대한불안의학회지 (Anxiety and mood)

  • 제9권1호
  • /
  • Pages.31-37
  • /
  • 2013
  • /
  • 2586-0151(pISSN)
  • /
  • 2586-0046(eISSN)
대한불안의학회 (Korean Academy of Anxiety Disorders)
권호 표지

한국판 정신장애 진단 선별 질문지의 표준화 연구

Study on Standardization of Korean Version of Psychiatric Diagnostic Screening Questionnaire(K-PDSQ)

  • 최형근 (계명대학교 의과대학 동산의료원 정신건강의학교실) ;
  • 정성원 (계명대학교 의과대학 동산의료원 정신건강의학교실) ;
  • 조현주 (영남대학교 의과대학 심리학교실) ;
  • 김정범 (계명대학교 의과대학 동산의료원 정신건강의학교실) ;
  • 정철호 (계명대학교 의과대학 동산의료원 정신건강의학교실)
  • Choi, Hyeong-Keun (Department of Psychiatry, Keimyung University School of Medicine, KeiMyung University Hospital) ;
  • Jung, Sung-Won (Department of Psychiatry, Keimyung University School of Medicine, KeiMyung University Hospital) ;
  • Jo, Hyun-Ju (Department of Psychology, Yeungnam University School of Medicine) ;
  • Kim, Jeong-Bum (Department of Psychiatry, Keimyung University School of Medicine, KeiMyung University Hospital) ;
  • Jung, Chul-Ho (Department of Psychiatry, Keimyung University School of Medicine, KeiMyung University Hospital)
  • 투고 : 2013.03.05
  • 심사 : 2013.04.15
  • 발행 : 2013.04.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

정신장애 진단선별 질문지(PDSQ)는 임상에서 흔하게 진단되는 DSM-IV 축 1의 장애를 평가하기위해 고안된 최초의 자기보고식 질문지이다. PDSQ는 포괄적인 평가가 가능하고, 공존질환을 평가 할 수 있으며 신뢰도와 타당도가 높은 것으로 알려져 있다. 이 연구는 K-PDSQ의 표준화를 위한 연구로서, K-PDSQ와 M.I.N.I.-Plus의 비교를 통해 K-PDSQ의 진단적 타당성과 유용성을 검증하고자 하였다. 계명대학교 동산병원 정신건강의학과를 방문한 외래와 입원환자 640명을 대상으로 K-PDSQ와 M.I.N.I.-Plus의 진단적 일치도, K-PDSQ의 시행시간, 민감도 및 특이도를 산출하였다. K-PDSQ와 M.I.N.I.-Plus의 Cohen's kappa계수는 .66로 일치도가 높게 나타났고, K-PDSQ의 시행 소요시간은 $18.2{\pm}11.80$분이었다. 타당도에 있어 국내 환자군 대상으로 산출된 절단점을 적용하였을 때 높은 수준의 민감도와 특이도를 나타냈다. 대부분의 하위척도에서 수용자 작업특성 곡선(ROC)이 대각선 위에 있었고 곡선아래 영역(AUC) 값이 .80 이상으로 선별검사로서 유용성이 입증되었다. K-PDSQ는 M.I.N.I.-Plus와 상당한 진단적 일치도를 보였고, 시행시간이 짧고, 민감도와 특이도에서 높은 수준을 보였다. 따라서 K-PDSQ는 외래 진료환경에 적용하여 임상면담 이전에 환자에 대한 진단적 평가와 공존질환을 선별해내는데 큰 도움이 될 것으로 생각된다.

Objective : The PDSQ is a brief and psychometrically strong self-report scale designed to screen for common DSM-IV Axis I disorders in clinical settings. In this study, the K-PDSQ was compared with the M.I.N.I.-Plus (Mini-International Neuropsychiatric Interview-Plus) for diagnostic validity and availability of the K-PDSQ as a part of standardization of the K-PDSQ. Methods : The 640 patients were evaluated with the K-PDSQ and the M.I.N.I.-Plus. Diagnosing with the M.I.N.I.-Plus, the diagnostic correspondence, administering time, sensitivity, specificity, ROC curve, and AUC of the K-PDSQ were evaluated. Results : For the diagnostic correspondence of the K-PDSQ, Cohen's kappa coefficient was .66 between the K-PDSQ and the M.I.N.I.-Plus. The administering time of the K-PDSQ was $18.2{\pm}11.80$ minutes. Both sensitivity and specificity of the K-PDSQ were higher: the mean sensitivity across 10 subscales of K-PDSQ was 86%; the mean specificity was 84%. All AUCs of each subscale were above .80, which were statistically significant. Conclusion : The K-PDSQ is valid and available as a diagnostic screening tool. It will be widely used in clinical settings for screening DSM-IV Axis I diagnosis because of its simplicity and high reliability.

키워드

참고문헌

  1. Goldberg D. A classification of psychological distress for use in primary care settings. Soc Sci Med 1992;35:189-193. https://doi.org/10.1016/0277-9536(92)90166-N
  2. Spitzer RL, Fleiss JL. A re-analysis of the reliability of psychiatric diagnosis. Br J Psychiatry 1974;125:341-347. https://doi.org/10.1192/bjp.125.4.341
  3. 조맹제, 이동우. 정신과 진단의 신뢰도와 타당도. 정신병리학 1997;6: 177-182.
  4. Endicott J, Spitzer RL. A diagnostic interview: the schedule for affective disorders and schizophrenia. Arch Gen Psychiatry 1978;35: 837-844. https://doi.org/10.1001/archpsyc.1978.01770310043002
  5. Robins LN, Helzer JE, Croughan J, Ratcliff KS. National Institute of Mental Health Diagnostic Interview Schedule. Its history, characteristics, and validity. Arch Gen Psychiatry 1981;38:381-389. https://doi.org/10.1001/archpsyc.1981.01780290015001
  6. Spitzer RL, Williams JB, Gibbon M, First MB. The Structed Clinical Interview for DSM-III-R (SCID). I: History, rationale, and description. Arch Gen Psychiatry 1992;49:624-629. https://doi.org/10.1001/archpsyc.1992.01820080032005
  7. Robins LN, Wing J, Wittchen HU, Heler JE, Babor TF, Burke J, et al. The Composite International Diagnostic Interview. An epidemiologic instrument suitable for use in conjunctino with different diagnostic systems and in different cultures. Arch Gen Psychiatry 1988; 45(12):1069-1077. https://doi.org/10.1001/archpsyc.1988.01800360017003
  8. Wing JK, Babor T, Brugha T, Burke J, Cooper JE, Giel R, et al. SCAN. Schedule for Clinical Assessment in Neuropsychiatry. Arch Gen Psychiatry 1990;47:589-593. https://doi.org/10.1001/archpsyc.1990.01810180089012
  9. 한오수, 안준호, 송선희, 조맹제, 김장규, 배재남 등. 한국어 판 구조화 임상면담 도구 개발: 신뢰도 연구. 신경정신의학 2000;39:362-72.
  10. 조맹제, 함봉진, 서동우, 홍진표, 배재남, 김장규 등. 한국어판 Composite International Diagnostic Interview (K-CIDI)의 개발. 신경정신의학 2002;41:123-137.
  11. Zimmerman M, Coryell W, Corenthal C, Wilson S. A self report scale to diagnose major depressive disorder. Arch Gen Psychiatry 1986; 43:1076-1081. https://doi.org/10.1001/archpsyc.1986.01800110062008
  12. Foa EB, Riggs DS, Dancu CV, Rothbaum Bo. Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. J Trauma Stress 1993;6:459-473. https://doi.org/10.1002/jts.2490060405
  13. Thelan MH, Farmer J, Wonderlich S, Smith M. A revision of the Bulimia Test: the BULIT-R. Psychol Assess J Consult Clin Psychol 1991;3:119-124.
  14. Coryell W, Endicott J, Andreasen NC, Keller MB, Clayton PJ, Hirschfeld RM, et al. Depression and panic attacks: the significance of overlap as reflected in follow-up and family study data. Am J Psychiatry 1988;145:293-300. https://doi.org/10.1176/ajp.145.3.293
  15. Coryell W, Noyes R. Placebo response in panic disorder. Am J Psychiatry 1988;145:1138-1140. https://doi.org/10.1176/ajp.145.9.1138
  16. Grunhans L. Clinical and psychological characteristics of simultaneous panic disorder and major depression. Am J Psychiatry 1988;145: 1214-1221. https://doi.org/10.1176/ajp.145.10.1214
  17. Keller MB, Klerman GL, Lavori PW, Coryell W, Endicott J, Taylor J. Long-term outcome of episodes of major depression. Clinical and public health significance. JAMA 1984;252:788-792. https://doi.org/10.1001/jama.1984.03350060032024
  18. Noyes R Jr, Reich J, Christiansen J, Suelzer M, Pfohl B, Coryell WA. Outcome of panic disorder. Relationship to diagnostic subtypes and comorbidity. Arch Gen Psychiatry 1990;47:809-818. https://doi.org/10.1001/archpsyc.1990.01810210017003
  19. Shear MK, Greeno C, Kang J, Ludwig D, Frank E, Swartz HA, et al. Diagnosis of nonpsychotic patients in community clinics. Am J Psychiarty 2000;157:581-587. https://doi.org/10.1176/appi.ajp.157.4.581
  20. Zimmerman M, Mattia JI. Psychiatric diagnosis in clinical practice: is comorbidity being missed? Compr Psychiatry 1999;40:182-191. https://doi.org/10.1016/S0010-440X(99)90001-9
  21. Zimmerman M, Mattia JI. A self-report scale to help make psychiatric disanoses: the Psychiatric Diagnostic Screening Questionnaire. Arch Gen Psychiatry 2001;58(8):787-794. https://doi.org/10.1001/archpsyc.58.8.787
  22. Zimmerman M, Chelminski I. A scale to screen for DSM-IV Axis I disorders in psychiatric out-patients: performance of the Psychiatric Diagnostic Screening Questionnaire. Psychol Med 2006;36:1601- 1611. https://doi.org/10.1017/S0033291706008257
  23. 최정식, 김희철, 정성원, 성형모, 사공정규, 김정범 등. 한국판 정신과적 진단 선별 질문지(Psychiatric Diagnostic Screening Questionnaire; PDSQ)의 진단적 타당도. 정신병리학 2009;18:57-66.
  24. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998;59:22-33.
  25. 곽재훈, 김정범, 최정식, 김희철, 정성원, 정철호 등. 한국판 정신정애 진단선별질문지의 표준화 연구: 최적절단점. J Korean Neuropsychiatr Assoc 2012;51:77-84. https://doi.org/10.4306/jknpa.2012.51.2.77
  26. 유상우, 김영신, 노주선, 오강섭, 김찬형, 남궁기 등. 한국판 Mini International Neuropsychiatric Interview 타당도 연구. 대한불안의학회지 2006;2:50-55.
  27. Vliet IM, Berus E. The MINI-International Neuropsychiatric Interveiw. A brief structured diagnostic psychiatric interview for DSM-IV en ICD-10 psychiatric disorders. Tijdschr Psychiatry 2007;49:393-397.
  28. Fairburn CG, Beglin SJ. Studies of the epidemiology of bulimia nervosa. Am J Psychiatry 1990;147:401-408. https://doi.org/10.1176/ajp.147.4.401
  29. 한오수, 유희정, 김창윤, 이 철, 민병근, 박인호. 한국인의 식이장애의 역학 및 성격특성. 정신의학 1990;15:270-287.
  30. Mai F. Somatization disorder: a practical review. Can J Psychiatry 2004;49:652-662. https://doi.org/10.1177/070674370404901002