Pence Brian Wells, Gaynes Bradley N, Whetten Kathryn, Eron Joseph J, Ryder Robert W, Miller William C
Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7160, USA.
J Acquir Immune Defic Syndr. 2005 Dec 1;40(4):434-44. doi: 10.1097/01.qai.0000177512.30576.9c.
Substance abuse (SA) and mental illness (MI) commonly co-occur with HIV infection in the United States and have important implications for clinical management of HIV/AIDS. Yet SA/MI often go untreated due in part to a lack of practical, validated screening tools.
HIV clinic in academic medical center.
The 16-item SA/MI Symptoms Screener (SAMISS) targets SA/MI in HIV-positive patients. Consecutive consenting HIV-positive patients completed the SAMISS and then a reference standard diagnostic tool, SCID, the Structured Clinical Interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition).
Twenty percent of participants (29/148) had an SA diagnosis and 41% (59/143) had an MI diagnosis in the past year on the SCID; 48% (68/143) had 1 or both. Thirty-seven percent (55/148) screened positive for SA and 69% (99/143) screened positive for MI on the SAMISS. The SAMISS had 86% (95% CI: 68%-96%) sensitivity and 75% (66%-82%) specificity for SA and 95% (86%-99%) sensitivity and 49% (38%-60%) specificity for MI. Patients with SA were likely to show up as false positives for MI and vice versa.
The SAMISS functioned well as a first-line screening tool for SA/MI in this HIV clinic population. It missed few cases and was easily incorporated into a busy clinical setting. Persons screening positive require a more rigorous confirmatory psychiatric evaluation.
在美国，药物滥用（SA）和精神疾病（MI）常与HIV感染同时出现，对HIV/AIDS的临床管理具有重要影响。然而，SA/MI往往未得到治疗，部分原因是缺乏实用、经过验证的筛查工具。
学术医疗中心的HIV诊所。
16项SA/MI症状筛查器（SAMISS）针对HIV阳性患者的SA/MI。连续同意参与的HIV阳性患者完成SAMISS，然后完成一种参考标准诊断工具，即DSM-IV（《精神疾病诊断与统计手册》第四版）的结构化临床访谈SCID。
在SCID上，20%的参与者（29/148）在过去一年被诊断为SA，41%（59/143）被诊断为MI；48%（68/143）有其中之一或两者皆有。在SAMISS上，37%（55/148）的SA筛查呈阳性，69%（99/143）的MI筛查呈阳性。SAMISS对SA的敏感性为86%（95%可信区间：68%-96%），特异性为75%（66%-82%）；对MI的敏感性为95%（86%-99%），特异性为49%（38%-60%）。患有SA的患者可能会被误诊为MI呈假阳性，反之亦然。
在该HIV诊所人群中，SAMISS作为SA/MI的一线筛查工具效果良好。它漏诊的病例很少，且易于纳入繁忙的临床环境。筛查呈阳性的人需要更严格的精神科确诊评估。
