Einfeld S, Tonge B, Chapman L, Mohr C, Taffe J, Horstead S
School of Psychiatry, University of New South Wales, Sydney.
J Appl Res Intellect Disabil. 2007 Sep;20(5):384-390. doi: 10.1111/j.1468-3148.2007.00381.x.
There is a history of over-prescription of antipsychotics to individuals with intellectual disability (ID), while antidepressants may be under-prescribed. However, appropriate treatment is best supported when the diagnosis of psychosis or depression is valid and carries good predictive validity. The present authors report a study examining one aspect of validity, namely whether skilled clinicians can agree on whether an individual with an ID is psychotic or depressed. MATERIALS AND METHODS: Pairs of clinicians assessed 52 individuals. Agreement was assessed using Cohen's kappa statistic and agreement proportion. RESULTS: Overall agreement was high for both psychosis and depression. Whether the individual had mild ID or moderate/severe ID did not have a significant impact on agreement. CONCLUSIONS: Experienced clinicians achieved a high level of agreement as to whether a person with ID was psychotic or depressed similar to that found for those without ID. The findings provide some support for treatment interventions based on diagnosis.
存在向智力残疾（ID）患者过度开具抗精神病药物的历史，而抗抑郁药的处方可能不足。然而，当精神病或抑郁症的诊断有效且具有良好的预测效度时，适当的治疗能得到最佳支持。本文作者报告了一项研究，该研究考察效度的一个方面，即熟练的临床医生能否就一名ID患者是否患有精神病或抑郁症达成一致。
临床医生对52名个体进行了评估。使用科恩kappa统计量和一致率评估一致性。
对于精神病和抑郁症，总体一致性都很高。个体是轻度ID还是中度/重度ID对一致性没有显著影响。
经验丰富的临床医生对于一名ID患者是否患有精神病或抑郁症达成了很高的一致性，这与非ID患者的情况相似。这些发现为基于诊断的治疗干预提供了一些支持。
