Nitsche Ines, Kallert Thomas W
Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany.
Psychopathology. 2007;40(4):242-53. doi: 10.1159/000101729. Epub 2007 Apr 17.
For optimizing the validity of diagnoses of mental disorders, several sources of information should be used to assess psychopathological symptoms. Among these are relatives of patients with mental illness. The very low number of empirical studies examining the assessment of psychopathology by relatives of adult, nondemented mentally ill patients stands in significant contrast to the clinical importance of this source of information, however.
Using the Positive and Negative Syndrome Scale (PANSS), researchers asked 163 relatives of patients with the main clinical ICD-10 diagnosis of schizophrenic, recurrent depressive or bipolar disorders to rate the current symptoms of the patients at the time of outpatient community-oriented treatment.
On average, severity of symptoms was rated as absent or minimal, although anxiety, depression and passive/apathetic social as well as emotional withdrawal, motor retardation, poor attention, and disturbance of volition were clearly rated above the PANSS mean total score for all patients. A six-factor structure identified by factor analysis better illustrates the significant differences in the assessments of the three main diagnostic groups than the three established PANSS scales. With the exception of 'problematic social behavior', differences among the diagnostic groups appeared in all factors and were particularly pronounced for 'delusional beliefs' and 'motor impairments'.
The results of this study showed that the use of standardized instruments such as PANSS for the assessment of psychopathology by relatives is not only practical, but produces adequately reliable results. The use of PANSS for this purpose, however, requires interviewing of relatives by trained experts able to explain technical terms. Because this study did not sufficiently explore the validity of this approach, further research on this specific issue is urgently needed and should, for example, assess the concordance of ratings between professionals and relatives as well as correlation with suitable external criteria.
为优化精神障碍诊断的有效性，应使用多种信息来源来评估精神病理症状。其中包括精神疾病患者的亲属。然而，针对成年非痴呆精神疾病患者亲属对精神病理学评估的实证研究数量极少，这与该信息来源的临床重要性形成了显著反差。
研究人员使用阳性和阴性症状量表（PANSS），让163名主要临床ICD-10诊断为精神分裂症、复发性抑郁症或双相情感障碍患者的亲属，对患者在门诊社区导向治疗时的当前症状进行评分。
平均而言，症状严重程度被评为不存在或轻微，尽管焦虑、抑郁、被动/冷漠社交以及情感退缩、运动迟缓、注意力不集中和意志障碍的评分明显高于所有患者的PANSS平均总分。通过因子分析确定的六因素结构，比三个既定的PANSS量表更能说明三个主要诊断组评估中的显著差异。除“有问题的社会行为”外，诊断组之间的差异出现在所有因素中，在“妄想信念”和“运动障碍”方面尤为明显。
本研究结果表明，使用PANSS等标准化工具让亲属评估精神病理学不仅实用，而且能产生足够可靠的结果。然而，为此目的使用PANSS需要由能够解释专业术语的训练有素的专家对亲属进行访谈。由于本研究没有充分探讨这种方法的有效性，因此迫切需要对这一具体问题进行进一步研究，例如评估专业人员和亲属评分之间的一致性以及与合适外部标准的相关性。
