CAJ | 학술논문

目的探讨32项轻躁狂症状清单(HCL-32)和心境障碍问卷(MDQ)筛查双相障碍或抑郁症自杀风险的可行性.方法使用简明国际神经精神障碍访谈(MINI-SCID)评价1478例双相障碍或抑郁症患者的临床特征,依据MINI-SCID对自杀意念进行自杀风险分级.采用logistic回归分析HCL-32和MDQ用来筛查双相障碍及抑郁症患者自杀风险的可行性,筛选与自杀风险相关的条目.结果 1478例患者中,692例(46.8％)无自杀风险,271例(18.3％)为低自杀风险,284例(19.2％)为中自杀风险,231例(15.6％)为高自杀风险.不同自杀风险患者的HCL-32和MDQ评分比较差异均有统计学意义(P＜0.01);双相障碍Ⅰ型中不同自杀风险患者的HCL-32评分比较差异有统计学意义(P＜0.01),抑郁症不同自杀风险患者的MDQ评分比较差异有统计学意义(P＜0.01);双相障碍Ⅱ型中不同自杀风险患者的HCL-32和MDQ评分比较差异均无统计学意义(P＞0.05).logistic回归分析显示,HCL-32量表中的1(需要的睡眠比平时少)、29(喝咖啡比平时多)、31(喝酒比平时多)、32(比平时服用更多的药物)项(OR分值别为1.382、1.623、1.817、1.354,95％可信区间分别为1.124～ 1.698,1.116～2.359,1.242～2.658,0.960 ～1.909),MDQ中2(容易发脾气,经常大声指责别人,或与别人争吵、吵架)、4(比平时睡的少,而且不想睡)、13(花钱太多,使自己或家庭陷入困境)项(OR分值别为1.265、1.330、2.382,95％可信区间分别为1.006 ～1.590,1.066 ～1.660,1.721～3.297)均进入自杀风险相关因素模型.HCL-32和MDQ评估双相障碍Ⅰ型自杀风险相关操作特征曲线下面积分别为0.66、0.62.结论 HCL-32与MDQ筛选双相障碍Ⅰ型自杀意念相关危险因素尚可,但对于双相障碍Ⅱ型及抑郁障碍效果不佳.
목적 탐토32항경조광증상청단(HCL-32)화심경장애문권(MDQ)사사쌍상장애혹억욱증자살풍험적가행성.방법 사용간명국제신경정신장애방담(MINI-SCID)평개1478례쌍상장애혹억욱증환자적림상특정,의거MINI-SCID대자살의념진행자살풍험분급.채용logistic회귀분석HCL-32화MDQ용래사사쌍상장애급억욱증환자자살풍험적가행성,사선여자살풍험상관적조목.결과 1478례환자중,692례(46.8％)무자살풍험,271례(18.3％)위저자살풍험,284례(19.2％)위중자살풍험,231례(15.6％)위고자살풍험.불동자살풍험환자적HCL-32화MDQ평분비교차이균유통계학의의(P＜0.01);쌍상장애Ⅰ형중불동자살풍험환자적HCL-32평분비교차이유통계학의의(P＜0.01),억욱증불동자살풍험환자적MDQ평분비교차이유통계학의의(P＜0.01);쌍상장애Ⅱ형중불동자살풍험환자적HCL-32화MDQ평분비교차이균무통계학의의(P＞0.05).logistic회귀분석현시,HCL-32량표중적1(수요적수면비평시소)、29(갈가배비평시다)、31(갈주비평시다)、32(비평시복용경다적약물)항(OR분치별위1.382、1.623、1.817、1.354,95％가신구간분별위1.124～ 1.698,1.116～2.359,1.242～2.658,0.960 ～1.909),MDQ중2(용역발비기,경상대성지책별인,혹여별인쟁묘、묘가)、4(비평시수적소,이차불상수)、13(화전태다,사자기혹가정함입곤경)항(OR분치별위1.265、1.330、2.382,95％가신구간분별위1.006 ～1.590,1.066 ～1.660,1.721～3.297)균진입자살풍험상관인소모형.HCL-32화MDQ평고쌍상장애Ⅰ형자살풍험상관조작특정곡선하면적분별위0.66、0.62.결론 HCL-32여MDQ사선쌍상장애Ⅰ형자살의념상관위험인소상가,단대우쌍상장애Ⅱ형급억욱장애효과불가.
Objective To evaluate the feasibility of screening for suicidal risk with the Hypomania Checklist (HCL-32) and Mood Disorder Questionnaire (MDQ) among patients of bipolar disorder or depression.Methods This was the re-analysis of data from Bipolar Screening Investigation Project.1487 consecutive subjects with bipolar disorder or depression were screened for suicidal ideation using the Chinese version of the HCL-32 and the MDQ,and diagnostically interviewed with the MINI-SCID by physician.According to the MINI-SCID screening for suicide risk,four risk groups were divided.The correlated items of suicide risk were screened in the HCL-32 and MDQ.Results In the 1478 screened patients,ones with non-,low-,middle-or high-suicide risk were 692 (46.8％),271 (18.3％),284 (19.2％) or 231 (15.6％) respectively.The scores of HCL-32 and MDQ in the four groups were significantly different (P ＜ 0.01).The score of HCL-32 was different in the four groups of suicide risk among the patients with bipolar Ⅰ disorder (P ＜ 0.01),and so was the score of MDQ among the patients with unipolar depression (P ＜ 0.01).No difference of HCL-32 and MDQ score were found in the four groups with bipolar [[disorder (P ＞ 0.05).With logistic regression analysis,factors of suicidal risk were screened with the 1 th,29th,31th and 32th items of HCL-32,i.e.,a decreased need for sleep,increased demand of coffee,alcohol and drugs.The other was with 2th,4th and 13th items of MDQ,i.e.,tend to lose temper and wrangle,decreased need for sleep,extravagancy.The comparison with the MDQ and HCL-32 performance showed that both screening tools might show passable effects in bipolar disorder with the area under ROC (0.66,0.62).Conclusion The results indicate passable accuracy of HCL-32 and MDQ as a screening instrument for suicide risk with bipolar Ⅰ disorder,but with a high rate of false negatives of identification for suicide risk in bipolar disorder Ⅱ.