Micoulaud-Franchi Jean-Arthur, Bartolomei Fabrice, McGonigal Aileen
Services d'explorations fonctionnelles du système nerveux, Clinique du sommeil, CHU de Bordeaux, Place Amélie Raba-Leon, 33076 Bordeaux, France; USR CNRS 3413 SANPSY, CHU Pellegrin, Université de Bordeaux, France.
Service de Neurophysiologie Clinique, APHM, Hôpital de la Timone, 13005 Marseille, France; INSERM UMR 1106, INS, 27 Bd Jean Moulin, 13385 Marseille, France; Aix Marseille Université, Faculté de Médecine, Marseille, France; Hôpital Henri Gastaut, Etablissement Hospitalier Spécialisé dans le traitement des Epilepsies, 300 Boulevard de Sainte-Marguerite, 13009 Marseille, France.
J Affect Disord. 2017 Mar 1;210:237-240. doi: 10.1016/j.jad.2016.12.038. Epub 2016 Dec 27.
Systematic screening is recommended for major depressive episode (MDE) with the Neurological Disorders Depression Inventory for Epilepsy NDDI-E, 6 items and generalized anxiety disorder (GAD) with the GAD 7 items in patients with epilepsy (PWE). Shorter versions of the NDDI-E and the GAD-7 could facilitate increased screening by busy clinicians and be more accessible to patients with mild cognitive and/or language impairments.
The effectiveness of ultra-short versions of the NDDI-E (2 items) and the GAD-7 (the GAD-2, 2 items, and the GAD-SI with a single item) in comparison with the original versions were statistically tested using ROC analysis.
ROC analysis of the NDDIE-2 showed an AUC of 0.926 (p<0.001), a sensitivity of 81.82% and a specificity of 89.16%, without significant difference with the NDDI-E (z=1.582, p=0.11). ROC analysis of the GAD-SI showed an AUC of 0.872 (p<0.001), a sensitivity of 83.67% and a specificity of 82.29%, without significant difference with the GAD-7 (z=1.281, p=0.2). The GAD-2 showed poorer psychometric properties.
The limitation is the use of data from previously reported subjects in a single language version, the NDDIE-2 that lacks detection of dysphoric symptoms in comparison with the NDDIE-6 and the GAD-SI that exhibited a more than 10% lower sensitivity than the GAD-7.
This study highlights the potential utility of the NDDIE-2 and the GAD-SI as ultra-short screening tools for MDE and GAD respectively in PWE. Further studies in a larger population, including multi-lingual versions, could be a valuable next step. However, the brevity and simplicity of this tool could be an advantage in PWE who present cognitive difficulties, especially attentional or language deficits.
对于癫痫患者（PWE），建议使用癫痫神经疾病抑郁量表（NDDI-E，6项）对重度抑郁发作（MDE）进行系统筛查，使用广泛性焦虑障碍量表（GAD-7，7项）对广泛性焦虑障碍（GAD）进行系统筛查。NDDI-E和GAD-7的较短版本可能有助于忙碌的临床医生增加筛查频率，并且对于有轻度认知和/或语言障碍的患者更容易获取。
使用ROC分析对NDDI-E（2项）和GAD-7的超短版本（GAD-2，2项；GAD-SI，单项）与原始版本相比的有效性进行统计学检验。
NDDIE-2的ROC分析显示曲线下面积（AUC）为0.926（p<0.001），灵敏度为81.82%，特异度为89.16%，与NDDI-E无显著差异（z=1.582，p=0.11）。GAD-SI的ROC分析显示AUC为0.872（p<0.001），灵敏度为83.67%，特异度为82.29%，与GAD-7无显著差异（z=1.281，p=0.2）。GAD-2的心理测量学特性较差。
局限性在于使用了来自单一语言版本的先前报告受试者的数据，与NDDIE-6相比，NDDIE-2缺乏对烦躁症状的检测，并且GAD-SI的灵敏度比GAD-7低10%以上。
本研究强调了NDDIE-2和GAD-SI分别作为PWE中MDE和GAD的超短筛查工具的潜在效用。下一步在更大人群中进行进一步研究，包括多语言版本，可能是有价值的。然而，该工具的简洁性在存在认知困难，尤其是注意力或语言缺陷的PWE中可能是一个优势。
