Marten P A, Brown T A, Barlow D H, Borkovec T D, Shear M K, Lydiard R B
Center for Stress and Anxiety Disorders, State University of New York, Albany 12203.
J Nerv Ment Dis. 1993 Nov;181(11):676-82. doi: 10.1097/00005053-199311000-00005.
In light of ongoing considerations for DSM-IV, the 18 ratings comprising the associated symptom criterion of DSM-III-R generalized anxiety disorder were evaluated. The interrater reliability and endorsement rates of each symptom were calculated from interview-based ratings of generalized anxiety disorder patients at four sites (total N = 204). Interrater reliability analyses indicated high agreement for the majority of the 18 symptoms. Regarding the frequency of symptom endorsement, significant Spearman correlations (range = .69 to .94) revealed marked consistency in the rates of symptom endorsement across the four sites. A list of "satisfactory" symptoms was generated from those meeting certain reliability and endorsement criteria. Seven symptoms were identified: irritability, restlessness, muscle tension, difficulty concentrating, sleep difficulties, feeling keyed up, and easy fatigability. Interestingly, all of the above belong to either the motor tension or vigilance and scanning clusters of the DSM-III-R associated symptom ratings. In contrast, symptoms belonging to the autonomic hyperactivity cluster were endorsed infrequently at all sites. Although additional research is needed (e.g., examination of the symptoms' discriminant validity), these findings essentially support revising the associated symptom criterion of generalized anxiety disorder in accord with option E3 in the DSM-IV Options Book.
鉴于对《精神疾病诊断与统计手册》第四版（DSM-IV）的持续考量，对构成《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）广泛性焦虑障碍相关症状标准的18项评定进行了评估。从四个地点对广泛性焦虑障碍患者进行基于访谈的评定中计算出每项症状的评定者间信度和认可率（总样本量N = 204）。评定者间信度分析表明，18项症状中的大多数具有高度一致性。关于症状认可频率，显著的斯皮尔曼相关性（范围为0.69至0.94）显示四个地点的症状认可率具有明显的一致性。从符合某些信度和认可标准的症状中生成了一份“满意”症状清单。确定了7项症状：易怒、坐立不安、肌肉紧张、注意力难以集中、睡眠困难、感觉紧张和容易疲劳。有趣的是，上述所有症状均属于DSM-III-R相关症状评定中的运动紧张或警觉及扫描类别。相比之下，自主神经活动亢进类别的症状在所有地点的认可频率都很低。尽管还需要进一步研究（例如，对症状的区分效度进行检验），但这些发现基本上支持根据《精神疾病诊断与统计手册》第四版选项手册中的选项E3修订广泛性焦虑障碍的相关症状标准。
