Zanarini Mary C, Vujanovic Anna A, Parachini Elizabeth A, Boulanger Jennifer L, Frankenburg Frances R, Hennen John
Department of Psychiatry, McLean Hospital, Belmont, Massachusetts 02478, USA.
J Pers Disord. 2003 Jun;17(3):233-42. doi: 10.1521/pedi.17.3.233.22147.
The purpose of this study was to assess the psychometric properties of the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD), the first clinician-administered scale for the assessment of change in DSM-IV borderline psychopathology. The questions for the measure were adapted from the BPD module of the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV) to reflect a 1-week time frame and each of the nine criteria for BPD is rated on a five-point anchored rating scale of 0 to 4, yielding a total score of 0 to 36. Two diagnostic interviews that assess the presence of BPD were administered to 200 nonpsychotic patients: the BPD module of the DIPD-IV and the Revised Diagnostic Interview for Borderlines (DIB-R). The ZAN-BPD was also administered, blind to diagnostic information. In addition, each patient filled out a self-report measure of general psychopathology that is often used in borderline treatment studies, the Symptom Checklist 90 (SCL-90). The convergent validity of the ZAN-BPD and relevant scales of the SCL-90 and the DIB-R was assessed and found to be highly significant. The discriminant validity of the various scores of the ZAN-BPD was also found to be highly significant, easily discriminating the 139 patients who met the DSM-IV criteria for BPD from the 61 patients who did not. In addition, internal consistency of the ZAN-BPD was found to be high (Cronbach's alpha=0.85). The interrater reliability of the ZAN-BPD was assessed using 32 conjoint interviews, while same day test-retest reliability was assessed in a separate sample of 40 patients. All reliability raters were blind to all previously collected information concerning each subject. All intraclass correlations were in the good to excellent range. Finally, the sensitivity of the ZAN-BPD to change was assessed using a third sample of 41 patients who were reinterviewed by a blind rater 7 to 10 days after the ZAN-BPD was first administered. The SCL-90 was also readministered at this time. The correlations between difference scores of the ZAN-BPD and difference scores of the SCL-90 were found to be significant, indicating that the ZAN-BPD measures change in a clinically meaningful manner. Taken together, the results of this study suggest that the ZAN-BPD is a promising clinician-administered scale for the assessment of change in borderline psychopathology over time.
本研究的目的是评估边缘型人格障碍赞纳里尼评定量表（ZAN - BPD）的心理测量特性，这是首个由临床医生使用的用于评估《精神疾病诊断与统计手册》第四版（DSM - IV）边缘型精神病理学变化的量表。该测量的问题改编自《DSM - IV人格障碍诊断访谈》（DIPD - IV）的边缘型人格障碍模块，以反映1周的时间范围，边缘型人格障碍的九条标准中的每一条都采用0至4的五点锚定评定量表进行评分，总分范围为0至36。对200名非精神病患者进行了两项评估边缘型人格障碍存在情况的诊断访谈：DIPD - IV的边缘型人格障碍模块和《边缘型人格障碍修订诊断访谈》（DIB - R）。同时还对患者实施了ZAN - BPD，且不告知诊断信息。此外，每位患者填写了一份常用于边缘型人格障碍治疗研究的一般精神病理学自评量表，即症状自评量表90（SCL - 90）。研究评估了ZAN - BPD与SCL - 90及DIB - R相关量表的收敛效度，发现具有高度显著性。ZAN - BPD各分数的区分效度也具有高度显著性，能够轻松区分139名符合DSM - IV边缘型人格障碍标准的患者和61名不符合该标准的患者。此外，发现ZAN - BPD的内部一致性较高（克朗巴哈系数α = 0.85）。使用32次联合访谈评估了ZAN - BPD的评分者间信度，同时在40名患者的独立样本中评估了同日重测信度。所有参与信度评估的人员均不了解之前收集的有关每个受试者的所有信息。所有组内相关系数均处于良好到优秀的范围。最后，使用41名患者的第三个样本评估了ZAN - BPD对变化的敏感性，这些患者在首次实施ZAN - BPD后7至10天由一名不知情的评分者再次进行访谈。此时也再次施测了SCL - 90。发现ZAN - BPD的差异分数与SCL - 90的差异分数之间的相关性具有显著性，表明ZAN - BPD能够以具有临床意义的方式测量变化。综上所述，本研究结果表明，ZAN - BPD是一种很有前景的由临床医生使用的量表，可用于评估边缘型精神病理学随时间的变化。
