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[辅助检查在成人广泛性发育障碍诊断中的价值]

[Value of ancillary testing in the diagnosis of pervasive developmental disorder in adults].

作者信息

Ota Toyosaku, Iida Junzo, Kishimoto Toshifumi

机构信息

Department of Psychiatry, Nara Medical University School of Medicine.

出版信息

Seishin Shinkeigaku Zasshi. 2011;113(11):1137-44.

Abstract

Recently, there has been increasing interest in adults with pervasive developmental disorder (PDD) who seek general psychiatric services for various psychiatric problems. The diagnosis of PDD requires the careful collection of information about the patient's developmental history. A structured diagnostic interview is useful and should be performed, but has limitations now. The clinical value of the measurement of the Wechsler Adult Intelligence Scale, the Autism-Spectrum Quotient Japanese Version, and the Pervasive Developmental Disorders Autism Society Japan Rating Scale was demonstrated by a questionnaire survey that the authors conducted in 2010. These additional tests are useful if interpreted with caution. For example, a discrepancy between the performance intelligence quotient (IQ) and the verbal IQ in the Wechsler Adult Intelligence Scale does not by itself diagnose PDD. We examined whether the Japanese version of the National Adult Reading Test (Japanese Adult Reading Test; JART), a valid scale for evaluating pre-morbid IQ in patients with schizophrenia, and the Wechsler Adult Intelligence Scale-Revised (WAIS-R) are useful for discriminating between PDD and schizophrenia. Sixteen patients with adult PDD and 16 patients with schizophrenia matched for age, education and sex participated in this study. In addition, the two groups were matched for JART and the Global Assessment of Functioning scores. All subjects were scored on the JART and WAIS-R after giving informed consent for the study. The result was that significant diagnosis-by-IQ examination interactions were found (F [1, 30]=10.049, P=0.003). Also, the WAIS-R scores of the PDD group were higher than those of the schizophrenia group (P=0.002) when the two groups were matched for JART. In conclusion, the comparison of IQ in the PDD group and in the schizophrenia group by JART and WAIS-R might be an easy and useful method for helping to discriminate between PDD and schizophrenia. In addition, the difference in IQ scores measured by JART and by WAIS-R may be helpful in diagnosing PDD. The diagnosis of PDD in adults may be assisted by the use of these additional tests.

摘要

近年来,越来越多患有广泛性发育障碍(PDD)的成年人因各种精神问题寻求普通精神科服务。PDD的诊断需要仔细收集患者发育史的信息。结构化诊断访谈很有用且应该进行,但目前存在局限性。作者在2010年进行的一项问卷调查显示了韦氏成人智力量表、日本版自闭症谱系商数以及日本广泛性发育障碍自闭症协会评定量表测量的临床价值。如果谨慎解读,这些额外的测试是有用的。例如,韦氏成人智力量表中操作智商(IQ)和言语智商之间的差异本身并不能诊断PDD。我们研究了用于评估精神分裂症患者病前IQ的有效量表——日本版国家成人阅读测验(JART)以及修订版韦氏成人智力量表(WAIS-R)是否有助于区分PDD和精神分裂症。16名患有成人PDD的患者和16名年龄、教育程度及性别相匹配的精神分裂症患者参与了本研究。此外,两组在JART和功能总体评定分数方面也进行了匹配。所有受试者在签署研究知情同意书后接受JART和WAIS-R测试。结果发现存在显著的智商检查诊断交互作用(F [1, 30]=10.049,P = 0.003)。而且,当两组在JART方面匹配时,PDD组的WAIS-R分数高于精神分裂症组(P = 0.002)。总之,通过JART和WAIS-R比较PDD组和精神分裂症组的智商可能是一种简单且有用的方法,有助于区分PDD和精神分裂症。此外,JART和WAIS-R测量的智商分数差异可能有助于诊断PDD。使用这些额外的测试可能有助于成人PDD的诊断。

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