目的 分析心境障碍问卷(MDQ)和32项轻躁狂症状清单(HCL-32)在精神病专科医院抑郁症患者中筛查轻躁狂/躁狂症状的检出率差异、阴性与阳性患者临床特征的差异.方法 选取2014年9月至2015年12月于首都医科大学附属北京安定医院住院或门诊就诊的105例抑郁症患者为研究对象,使用MDQ和HCL-32调查患者既往轻躁狂/躁狂症状,其中MDQ总分≥7分、HCL-32总分≥14分为既往轻躁狂/躁狂症状阳性,比较2个量表的阳性检出率、阳性与阴性患者的临床特征.采用Cronbach'sα系数检验量表信度.结果 MDQ的Cronbach'sα系数为0.784(95％CI:0.718～0.840,P<0.01),HCL-32的Cronbach'sα系数为0.943(95％CI:0.926～0.958,P<0.01).MDQ筛查的阳性率为15.24％(16/105),低于HCL-32筛查的40.95％(43/105),差异有统计学意义(P<0.01).2个量表的一致性较低,差异有统计学意义(Kappa=0.281,P<0.01).MDQ筛查阳性的患者中,伴有自杀观念、企图或行为者占7/16,伴不典型抑郁症状者占6/16,高于阴性患者的29.21％(26/89)和13.48％(12/89),差异有统计学意义(P<0.05).结论 HCL-32对抑郁症患者既往轻躁狂/躁狂症状的检出率高于MDQ,并且筛查阳性的抑郁症患者的自杀风险高,伴不典型抑郁特征.

Background To assess the reliability and validity of Patient Health Questionnaire-9 (PHQ-9) for patients with major depressive disorder (MDD) and to assess the feasibility of its use in psychiatric hospitals in China. Methods One hundred nine outpatients or inpatients with MDD who qualified the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria completed PHQ-9 and Hamilton Depression Scale (HAMD-17). Two weeks after the initial evaluation, 54 randomly selected patients underwent repeat assessment using PHQ-9. For validity analysis, the construct validity and criterion validity were assessed. The internal concordance coefficient and the test-retest correlation coefficients were used for reliability analysis. The correlation between total score and scores for each item and the correlation between scores for various items were evaluated using Pearson correlation coefficient. Results Principal components factor analysis showed good construct validity of the PHQ-9. PHQ-9 total score showed a positive correlation with HAMD-17 total score ( r = 0.610, P < 0.001). With HAMD as the standard, PHQ-9 depression scores of 7, 15, and 21 points were used as cut-offs for mild, moderate, and severe depression, respectively. Consistency assessment was conducted between the depression severity as assessed by PHQ-9 and HAMD (Kappa = 0.229, P < 0.001). Intraclass correlation coefficient between PHQ-9 total score and HAMD total score was 0.594 (95% confidence interval, 0.456–0.704, P < 0.001). The Cronbach’s α coefficient of PHQ-9 was 0.892. Correlation coefficients between each item score and the total score ranged from 0.567–0.789 ( P < 0.01); the correlation coefficient between various item scores ranged from 0.233–0.747. The test-retest correlation coefficient for total score was 0.737. Conclusions PHQ-9 showed good reliability and validity, and high adaptability for patients with MDD in psychiatric hospital. It is a simple, rapid, effective, and reliable tool for screening and evaluation of the severity of depression.

目的 采用德尔菲法调查国内精神分裂症认知行为治疗(CBT)技术的应用现状,进一步规范国内精神分裂症CBT技术.方法 在文献复习、专家论证会基础上制订专家咨询表,经过两轮专家咨询,对各项技术成分从可操作性、使用频率、对治疗效果的贡献及来访者的可接受性4个不同维度进行综合评价,根据各项技术综合秩次大小进行排序;采用描述性统计分析的方法对专家基本情况、专家意见集中程度及协调程度进行分析,并评价专家咨询的可靠性.结果 (1)参与本研究的23位专家平均权威系数为0.84,专家积极系数均为100％.(2)经过两轮咨询,在四个维度上评分的变异系数>0.30的技术明显减少,全部技术的协调系数在0.4～0.5.(3)综合4个维度的权重,根据各项技术成分综合秩次大小排出46项技术的顺序,前35位的技术成分除行为激活、声音日记外在各个维度上均达成专家共识,排序为36～46位的主要是针对阴性症状的治疗技术专家意见存在一定程度分歧.结论 本研究的专家积极程度高,权威性高,结果可靠;专家意见的协调程度较好;经过两轮咨询,综合4个不同维度确定了46项技术的权重.

Objective:To investigate the insight impact on social functioning in patients with schizophre-nia. Method:Used the schedule for assessing insight( SAI),personal and social performance scale( PSP)to assess the insight and social function of 168 patients who met the diagnostic and statistical manual of mental dis-orders,fourth edition,criteria for schizophrenia at the baselines,and at the 12 th and 24 th week. Analyzed com-parison the change and correlation of PSP and SAI in different time points. Results:From baseline to 12 weeks,the change of PSP was positively correlated with the change of total score of SAI,compliance,disease awareness and mental symptom sign(r=0. 359,r=0. 186,r=0. 357,r=0. 214;all P<0. 001). The change of total score of SAI had an impact on the change of score of PSP(β=0. 359,P=0. 000). From 12 weeks to 24 weeks,the change of score of PSP was positively correlated with changes of total score of SAI,compliance,dis-ease awareness and mental symptom sign(r=0. 232,r=0. 129,r=0. 224,r=0. 174,all P<0. 05). The change of score of PSP was affected by change of total score of SAI(β=0. 232,P=0. 003). Conclusion:The recov-ery of insight has a significant impact on social function improvement in patients with schizophrenia.

目的:探讨精神分裂症患者自知力及精神症状对生活质量的影响.方法:选取符合美国精神疾病诊断与统计手册第4版(DSM-Ⅳ)中精神分裂症诊断标准的医院门诊和住院患者共180例.采用世界卫生组织生存质量测定量表简表(WHOQOL-BREF)、自知力评定量表(SAI)、阳性与阴性症状量表(PANSS)对患者进行评估.结果:生活质量的生理因子与依从性、疾病意识、精神症状标识及自知力总分显著负相关(r =-0.232,-0.243,-0.171,-0.274;P ＜0.05);心理因子与疾病意识和自知力总分显著负相关(r=-0.219,-0.203;P ＜0.01);生活质量总分与疾病意识和自知力总分负相关(r =-0.169,-0.175;P ＜0.05),生活质量受自知力总分和阴性症状的影响(β=-0.312,P=0.000;β=-0.157,P=0.037),疾病意识对生活质量心理因子有预测作用(β=-0.291,P=0.003);生活质量总分受自知力总分的影响(β=-0.594,P=0.019).结论:①自知力较好的患者生活质量较低;②心理因子受疾病意识的影响;③阴性症状对生活质量有影响.

Objective:To explore the status of cognitive-behavioral therapy(CBT) components for generalized anxiety disorder(GAD) by Delphi Poll,in order to lay a foundation to standard domestic CBT techniques.Methods:Totally 35 technique components for GAD were chosen from foreign literatures of randomcontrol study.Questionnaires including these 35 components were filled in by 31 experts of CBT.After two rounds of expert consultation,the CBT components for GAD were sorted.Results:The components of establishing therapeutic alliance,psychoeducation,assessment and relaxation training were on the first 4 ranks.However the commonly used components in foreign clinical trials such as socratic questioning and worry exposure,only on the rank of 26 and 22,and the coefficient of variation of thought stopping on the dimensions of operability,frequency of utilization and contribution of treatment were 0.25,0.36,and 0.31,respectively.Conclusion:It suggests that in the GAD therapy,establishing therapeutic alliance,psychoeducation,collection/assessment and relaxation training are reached agreement by CBT experts,and whether the technique of thought stopping should be rejected need to be further studied.

Objective To investigate reliability and validity of the Chinese version of the schedule for assessment of insight (SAI).Methods The original version of SAI was translated into Chinese and then backtranslated into English to develop the Chinese version of SAI which reliability and validity were tested.220 subjects who met the diagnosis of Schizophrenia,schizophreniform disorder,schizoaffective disorder,delusional disorder or brief psychotic disorder were assessed.Results The Cronbach's α was 0.890 ; the test-retest reliability was 0.742 ; the inter-rater reliability was 0.986.Three main factors were obtained from the factor load matrix as awareness of illness,ability to relabel psychotic experience,compliance with treatment.The loading coefficient were 0.883-0.944.The correlation of the SAI total score and three subscales with insight of PANSS were-0.635,-0.305,-0.631 and-0.512 respectively (P ＜ 0.01).Conclusion The SAI has good reliability and validity.The scale is useful to measure insight in psychosis.

本文论述了运用认知行为治疗(CBT)治疗精神分裂症的主要技术。