Atli Abdullah, Boysan Murat, Çetinkaya Nuralay, Bulut Mahmut, Bez Yasin
Department of Psychiatry, Faculty of Medicine, Dicle University, Diyarbakir 21280, Turkey.
Department of Psychology, Faculty of Arts, Yuzuncu Yil University, Van 65200, Turkey.
Compr Psychiatry. 2014 Apr;55(3):604-12. doi: 10.1016/j.comppsych.2013.08.029. Epub 2013 Oct 22.
Obsessive-compulsive disorder (OCD) is probably a heterogeneous condition. To date, research investigating the symptom structure of OCD has generally focused on variable-classification approaches, primarily factor analysis. Our aim was to use the latent class analysis, an advanced individual-classification method, in order to define homogeneous sub-groups based on the Yale-Brown Obsessive-Compulsive Scale Check List (Y-BOCS CL) assessments within 193 outpatients with OCD.
Latent class analysis of 13 obsessive-compulsive symptom-clusters measured by the Yale-Brown Obsessive-Compulsive Scale Check List was performed. Associations of demographic and clinical features with latent class membership were tested by using logistic regression models. Differences in severity of obsessive-compulsive symptoms, obsessive beliefs, and depressive symptomotology between latent classes were evaluated with the chi-square likelihood test.
Latent class analysis models of best fit yielded 3 latent classes: "autogenous obsessions", "reactive obsessive-compulsive", and "reactive obsessions". Outpatients in reactive obsessive-compulsive group reported significantly higher scores on the Y-BOCS global, obsessions, and compulsions scales than outpatients in other two sub-groups. Participants in reactive obsessive-compulsive group were predominantly female, single, and had a history of family psychopathology; whereas autogenous and reactive obsessions groups were predominantly male. There were no differences in severity of depression and obsessive belief domains.
The results provide support for the validity of autogenous/reactive distinction for OCD. These three classes may have important implications for research and clinical purposes.
强迫症(OCD)可能是一种异质性疾病。迄今为止,对强迫症症状结构的研究通常集中在变量分类方法上,主要是因子分析。我们的目的是使用潜在类别分析(一种先进的个体分类方法),以便根据193名强迫症门诊患者的耶鲁-布朗强迫症量表检查表(Y-BOCS CL)评估来定义同质亚组。
对通过耶鲁-布朗强迫症量表检查表测量的13个强迫症状群进行潜在类别分析。使用逻辑回归模型测试人口统计学和临床特征与潜在类别成员资格之间的关联。通过卡方似然检验评估潜在类别之间强迫症状、强迫观念和抑郁症状严重程度的差异。
最佳拟合的潜在类别分析模型产生了3个潜在类别:“原发性强迫观念”、“反应性强迫”和“反应性强迫观念”。反应性强迫组的门诊患者在Y-BOCS总分、强迫观念和强迫行为量表上的得分显著高于其他两个亚组的门诊患者。反应性强迫组的参与者主要为女性、单身,并有家族精神病理学病史;而原发性强迫观念组和反应性强迫观念组主要为男性。抑郁严重程度和强迫观念领域没有差异。
结果为强迫症原发性/反应性区分的有效性提供了支持。这三个类别可能对研究和临床目的具有重要意义。