筛查物质使用障碍门诊患者中的双相情感障碍。
Screening for bipolar disorder among outpatients with substance use disorders.
机构信息
Geneva University Hospital, Department of Mental Health and Psychiatry, Service of General Psychiatry, Bipolar Program, 6-8, rue du 31-Décembre, 1207 Geneva, Switzerland.
出版信息
Eur Psychiatry. 2013 Mar;28(3):147-53. doi: 10.1016/j.eurpsy.2011.07.004. Epub 2011 Oct 2.
BACKGROUND
Comorbidity of bipolar disorder and alcohol or substance abuse/dependence is frequent and has marked negative consequences on the course of the illness and treatment compliance. The objective of this study was to compare the validity of two short instruments aimed at screening bipolar disorders among patients treated for substance use disorders.
METHODS
The Mood Disorder Questionnaire (MDQ) and the Hypomania Checklist-32 (HCL-32) were tested with reference to the mood section of the Structured Clinical Interview for DSM-IV axis I disorders (SCID) in 152 patients, recruited in two outpatient clinics providing specialized treatment for alcohol and opiate dependence.
RESULTS
According to the SCID, 33 patients (21.7%) had a diagnosis within the bipolar spectrum (two bipolar I, 21 bipolar II and 10 bipolar not otherwise specified). The HCL-32 was more sensitive (90.9% vs. 66.7%) and the MDQ more specific (38.7% vs. 77.3%) for the whole sample. The MDQ displayed higher sensitivity and specificity in patients treated for alcohol than for opiate dependence, whereas the HCL-32 was highly sensitive but poorly specific in both samples. Both instruments had a positive predictive value under 50%.
CONCLUSIONS
Caution is needed when using the MDQ and HCL-32 in patients treated for substance use disorders.
背景
双相情感障碍与酒精或物质滥用/依赖共病的情况较为常见，这对疾病的病程和治疗依从性都有显著的负面影响。本研究的目的是比较两种旨在筛选物质使用障碍患者中双相障碍的简短工具的有效性。
方法
在两个为酒精和阿片类物质依赖提供专门治疗的门诊诊所中，共招募了 152 名患者，对这些患者使用心境障碍问卷（MDQ）和 32 项轻躁狂清单（HCL-32）与 DSM-IV 轴 I 障碍结构临床访谈（SCID）的心境部分进行了测试。
结果
根据 SCID，33 名患者（21.7%）被诊断为双相谱系内的疾病（2 名双相 I 型、21 名双相 II 型和 10 名双相未特定型）。HCL-32 对整个样本的敏感性（90.9% vs. 66.7%）更高，MDQ 的特异性（38.7% vs. 77.3%）更高。MDQ 在治疗酒精依赖的患者中比治疗阿片类物质依赖的患者具有更高的敏感性和特异性，而 HCL-32 在两个样本中都具有很高的敏感性但特异性较差。两种工具的阳性预测值均低于 50%。
结论
在治疗物质使用障碍的患者中使用 MDQ 和 HCL-32 时需要谨慎。
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