Orygen, Melbourne, Australia; Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.
Orygen, Melbourne, Australia; Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia.
Schizophr Res. 2021 Feb;228:373-381. doi: 10.1016/j.schres.2020.12.015. Epub 2021 Feb 4.
Earlier recognition and accurate assessment of depressive symptoms is important to improving outcomes in individuals with recent-onset schizophrenia spectrum disorders (termed SSD hereafter)-regardless of whether positive psychotic symptoms are present or have resolved. The Montgomery-Åsberg Depression Rating Scale (MADRS) is frequently used to assess depressive symptoms in SSD, but no study has examined the psychometric validity of MADRS scores in individuals exclusively with SSD and sub-grouped by those with and without positive psychotic symptoms. This study involved baseline data from the Psychosis Recent Onset GRoningen Survey (PROGR-S). Measures used were: MADRS, depressive and negative subscales of Positive and Negative Syndrome Scale (PANSS, PANSS), and Schedules for Clinical Assessment in Neuropsychiatry (SCAN). The MADRS total score had sufficient concurrent validity with PANSS (evidence by ρ≥0.70), and insufficient divergent validity with PANSS (evidenced by ρ ≥0.30), in the full cohort and when sub-grouped by positive psychotic symptoms. In symptom networks, divergent communities comprising either MADRS or PANSS items were found, except the MADRS item inability to feel overlapped with PANSS items. The most divergent MADRS items were sadness, pessimism, and suicidal thoughts. The MADRS total score had sufficient predictive validity for determining caseness for MDD based on SCAN, but the optimal cut-off differed in those with and without positive psychotic symptoms (MADRS≥18 versus MADRS≥11). The MADRS has sufficient validity for assessing depressive symptoms in SSD. Since scores might depend upon symptoms of SSD, MADRS≥11 and the presence of sadness, pessimism, or suicidal ideation might be the best indicator of MDD in SSD.
早期识别和准确评估抑郁症状对于改善近期发病的精神分裂症谱系障碍（以下简称 SSD）患者的预后非常重要——无论是否存在阳性精神病症状或阳性精神病症状是否已经缓解。蒙哥马利-Åsberg 抑郁评定量表（MADRS）常用于评估 SSD 患者的抑郁症状，但尚无研究专门检查 MADRS 评分在仅患有 SSD 且按是否存在阳性精神病症状分组的患者中的心理测量学效度。本研究纳入了精神分裂症发病初期格罗宁根调查（PROGR-S）的基线数据。所用测量工具包括：MADRS、阳性与阴性症状量表（PANSS）的抑郁和阴性子量表、神经精神病临床评估量表（SCAN）。MADRS 总分与 PANSS 具有足够的同时效度（ρ≥0.70），与 PANSS 具有不足的差异效度（ρ≥0.30），这在全队列和按阳性精神病症状分组时均成立。在症状网络中，除了 MADRS 项目“无法感受到”与 PANSS 项目重叠外，还发现了 MADRS 或 PANSS 项目组成的差异社区。最具差异的 MADRS 项目为悲伤、悲观和自杀念头。MADRS 总分对基于 SCAN 确定 MDD 病例具有足够的预测效度，但最佳截断值在有或没有阳性精神病症状的患者中有所不同（MADRS≥18 与 MADRS≥11）。MADRS 对评估 SSD 中的抑郁症状具有足够的有效性。由于分数可能取决于 SSD 的症状，因此 MADRS≥11 以及悲伤、悲观或自杀意念的存在可能是 SSD 中 MDD 的最佳指标。
