Moss S, Prosser H, Goldberg D
Br J Psychiatry. 1996 Mar;168(3):359-67. doi: 10.1192/bjp.168.3.359.
First rank symptoms are central to the diagnosis of schizophrenia, but their complexity makes it difficult to validly detect them in people with learning disability. This report investigates ability of PAS-ADD to detect schizophrenia, validated against expert clinical opinion.
The sample consisted of 98 patients with learning disabilities and a key informant for each sample member. Clinical opinions of the referring psychiatrists were sought using a symptom checklist. Reportage of remission, and the number of core schizophrenia symptoms identified, were used to estimate level of symptom activity at time of interview.
The proportion of schizophrenia cases detected by PAS-ADD increases with the number of active core symptoms identified by the referrer. Where two or more core symptoms were indicated, PAS-ADD detected 71% cases. The most frequently fulfilled criterion was third-person auditory hallucinations. Six schizophrenia diagnoses disagreed with the clinician, four of which were referred as being hypomania. Overall symptom frequency detected by PAS-ADD was positively correlated with IQ.
Results suggest there may be scope for modifying the ICD-10 diagnostic algorithm for use with learning disability, particularly in relation to the delusions and negative symptoms criteria.
一级症状是精神分裂症诊断的核心，但因其复杂性，难以在学习障碍患者中有效识别。本报告调查了PAS - ADD检测精神分裂症的能力，并与专家临床意见进行了验证。
样本包括98名学习障碍患者以及每位样本成员的一名关键信息提供者。使用症状清单征求转诊精神科医生的临床意见。缓解情况报告以及所识别的核心精神分裂症症状数量，用于估计访谈时的症状活动水平。
PAS - ADD检测出的精神分裂症病例比例随转诊医生识别出的活跃核心症状数量增加而上升。当指出两个或更多核心症状时，PAS - ADD检测出71%的病例。最常满足的标准是第三人称幻听。有6例精神分裂症诊断与临床医生的诊断不一致，其中4例被诊断为轻躁狂。PAS - ADD检测到的总体症状频率与智商呈正相关。
结果表明，可能有必要修改ICD - 10诊断算法以用于学习障碍患者，特别是在妄想和阴性症状标准方面。
