探讨创伤后应激障碍诊断中情绪症状的重叠：在双相情感障碍患者样本中比较 ICD-11 和 DSM-5 标准。
Exploring mood symptoms overlap in PTSD diagnosis: ICD-11 and DSM-5 criteria compared in a sample of subjects with Bipolar Disorder.
机构信息
Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy.
Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy.
出版信息
J Affect Disord. 2020 Nov 1;276:205-211. doi: 10.1016/j.jad.2020.06.056. Epub 2020 Jul 15.
BACKGROUND
The latest edition of the ICD (ICD-11) introduced relevant modifications to Post-traumatic Stress Disorder (PTSD) diagnostic criteria with respect to those of the DSM-5, including the exclusion of DSM-5 symptoms that potentially overlapped with mood disorders. To date, no study has yet investigated the differences in PTSD and its related symptoms, according to the two diagnostic systems in subjects with mood disorders. The aim of the present study was to compare the DSM-5 and ICD-11 diagnostic criteria for PTSD in a sample of patients with Bipolar Disorder (BD).
METHODS
An overall sample of 210 in-patients with BD completed the Trauma and Loss Spectrum-Self Report, assessing post-traumatic stress symptoms, to compare symptomatological PTSD diagnosis according to either the DSM-5 or the ICD-11 criteria.
RESULTS
DSM-5 PTSD was detected in 41% of the whole sample, whereas ICD-11 PTSD in 31.8%. The two diagnostic systems showed good concordance (Cohen's k = 0.643), whereas the concordance of re-experiencing and arousal criteria were moderate (Cohen's k = 0.578) and good (Cohen's k = 0.791), respectively. Almost all the subjects with a diagnosis of ICD-11 PTSD (92.5%) endorsed the "negative alterations in cognitions and mood" DSM-5 criterion.
LIMITATIONS
The small size, the use of a self-report instrument.
CONCLUSION
Our findings show high rates of PTSD and post-traumatic stress symptoms among subjects with BD according to both DSM-5 and ICD-11 criteria, despite significantly lower with the latter. However, potentially DSM-5 mood overlapping symptoms appear to be significantly higher among bipolar patients with ICD-11 PTSD with respect to those without.
背景
最新版的《国际疾病分类》（ICD-11）对创伤后应激障碍（PTSD）的诊断标准进行了相关修改，与 DSM-5 相比，包括排除了可能与心境障碍重叠的 DSM-5 症状。迄今为止，尚无研究调查心境障碍患者中，根据这两种诊断系统，PTSD 及其相关症状的差异。本研究的目的是比较双相情感障碍（BD）患者样本中 DSM-5 和 ICD-11 的 PTSD 诊断标准。
方法
一个由 210 名住院 BD 患者组成的总体样本完成了创伤和丧失谱-自我报告，评估创伤后应激症状，根据 DSM-5 或 ICD-11 标准比较症状性 PTSD 诊断。
结果
DSM-5 PTSD 检出率为 41%，ICD-11 PTSD 为 31.8%。两种诊断系统具有良好的一致性（Cohen's k=0.643），而再体验和觉醒标准的一致性为中度（Cohen's k=0.578）和良好（Cohen's k=0.791）。几乎所有 ICD-11 PTSD 诊断的患者（92.5%）都符合 DSM-5 的“认知和情绪的负性改变”标准。
局限性
样本量小，使用自我报告工具。
结论
我们的研究结果显示，根据 DSM-5 和 ICD-11 标准，BD 患者 PTSD 和创伤后应激症状的发生率较高，尽管后者的发生率明显较低。然而，与 ICD-11 PTSD 患者相比，具有 DSM-5 心境重叠症状的双相患者明显更高。
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