Kissane D W, Bobevski I, Gaitanis P, Brooker J, Michael N, Lethborg C, Richardson G, Webster P, Hempton C
Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia; Szalmuk Family Psycho-Oncology Research Unit, Cabrini Health, Malvern, VIC, Australia.
Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia.
Gen Hosp Psychiatry. 2017 May;46:20-24. doi: 10.1016/j.genhosppsych.2017.01.007. Epub 2017 Feb 3.
Demoralization, a state of lowered morale and poor coping, has a prevalence of 13-18% among patients with advanced cancer. We surveyed clinicians' perspectives of the utility of "with demoralization" as a diagnostic specifier for adjustment and depressive disorders.
Using comparative clinical vignettes in a field survey, clinicians from a range of disciplines were asked their perception of the utility of diagnosis and treatment options. Response frequencies were compared using Cochran's Q and McNemar's tests, with sensitivity and specificity rated against expert rankings of diagnosis. Analysis of variance and paired t-tests examined significant differences in ratings of utility.
Vignettes were assessed by 280 clinicians; 77% supported utility of the category 'adjustment disorder with demoralization' compared to 33% supporting 'adjustment disorder with anxiety' (McNemar test, p<0.001), while 83% supported the utility of 'with demoralization' for major depressive episode, matching 83% perceiving utility for 'with melancholia.' Sensitivity and specificity ratings were 77% and 94% for adjustment disorder with demoralization and 83% and 91% for major depression with demoralization.
Clinicians perceived the specifier 'with demoralization' to deepen diagnostic understanding, treatment choice, and ability to communicate with clinicians and patients, particularly for the category of adjustment disorder with demoralization.
士气低落是一种士气低落和应对能力差的状态，在晚期癌症患者中的患病率为13%-18%。我们调查了临床医生对于“伴有士气低落”作为适应障碍和抑郁症诊断说明符效用的看法。
在一项现场调查中使用比较临床病例 vignettes，询问了来自一系列学科的临床医生对诊断和治疗选项效用的看法。使用 Cochr an's Q 检验和 McNemar 检验比较反应频率，并根据专家诊断排名对敏感性和特异性进行评级。方差分析和配对 t 检验检查了效用评级的显著差异。
280名临床医生对病例 vignettes 进行了评估；77% 的人支持“伴有士气低落的适应障碍”这一类别有用，相比之下，33% 的人支持“伴有焦虑的适应障碍”（McNemar 检验，p<0.001），而83% 的人支持“伴有士气低落”用于重度抑郁发作有用，这与83% 的人认为“伴有 melancholia”有用相匹配。伴有士气低落的适应障碍的敏感性和特异性评级分别为77% 和94%，伴有士气低落的重度抑郁症的敏感性和特异性评级分别为83% 和91%。
临床医生认为“伴有士气低落”这一说明符有助于深化诊断理解、治疗选择以及与临床医生和患者沟通的能力，特别是对于伴有士气低落的适应障碍类别。
