简明相关症状跟踪量表：一种简短的自我报告和临床医生对与自杀相关症状的评估。

Concise Associated Symptoms Tracking scale: a brief self-report and clinician rating of symptoms associated with suicidality.

机构信息

Department of Psychiatry, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9119, USA.

出版信息

J Clin Psychiatry. 2011 Jun;72(6):765-74. doi: 10.4088/JCP.11m06840.

DOI:10.4088/JCP.11m06840

PMID:21733477

Abstract

OBJECTIVE

US Food and Drug Administration (FDA) warnings recommend monitoring negative symptoms associated with the initiation of antidepressant medications as these symptoms may interfere with full recovery and pose safety concerns. There is currently no brief, reliable rating instrument for assessing treatment-emergent, negative symptoms. We evaluated the psychometric properties of 2 versions of the newly developed 17-item Concise Associated Symptom Tracking (CAST) scale, the CAST Clinician Rating (CAST-C) and CAST Self-Rated (CAST-SR), which are brief instruments designed to measure the 5 relevant associated symptom domains (irritability, anxiety, mania, insomnia, and panic).

METHOD

The study enrolled 265 outpatients with major depressive disorder (MDD), from July 2007 through February 2008, into an 8-week, open-label trial with a selective serotonin reuptake inhibitor. Diagnosis of MDD was determined by the Psychiatric Diagnostic Screening questionnaire and an MDD checklist based on DSM-IV-TR criteria. Suicidality (suicidal ideation with associated behaviors) is 1 of 9 symptoms of MDD (depressed mood, loss of interest, appetite or weight change, sleep disturbance, reduced concentration or indecisiveness, fatigue or decreased energy, psychomotor agitation or retardation, feelings of worthlessness or excessive guilt). Psychometric evaluations were conducted on both versions of the CAST.

RESULTS

Cronbach α was .80 (CAST-C) and .81 (CAST-SR). Factor analysis identified 5 factors for each scale: (1) irritability, (2) anxiety, (3) mania, (4) insomnia, and (5) panic. When the item that cross-loaded on 2 factors was eliminated, the 16-item solution had a better goodness of fit (CAST-C: 0.90 vs 0.87; CAST-SR: 0.88 vs 0.84). Cronbach α for the 16-item versions was .77 (CAST-C) and .78 (CAST-SR). The 5 associated CAST symptom domains correlated well with other standard measures of these domains.

CONCLUSIONS

The 16-item CAST-C and CAST-SR demonstrated excellent psychometric properties. These are potentially useful measures for monitoring treatment-emergent negative symptoms associated with antidepressants, as recommended by the FDA.

TRIAL REGISTRATION

Clinicaltrials.gov Identifier: NCT00532103.

摘要

目的

美国食品和药物管理局（FDA）警告建议监测与抗抑郁药物起始相关的负面症状，因为这些症状可能会干扰完全康复并带来安全隐患。目前还没有用于评估治疗后出现的负面症状的简短、可靠的评分工具。我们评估了新开发的 17 项简明相关症状跟踪（CAST）量表的两种版本，即 CAST 临床医生评定量表（CAST-C）和 CAST 自评量表（CAST-SR）的心理测量学特性，这两种量表都是用于测量 5 个相关的伴随症状领域（易怒、焦虑、躁狂、失眠和惊恐）的简短工具。

方法

这项研究于 2007 年 7 月至 2008 年 2 月期间共招募了 265 名患有重度抑郁症（MDD）的门诊患者，进行了一项为期 8 周的、开放性、选择性 5-羟色胺再摄取抑制剂试验。MDD 的诊断是通过精神病诊断筛查问卷和基于 DSM-IV-TR 标准的 MDD 检查表确定的。自杀意念（自杀意念伴行为）是 MDD 的 9 个症状之一（情绪低落、兴趣丧失、食欲或体重变化、睡眠障碍、注意力或决断力减退、疲劳或精力减退、精神运动性激越或迟滞、自我价值感丧失或过度内疚）。对 CAST 的两种版本进行了心理测量评估。

结果

Cronbach α 分别为 0.80（CAST-C）和 0.81（CAST-SR）。因素分析为每个量表确定了 5 个因素：（1）易怒，（2）焦虑，（3）躁狂，（4）失眠，和（5）惊恐。当交叉加载在两个因素上的项目被删除时，16 项解决方案具有更好的拟合优度（CAST-C：0.90 与 0.87；CAST-SR：0.88 与 0.84）。16 项版本的 Cronbach α 分别为 0.77（CAST-C）和 0.78（CAST-SR）。5 个相关的 CAST 症状领域与这些领域的其他标准测量方法密切相关。