Baillie Andrew J, Rapee Ronald M
Psychology Department, Macquarie University, Sydney, NSW 2109, Australia.
Behav Res Ther. 2004 May;42(5):513-27. doi: 10.1016/S0005-7967(03)00157-8.
Self-help and psychoeducation have been identified as effective methods for delivering treatment, yet not everyone benefits from these brief interventions. Therefore it is clinically and economically useful to identify who is likely to require more intensive assistance. This paper develops a prognostic scale which predicts who will recover from panic attacks and who will require more assistance.
Random regression models were used to evaluate the relationship between predictive variables, baseline severity, and the rate of improvement in 117 people with DSMIV panic attacks who participated in a trial of a psycho-educational booklet, a self-help workbook, and brief group CBT over a 9-month period. ROC analysis was used to choose cut-off points on a scale made up of significant predictors.
Panic disorder and agoraphobia symptom measures were predicted by baseline social anxiety, and general mental health. There was no significant effect on the outcome for baseline depression or anxiety sensitivity. While general mental health (SF12 Mental Component scores) was predicted by the age at first panic attack, neuroticism, panic disorder and/or agoraphobia symptoms and a positive screen for alcohol use disorders. A prognostic scale based on simple additive scoring was equivalent to standard scores and significantly better than chance at predicting who would recover and who required face-to-face therapy.
The prognostic scale may be used to guide the choice of psychoeducation, self-help or face-to-face therapy as the first step in stepped care.
自助和心理教育已被确认为有效的治疗方法，但并非所有人都能从这些简短干预中受益。因此，确定谁可能需要更强化的帮助在临床和经济方面都很有用。本文开发了一种预后量表，用于预测哪些人会从惊恐发作中康复，哪些人需要更多帮助。
采用随机回归模型评估预测变量、基线严重程度与117名患有DSM-IV惊恐发作的患者在9个月期间参与心理教育手册、自助工作手册和简短团体认知行为疗法试验的改善率之间的关系。ROC分析用于在由显著预测因素组成的量表上选择临界点。
惊恐障碍和广场恐惧症症状测量由基线社交焦虑和总体心理健康状况预测。基线抑郁或焦虑敏感性对结果没有显著影响。而总体心理健康状况（SF12心理成分得分）由首次惊恐发作的年龄、神经质、惊恐障碍和/或广场恐惧症症状以及酒精使用障碍的阳性筛查预测。基于简单相加评分的预后量表与标准评分相当，在预测谁会康复以及谁需要面对面治疗方面明显优于随机猜测。
该预后量表可用于指导在分级护理中作为第一步选择心理教育、自助或面对面治疗。
