精神分裂症抑郁症状的识别与诊断——四种抑郁量表的比较

目的 比较四种抑郁量表对精神分裂症抑郁症状的诊断效能.方法 100例符合CCMD-3精神分裂症诊断标准的患者进入研究,以CCMD-3抑郁发作标准判断是否存在有抑郁症状,同时进行CDSS-C、MADRS、HAMD-24、PANSS及RSESE测评.结果 (1)100例患者中符合CCMD-3抑郁发作标准诊断抑郁者22人,抑郁发生率为22％；(2)CDSS-C、MADRS、HAMD-24、PANSS-G相互之间相关性均较高,但只有CDSS-C与PANSS-N、阴性症状各条目及RSESE无相关；(3) CDSS-C与MADRS、HAMD- 24、PANSS- G6的工作特征曲线下面积(AUROC)分别为:0.933、0.826、0.883及0.887,CDSS-C的AUROC要明显高于其他三个抑郁量表(P＜0.05).结论 CDSS-C是较理想的测评精神分裂症抑郁症状的工具,可在临床尝试使用.

The discrimination and diagnosis for the depressive symptoms in patients with Schizophrenia- Comparison of the four assessment scales for depression

Objective To＇compare the diagnostic validity of 4 commonly used assessment scales for depression in schizophrenia. Methods The study population consisted of 100 schizophrenic patients who met CCMD-3 criteria for schizophrenia. Depression in the study subjects was defined by the CCMD -3 criteria for a major depressive episode. The following 4 depression scales were assessed for their diagnostic validity as measures of depressive disorder in schizophrenia： the Calgary Depression Scale for Schizophrenia （CDSS-C）,the Montgomery-Asberg Depression Rating Scale （MADRS）, the Hamilton Rating Scale for Depression （HAMD-24）,and the depression subscale of the PANSS （PANSS-D）. At the same time,we also undertook the negative subscale of the PANSS（PANSS-N） and the Rating Scale for Extrapyramidal Side Effects（RSESE）. Results （1） There were 22 patients who met the CCMD-3 criteria for a major depressive episode among the 100 schizophrenia patients,so the incidence of depression was 22%. （2）The depression scales were found to be highly intercorrelated with each other. Of the 4 depression scales studied,only CDSS.-C can discriminate between depression and a PANSS negative symptoms subscale score or negative item scores or a RSESE score. （3）The areas under the receiver 0p- crating characteristic curves of the CDSS-C, MARDS, HAMD-24, and PANSS-D were 0. 933,0. 826, 0. 883 and 0. 887 respectively. The area under the receiver operating characteristic curve of the CDSS-C was significantly greater than those of MARDS, HAMD-24,and PANSS-D. Conclusions Our study suggests that the CDSS-C may provide optimal assessment on depression in patients with schizophrenia and is feasible to attempt to use in the clinic.