Department of Psychiatry and Human Behavior, Brown Medicine School, Providence, RI, USA.
Psychiatry Res. 2011 Feb 28;185(3):444-9. doi: 10.1016/j.psychres.2010.06.025. Epub 2010 Jul 24.
Bipolar disorder is prone to being overlooked because its diagnosis is more often based on retrospective report than cross-sectional assessment. Recommendations for improving the detection of bipolar disorder include the use of screening questionnaires. The Mood Disorder Questionnaire (MDQ) is the most widely studied self-report screening scale that has been developed to improve the detection of bipolar disorder. Although developed as a screening scale, the MDQ has also been used as a case-finding measure. However, studies of the MDQ in psychiatric patients have found high false positive rates, though no study has determined the psychiatric diagnoses associated with false positive results on the MDQ. The goal of the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project was to identify the psychiatric disorders associated with increased false positive rates on the MDQ. Four hundred eighty psychiatric outpatients were interviewed with the Structured Clinical Interview for DSM-IV (SCID) and completed the MDQ. After excluding the 52 patients diagnosed with a lifetime history of bipolar disorder we compared diagnostic frequencies in patients who did and did not screen positive on the MDQ. Based on the Hirschfeld et al. scoring guidelines of the MDQ, 15.2% (n=65) of the 428 nonbipolar patients screened positive on MDQ. Compared to patients who screened negative, the patients who screened positive were significantly more likely have a current and lifetime diagnosis of specific phobia, posttraumatic stress disorder, alcohol and drug use disorders, any eating disorder, any impulse control disorder, and attention deficit disorder. Results were similar using a less restrictive threshold to identify MDQ cases. That is, MDQ caseness was associated with significantly elevated rates of anxiety, impulse control, substance use, and attention deficit disorders. Studies using the MDQ as a stand-alone proxy for the diagnosis of bipolar disorder should consider whether the presence of these other forms of psychopathology could be responsible for differences between individuals who screen positive and negative on the scale.
双相情感障碍容易被忽视，因为其诊断更多地基于回顾性报告而非横断面评估。提高双相情感障碍检出率的建议包括使用筛查问卷。心境障碍问卷（MDQ）是研究最多的自我报告筛查量表，旨在提高双相情感障碍的检出率。虽然 MDQ 是作为一种筛查量表开发的，但它也被用作病例发现的测量工具。然而，在精神科患者中进行的 MDQ 研究发现，假阳性率较高，尽管没有研究确定与 MDQ 假阳性结果相关的精神科诊断。罗德岛提高诊断评估和服务（MIDAS）项目的这份报告的目的是确定与 MDQ 假阳性率增加相关的精神科诊断。对 480 名精神科门诊患者进行了 DSM-IV 结构临床访谈（SCID）和 MDQ 问卷调查。在排除了 52 名被诊断为双相情感障碍终身病史的患者后，我们比较了 MDQ 筛查阳性和阴性患者的诊断频率。根据 Hirschfeld 等人的 MDQ 评分指南，428 名非双相患者中有 15.2%（n=65）MDQ 筛查阳性。与 MDQ 筛查阴性的患者相比，筛查阳性的患者更有可能被诊断为当前和终身特定恐惧症、创伤后应激障碍、酒精和药物使用障碍、任何饮食障碍、任何冲动控制障碍和注意缺陷障碍。使用较少的限制阈值来确定 MDQ 病例，结果相似。也就是说，MDQ 病例与焦虑、冲动控制、物质使用和注意缺陷障碍的发生率显著升高有关。使用 MDQ 作为双相情感障碍诊断的独立代理进行的研究应考虑到这些其他形式的精神病理学是否可能导致量表上阳性和阴性个体之间的差异。
