Department of Psychiatry, University of Edinburgh, Edinburgh, UK Department of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK.
Department of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK.
J Neurol Neurosurg Psychiatry. 2015 Mar;86(3):295-301. doi: 10.1136/jnnp-2014-308234. Epub 2014 Jun 16.
Somatic symptoms unexplained by disease are common in all medical settings. The process of identifying such patients requires a clinical assessment often supported by clinical tests. Such assessments are time-consuming and expensive. Consequently the observation that such patients tend to report a greater number of symptom has led to the use of self-rated somatic symptom counts as a simpler and cheaper diagnostic aid and proxy measure for epidemiological surveys. However, despite their increasing popularity there is little evidence to support their validity.
We tested the score on a commonly used self-rated symptom questionnaire- the Patient Health Questionnaire (PHQ 15) (plus enhanced iterations including an additional 10 items on specific neurological symptoms and an additional 5 items on mental state) for diagnostic sensitivity and specificity against a medical assessment (with 18 months follow-up) in a prospective cohort study of 3781 newly attending patients at neurology clinics in Scotland, UK.
We found 1144/3781 new outpatients had symptoms that were unexplained by disease. The patients with symptoms unexplained by disease reported higher symptoms count scores (PHQ 15: 5.6 (95% CI 5.4 to 5.8) vs 4.2 (4.1 to 4.4) p<0.0001). However, the PHQ15 performed little better than chance in its ability to identify patients with symptoms unexplained by disease. The findings with the enhanced scales were similar.
Self-rated symptom count scores should not be used to identify patients with symptoms unexplained by disease.
在所有医疗环境中，无法用疾病解释的躯体症状都很常见。识别此类患者需要临床评估，通常需要临床检查支持。此类评估既耗时又昂贵。因此，观察到此类患者往往报告更多的症状，导致使用自评躯体症状计数作为更简单、更经济的诊断辅助手段和流行病学调查的替代指标。然而，尽管它们越来越受欢迎，但几乎没有证据支持它们的有效性。
我们在苏格兰神经病学诊所的前瞻性队列研究中，对 3781 名新就诊患者的常用自评症状问卷-患者健康问卷（PHQ 15）（加上增强迭代版，包括 10 项关于特定神经症状的额外项目和 5 项关于精神状态的额外项目）进行了评分，以测试其对医疗评估（18 个月随访）的诊断敏感性和特异性。
我们发现 3781 名新门诊患者中有 1144 名患有无法用疾病解释的症状。无法用疾病解释的症状患者报告的症状计数评分更高（PHQ 15：5.6（95%CI 5.4 至 5.8）与 4.2（4.1 至 4.4）相比，p<0.0001）。然而，PHQ15 在识别无法用疾病解释的症状的患者方面的能力几乎不比偶然好。增强量表的发现也相似。
自评症状计数评分不应用于识别无法用疾病解释的症状的患者。
