Patterson T L, Goldman S, McKibbin C L, Hughs T, Jeste D V
Department of Psychiatry, University of California, La Jolla, San Diego 92093-0680, USA.
Schizophr Bull. 2001;27(2):235-45. doi: 10.1093/oxfordjournals.schbul.a006870.
Instruments to assess everyday functioning have utilized self-report, proxy report, clinician ratings, or direct observation of performance. Each of these methods has strengths and weaknesses. In this article we argue for the inclusion of performance-based measures of functional capacity in studies of severely mentally ill persons and describe a new measure, the UCSD Performance-Based Skills Assessment (UPSA). We administered the UPSA to 50 middle-aged and older outpatients with schizophrenia or schizoaffective disorder, and 20 normal comparison subjects. Participants' performance in five domains of functioning (Household Chores; Communication; Finance; Transportation; and Planning Recreational Activities) was assessed in standardized role-play situations. Administration of the UPSA required an average of 30 minutes to complete. Interrater reliability of ratings was excellent. Patients' performance was significantly more impaired than that of normal subjects. Among patients, the UPSA performance correlated significantly with severity of negative symptoms and of cognitive impairment but not with that of positive or depressive symptoms. The UPSA scores correlated highly with those on another performance-based measure. We believe that UPSA would be useful for assessing everyday functioning in severely mentally ill adults.
评估日常功能的工具采用了自我报告、代理报告、临床医生评分或对表现的直接观察。这些方法各有优缺点。在本文中，我们主张在重度精神疾病患者的研究中纳入基于表现的功能能力测量方法，并描述一种新的测量方法，即加州大学圣地亚哥分校基于表现的技能评估（UPSA）。我们对50名患有精神分裂症或分裂情感性障碍的中老年门诊患者以及20名正常对照受试者进行了UPSA测试。在标准化的角色扮演情境中评估了参与者在五个功能领域（家务；沟通；财务；交通；以及规划娱乐活动）的表现。完成UPSA测试平均需要30分钟。评分者间的信度极佳。患者的表现明显比正常受试者受损更严重。在患者中，UPSA表现与阴性症状和认知障碍的严重程度显著相关，但与阳性或抑郁症状的严重程度无关。UPSA分数与另一种基于表现的测量方法的分数高度相关。我们认为UPSA对于评估重度精神疾病成年人的日常功能会很有用。
