INSERM U1114, Strasbourg, France; Psychiatry Department, University Hospital of Strasbourg, Strasbourg, France.
Department of Medicine and Surgery(,) Università di Parma, Parma, Italy.
J Affect Disord. 2019 Aug 1;255:69-76. doi: 10.1016/j.jad.2019.05.033. Epub 2019 May 21.
Racing and crowded thoughts are frequently reported respectively in manic and mixed episodes of bipolar disorder (BD). However, questionnaires assessing this symptom are lacking. Here we aimed to investigate racing thoughts across different mood episodes of BD through a self-report questionnaire that we developed, the 34-item Racing and Crowded Thoughts Questionnaire (RCTQ). In addition to assessing its factor structure and validity, we were interested in the RCTQ's ability to discriminate mixed and non-mixed depression.
221 BD patients and 120 controls were clinically assessed via the YMRS (mania) and the QIDS-C16 (depression), then fulfilled the RCTQ, rumination, worry, and anxiety measures. Three depression groups were operationalized according to YMRS scores: YMRS scores 2 > 6 and YMRS scores = 1 or 2, for respectively mixed and non-pure depression, and YMRS = 0 for pure-depression.
Confirmatory factor analysis showed that the three-factor model of the RCTQ yielded the best fit indices, which improved after the removal of redundant items, resulting in a 13-item questionnaire. Hypomanic and anxiety symptoms were the main predictors of scores; rumination was not a significant predictor. RCTQ results were similar between mixed groups and non-pure depression, and both were higher than in pure-depression.
Patients' pharmacological treatment might have influenced the results.
The 13-item RCTQ captures different facets of racing thoughts heightened in hypomanic and mixed states, but also in depression with subclinical hypomanic/activation symptoms (e.g. non-pure depression characterized by enhanced subjective irritability), suggesting that it is particularly sensitive to activation symptoms in BD, and could become a valuable tool in the follow-up of patients.
在双相情感障碍（BD）的躁狂和混合发作中，分别频繁报告有思维奔逸和思维拥挤。然而，评估这些症状的问卷尚缺乏。在此，我们旨在通过我们开发的一个自评问卷——34 项思维奔逸和拥挤思维问卷（RCTQ），来研究 BD 的不同心境发作中的思维奔逸。除了评估其因子结构和有效性之外，我们还对 RCTQ 区分混合和非纯抑郁的能力感兴趣。
221 名 BD 患者和 120 名对照者通过 YMRS（躁狂）和 QIDS-C16（抑郁）进行临床评估，然后完成 RCTQ、反刍、担忧和焦虑量表。根据 YMRS 评分将三组抑郁分为以下三种情况：YMRS 评分 2>6 和 YMRS 评分=1 或 2，分别代表混合和非纯抑郁，YMRS=0 代表纯抑郁。
验证性因子分析表明，RCTQ 的三因子模型得出了最佳的拟合指数，在剔除冗余项目后得到改善，形成了一个 13 项的问卷。轻躁狂和焦虑症状是得分的主要预测因素；反刍不是一个显著的预测因素。混合组和非纯抑郁的 RCTQ 结果相似，均高于纯抑郁。
患者的药物治疗可能影响了结果。
13 项 RCTQ 捕捉到了在轻躁狂和混合状态下以及在具有亚临床轻躁狂/激活症状的抑郁中（例如以增强的主观烦躁为特征的非纯抑郁）思维奔逸的不同方面，这表明它对 BD 中的激活症状特别敏感，可能成为患者随访的一个有价值的工具。
