Gordon Pedro Caldana, Rocha Maria Sheila G, Kauark Roberta Gomes, Costa Carlos Daniel Miranda, de Oliveira Maira Okada, Godinho Fabio, Borges Vanderci
Neurology Department, Hospital Santa Marcelina, São Paulo, Brazil.
Neurology Department, Hospital Santa Marcelina, São Paulo, Brazil.
Am J Geriatr Psychiatry. 2017 Jan;25(1):73-80. doi: 10.1016/j.jagp.2016.08.011. Epub 2016 Aug 26.
Parkinson disease (PD) psychosis is a condition associated with several negative outcomes. Despite its impact, there is a lack of validated diagnostic tools for this condition. In this study, we aim to verify the validity of the proposed NINDS criteria for PD psychosis and explore its possible applications in clinical practice.
DESIGN, SETTINGS, PARTICIPANTS: We prospectively selected 104 subjects with idiopathic PD referred to a movement disorder clinic for a cross-sectional evaluation.
A neurological evaluation confirmed idiopathic PD and classified PD psychosis according to the NINDS criteria. A psychiatrist then classified the subject according to DSM-IV-TR criteria for psychosis, considered the reference standard. We used Cohen's kappa (κ) to quantify reliability between methods. Finally, we designed models assigning a weighted score to each characteristic psychotic symptom from the NINDS criteria (criterion A), and plotted receiver operating curves for each model.
Of the total sample, 52 (50%) met proposed criteria for NINDS PD psychosis and 16 (15.6%) met reference standard criteria. Inter-rater reliability showed only a fair agreement (κ = 0.30). By using a scoring approach for each NINDS criteria item and a cutoff total score for the diagnosis of PD psychosis, we significantly increased the agreement for diagnosis reliability (κ = 0.72), with sensitivity of 94% and specificity of 91%.
Although the NINDS criteria had limited reliability for diagnosing PD psychosis, a scoring approach for symptoms showed good reliability, with sensitivity and specificity above 90%. This scoring approach may be an accurate tool for identifying patients with PD psychosis.
帕金森病（PD）精神病是一种与多种负面结果相关的病症。尽管其具有影响，但针对这种病症缺乏经过验证的诊断工具。在本研究中，我们旨在验证所提出的美国国立神经疾病与中风研究所（NINDS）PD精神病标准的有效性，并探索其在临床实践中的可能应用。
设计、地点、参与者：我们前瞻性地选择了104名转诊至运动障碍诊所进行横断面评估的特发性PD患者。
神经学评估确认特发性PD，并根据NINDS标准对PD精神病进行分类。然后，精神科医生根据精神病的《精神疾病诊断与统计手册》第四版修订版（DSM-IV-TR）标准对受试者进行分类，将其视为参考标准。我们使用科恩kappa（κ）系数来量化方法之间的可靠性。最后，我们设计了模型，根据NINDS标准（标准A）为每个特征性精神病症状赋予加权分数，并为每个模型绘制受试者工作特征曲线。
在总样本中，52名（50%）符合NINDS PD精神病的拟议标准，16名（15.6%）符合参考标准。评分者间信度仅显示出一般的一致性（κ = 0.30）。通过对每个NINDS标准项目采用评分方法以及设定PD精神病诊断的总分临界值，我们显著提高了诊断可靠性的一致性（κ = 0.72），敏感性为94%，特异性为91%。
尽管NINDS标准在诊断PD精神病方面的可靠性有限，但症状评分方法显示出良好的可靠性，敏感性和特异性均高于90%。这种评分方法可能是识别PD精神病患者的准确工具。
