估不良反应。对治疗组于治疗结束后在1、3、6个月进行随访。结果:共有108例(88.5%)患者完成治疗。两组间治疗6周末PANSS、AHRS、CGI量表得分差异无统计学意义(均P0.05)。但治疗组病程≤10年、病程10～20年的患者AHRS评分低于同病程的对照组(均P0.05),病程在20年以上的治疗组和对照组间差异无统计学意义(P=0.929,F=0.008)。治疗组除4例患者治疗时出现头痛外,余无不适主诉。结论:1Hz左背外侧前额叶低频rTMS治疗能减轻病程20年内的精神分裂症患者的顽固性幻听,可作为一种有效的安全性好的治疗手段。     

Insight among psychotic patients with auditory hallucinations

Poor insight in psychosis has been described as a seeming lack of awareness of the deficits, consequences of the disorder, and of the need for treatment. The aim of this study is to investigate whether patients with auditory hallucinations have less insight than those without hallucinations, and to determine which hallucination characteristics are related to patient insight. Using the PANSS and PSYRATS, the authors have evaluated the lack of insight data corresponding to 168 psychotic patients divided into three groups: patients with a history of nonpersistent hallucinations, patients with persistent hallucinations, and patients without hallucinations. Patients with persistent hallucinations showed significantly less insight than patients without persistent hallucinations and patients without hallucinations, the farther away the hallucination is located, the greater the lack of patient insight. Patients who hear the hallucination inside their head rather than outside show better insight, possibly because such patients can understand the voice as being created by their own mind.     

低频重复经颅磁刺激治疗左右利手精神分裂症幻听对照研究

目的:探讨低频重复经颅磁刺激治疗左、右利手精神分裂症幻听的疗效及安全性。方法:95例精神分裂症幻听按左、右利手分为两组,右利手组(72例)和左利手组(23例),均在原来抗精神病药治疗的基础上给予低频重复经颅磁刺激治疗共4周。治疗前及治疗后2、4周末分别用幻听评定量表(AHRS)评定幻听治疗效果,用阳性和阴性症状量表(PANSS)评定临床疗效,用副反应量表(TESS)评定不良反应。结果:治疗中左、右利手组各有1例脱落。4周末右利手组与左利手组AHRS比较有显著性差异(t=2.12,P0.05),右利手组减分高于左利手组。PANSS评分两组比较有显著性差异(t=2.30,P0.05)。不良反应两组间比较无显著性差异。结论:低频重复经颅磁刺激治疗右利手精神分裂症幻听好于左利手者。     

Auditory hallucinations: a review of assessment tools

Auditory hallucinations are a common and troubling symptom in psychotic disorders. We aimed to identify measures that could be used by clinicians and researchers to assess the experience of auditory hallucinations. A literature review was conducted to identify auditory hallucination measures that were developed since the last such review in 1998. We identified 10 tools: eight self-report measures and two clinical interviews. The scales measured diverse constructs and are divided into four categories for review: multidimensional assessment, coping strategies, rating of beliefs and acceptance or mindfulness. Evidence of the measures' reliability, validity and sensitivity to change are discussed. There has been an expansion in the range of instruments available, particularly in self-report questionnaires and in measures that focus on psychological aspects such as attitudes and beliefs regarding voices.     

个体和社会功能量表中文版在精神分裂症患者中的信效度

目的:考察个体和社会功能量表(Personal and Social Performance scale,PSP)中文版(PSP-CHN)在精神分裂症患者中的信度和效度.方法:收集165例符合DSM-IV-TR精神分裂症诊断标准的门诊或住院精神分裂症患者,10例患者用于研究者一致性培训,155例进行大体社会功能量表(Global Assessment of Functioning Scale,GAF))、阳性和阴性症状量表(Positive and Negative Syndrome Scale,PANSS)和PSP-CHN检查,分析PSP-CHN量表的内部一致性、PSP-CHN与GAF的一致性(效标效度)以及与患者疾病严重度的相关性(关联效度).66例患者在首次PSP-CHN评估后的5～7天内,由另一名研究者对患者进行第2次检查,评价PSP-CHN的重测信度.27例PANSS总分≥60分的患者,接受系统药物治疗8周,评估8周后PANSS及PSP-CHN评分改变,以及二者的相关性.结果:PSP-CHN量表的内部一致性Cronbach α系数为0.84,PSP-CHN总分的研究者之间一致性Kappa值为0.56(ICC=0.94),重测一致性ICC＝0.95.PSP-CHN总分与GAF有较好的相关性(ICC＝0.95),与PANSS总分及分量表分负相关(r=-0.79,-0.57,-0.63和-0.71,P＜0.01).治疗8周后,治疗有效患者(定义为PANSS与基线比较的减分率≥50%)PSP评分增加(平均增加21.2)明显高于部分有效的患者(定义为PANSS与基线比较的减分率<50%,PSP增加10.2分).结论:个体和社会功能量表中文版是评估精神分裂症急性期和稳定期患者个人和社会功能的一个简洁、易操作、较稳定的工具,适用于临床实践或研究中使用.     

31例住院精神疾病患者使用日常生活用具自杀未遂调查分析

目的探讨31例住院精神疾病患者使用日常生活用具自杀未遂的原因及相关因素分析。方法 1999-2011年住院精神疾病患者。运用自编自杀未遂登记表及阳性与阴性症状量表(PANSS)、焦虑自评量表(SAS)、抑郁自评量表(SDS)进行分析。结果年龄低,文化水平低,无业下岗患者多;经济收入低,家人关心少。1月内发病5例(16%),吞异物18例(58%),不安心住院12例(38%),幻觉、妄想11例(35%),冲动控制障碍14例(45%),PANSS因子分均提示偏重。6例(19%)情感性精神障碍抑郁发作,SDS、SAS显示中度抑郁和轻度焦虑。抑郁发作和精神分裂症发生率高(83%),与精神症状有关。结论自杀未遂者弱势群体多与精神症状有关,早期住院患者与不安心住院患者应引起重视。     

Validation of the Korean-Version of the Clinical Assessment Interview for Negative Symptoms of Schizophrenia (CAINS)

The Clinical Assessment Interview for Negative Symptoms (CAINS) was developed to overcome the limitations of existing instruments and reflect the current view of negative symptoms. The aim of the present study was to evaluate the reliability and validity of the Korean version of the Clinical Assessment Interview for Negative Symptoms (K-CAINS). Inpatients (n = 49) and outpatients (n = 70) with schizophrenia were recruited from three institutions. The confirmative factor analysis, test-retest reliability, inter-rater reliability, convergent validity, and discriminant validity were assessed. The study group consisted of 71 males (59.7%) and 48 females (40.3%). Their mean age was 42.15 years (SD = 12.2). The K-CAINS was confirmed to be divided into two subscales of 9 items related to "motivation/pleasure" and 4 items related to "expression" in concordance with the original version of the CAINS. The results showed that the K-CAINS had a good inter-rater reliability (ICC = 0.84-0.94), test-retest reliability (r = 0.90, P < 0.001). Convergent validity was proven by demonstrating a significant correlation with the Positive and Negative Syndrome Scale (PANSS) negative subscale, and the Scale for the Assessment of Negative Symptoms (SANS). Discriminant validity was proven by the lack of a significant correlation with the PANSS positive subscale, the Korean version of the Beck depression inventory (BDI), the Korean version of the Calgary depression scale for schizophrenia (K-CDSS), and the Modified Simpson Angus scale (MSAS). The K-CAINS could be a reliable and valid tool to assess the negative symptoms of Korean schizophrenia patients.     

Hallucinations auditives induites par le voriconazole : illustration par le monitorage plasmatique

Voriconazole is a second-generation azole antifungal that is widely indicated in the treatment of invasive aspergillosis. It is generally well tolerated. It has nevertheless numerous side effects like hepatotoxicity, photosensitivity, skin rashes, and visual disturbances. Hallucinations were also reported as side effects to voriconazole but auditory hallucinations were rarely reported and seem to be related to toxic voriconazole blood levels. We report, herein, a case of auditory hallucination with monitoring of voriconazole plasma concentration during hallucination and after its disappearance. A 38-year-old man was treated with intravenously voriconazole for a pulmonary aspergillosis. Seven days after the initiation of voriconazole, the patient presented a sudden history of auditory hallucination associated to incoherence and temporo-spatial disorientation. Therapeutic drug monitoring of voriconazole showed a plasmatic residual concentration (C₀) of 7.5 μg/mL (therapeutic interval: 1.4–1.8 μg/mL) and a pic concentration (C_max) of 9.83 μg/mL (therapeutic interval: 2.1–4.8 μg/ml). Voriconazole was then stopped and, two days later, symptomatology completely disappeared and at the same time levels of voriconazole decreased (C₀ = 0.11 μg/mL and C_max = 2.17 μg/mL). We concluded in our case that the patient's auditory hallucinations were caused by voriconazole treatment. In fact, the sudden onset of hallucinations was concomitant with high plasmatic voriconazole levels, and since the medication was stopped, an important decrease of voriconazole levels was observed which was associated with a sudden disappearance of the auditory hallucinations.