Vazquez-Montes Maria D L A, Stevens Richard, Perera Rafael, Saunders Kate, Geddes John R
Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
Department of Psychiatry, Warneford Hospital, University of Oxford, Warneford Lane, Oxford, OX3 7JX, UK.
Int J Bipolar Disord. 2018 Apr 4;6(1):7. doi: 10.1186/s40345-017-0116-2.
Recurrent mood episodes and subsyndromal mood instability cause substantial disability in patients with bipolar disorder. Early identification of mood episodes enabling timely mood stabilization is an important clinical goal. This study investigates the ability of control chart methodology to predict manic and/or depressive episodes by applying Shewhart's control rules to weekly self-reported scores from mania and depression questionnaires.
Shewhart's control rules were applied to weekly self-reported scores from the Altman Self-Rating Mania Scale (ASRM) and the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS) collected from 2001 to 2012 as part of the OXTEXT programme. Manic and depressive episodes were defined as an ASRM score ≥ 10 or a QIDS score ≥ 15, respectively. An episode-free run-in period of eight consecutive weeks without an episode of either type was used to calibrate control charts. Shewhart's rules were then applied to follow-up data. Their sensitivity and positive predictive value for predicting manic or depressive episodes within the next 4 weeks were calculated focusing on the first episode. Secondary analyses varying control chart type, length of episode-free run-in period, time frames to evaluate diagnostic accuracy, thresholds defining either manic or depressive episodes, and missing data methods were performed.
Data from 146 participants (37% men) were included. The mean age was 43.4 (SD = 13.3) years. The median follow-up was 10 (IQR 5-40) weeks for mania and 10 (IQR 5-23) weeks for depression. A total of 53 (36%) participants had a manic episode and 67 (46%) had a depressive episode. For manic episodes, the sensitivity and positive predictive value of Shewhart's control rules were 30% (95% CI 19-45%) and 7% (95% CI 5-9%), and for depressive episodes, 33% (95% CI 22-46%) and 9% (95% CI 6-12%), respectively. Results from secondary analyses were similar to these.
Tele-monitoring with control rules has the potential to predict about one-third of manic or depressive episodes before they occur, at the cost of a high false positive rate. Given the severe consequences of manic and depressive episodes, this trade-off may be desirable.
双相情感障碍患者中，反复出现的情绪发作和亚综合征性情绪不稳定会导致严重的残疾。早期识别情绪发作以便及时稳定情绪是一项重要的临床目标。本研究通过将休哈特控制规则应用于躁狂和抑郁问卷的每周自我报告得分，来调查控制图方法预测躁狂和/或抑郁发作的能力。
休哈特控制规则应用于2001年至2012年作为OXTEXT项目一部分收集的阿尔特曼自我评定躁狂量表（ASRM）和抑郁症状快速自评量表（QIDS）的每周自我报告得分。躁狂发作和抑郁发作分别定义为ASRM得分≥10或QIDS得分≥15。使用连续八周无任何一种发作类型的无发作导入期来校准控制图。然后将休哈特规则应用于随访数据。计算其在接下来4周内预测躁狂或抑郁发作的敏感性和阳性预测值，重点关注首次发作。进行了次要分析，改变了控制图类型、无发作导入期长度、评估诊断准确性的时间框架、定义躁狂或抑郁发作的阈值以及缺失数据方法。
纳入了146名参与者（37%为男性）的数据。平均年龄为43.4（标准差=13.3）岁。躁狂的中位随访时间为10（四分位间距5 - 40）周，抑郁的中位随访时间为10（四分位间距5 - 23）周。共有53名（36%）参与者有躁狂发作，67名（46%）有抑郁发作。对于躁狂发作，休哈特控制规则的敏感性和阳性预测值分别为30%（95%置信区间19 - 45%）和7%（95%置信区间5 - 9%），对于抑郁发作分别为33%（95%置信区间22 - 46%）和9%（95%置信区间6 - 12%）。次要分析的结果与这些结果相似。
使用控制规则进行远程监测有可能在躁狂或抑郁发作发生前预测约三分之一的发作，但代价是假阳性率较高。鉴于躁狂和抑郁发作的严重后果，这种权衡可能是可取的。
