Robertson M M, Banerjee S, Kurlan R, Cohen D J, Leckman J F, McMahon W, Pauls D L, Sandor P, van de Wetering B J
Department of Neuropsychiatry, Royal Free and University College Medical School, London, UK.
Neurology. 1999 Dec 10;53(9):2108-12. doi: 10.1212/wnl.53.9.2108.
The clinical characteristics of Tourette syndrome (TS) present challenges for the systematic determination of whether individuals are affected and severity. Vocal and motor tics wax and wane, decrease over time, and may be voluntarily suppressible, and therefore may be absent at interview. Current instruments measure symptoms at interview or rate symptom severity only.
To minimize error in case ascertainment and produce an instrument measuring lifetime likelihood of having had TS, clinical members of the American Tourette Syndrome Association International Genetic Collaboration developed the Diagnostic Confidence Index (DCI). The expert group worked collaboratively with progressive revision in consensus workshops using existing diagnostic criteria as guidelines. The DCI produces a score from 0 to 100 that is a measure of the likelihood of having or ever having had TS.
The DCI was administered to 280 consecutive patients with TS attending a TS clinic; 264 (94%) completed it, indicating high feasibility and acceptability. Its correlation with other instruments and associations with psychopathology provide support for its being a lifetime measure of TS.
The DCI is a useful, practicable instrument in the clinic or research practice allowing an assessment of lifetime likelihood of TS. Further work is needed to test the DCI's psychometric properties, such as its validity and reliability in populations of interest.
抽动秽语综合征（TS）的临床特征给系统判定个体是否患病及病情严重程度带来了挑战。发声和运动抽动症状时轻时重，会随时间减轻，且可能可被自主抑制，因此在面谈时可能不存在。目前的工具仅在面谈时测量症状或评定症状严重程度。
为尽量减少病例确诊中的误差并研发一种测量患TS终生可能性的工具，美国抽动秽语综合征协会国际遗传协作组的临床成员开发了诊断置信指数（DCI）。专家组以现有诊断标准为指导方针，在共识研讨会上通过逐步修订进行合作。DCI产生一个0至100的分数，用于衡量患或曾患TS的可能性。
对连续就诊于一家TS诊所的280例TS患者施用了DCI；264例（94%）完成了测评，表明其具有高度可行性和可接受性。它与其他工具的相关性以及与精神病理学的关联为其作为TS的终生测量工具提供了支持。
DCI是临床或研究实践中一种有用且可行的工具，可用于评估患TS的终生可能性。还需要进一步开展工作来测试DCI的心理测量特性，例如其在目标人群中的有效性和可靠性。
