这个病人有临床抑郁症吗?
John W Williams1, Polly Hitchcock Noël, Jeffrey A Cordes
1Department of Veterans Affairs Medical Center, 508 Fulton St, HSR&D, Bldg 6, Durham, NC 27705, USA. jw.williams@duke.edu
JAMA
|March 7, 2002
概括
准确的抑郁症诊断是可以使用各种问卷和临床采访. 这些工具有助于临床医生以可靠的结果识别严重抑郁症.
科学领域:
- 精神病学和心理健康 精神病学和心理健康
- 诊断准确性研究 诊断准确性研究
- 初级医疗保健医学 一级医疗保健医学
背景情况:
- 抑郁症很常见,但由于缺乏确定的诊断测试,诊断是具有挑战性的.
- 有效的查和诊断工具对于及时干预和抑郁症管理至关重要.
研究的目的:
- 系统地审查抑郁症问卷的诊断准确性和精确性.
- 评估临床检查在诊断严重抑郁症中的可靠性.
- 为了比较各种查仪器和诊断方法的性能.
主要方法:
- 从1970-2000年使用MEDLINE和专门的注册表对英语语言研究进行了全面的文献搜索.
- 包括病例调查研究 (≥100名初级保健患者,验证的问卷) 和可靠性研究 (≥2名临床医生,基于标准的诊断).
- 严格的质量评估包括的研究,专注于样本大小,患者选择,蒙蔽和诊断程序.
主要成果:
- 11个抑郁症问卷,需要1-5分钟的时间进行管理,显示了可比的性能特征.
- 重度抑郁症的中位数正概率比为3.3;中位数负概率比为0.19.
- 在使用半结构面试的心理健康专业人员中观察到高interrater可靠性 (kappa=0.64-0.93);初级保健医生也表现出高的同意 (kappa=0.71).
结论:
- 有许多具有良好表现的实用抑郁症问卷可用于帮助临床医生.
- 由心理健康专业人员或初级保健医生进行的临床面试,特别是半结构面试,提供了可靠的诊断确认.
- 这些经过验证的工具有助于在临床环境中识别和诊断严重抑郁症.
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