Towards an empirically based validation of intuitive diagnostic: Rumke's 'praecox feeling' across the schizophrenia spectrum
Towards an empirically based validation of intuitive diagnostic: Rumke's 'praecox feeling' across the schizophrenia spectrum
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DOI：
10.1159/000093921
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发表时间：
2006-01-01
期刊：
影响因子：
3.6
通讯作者：
Grube, Michael
中科院分区：
文献类型：
--
作者：
Grube, Michael
背景精神分裂症的早期识别对于建立适当的治疗干预非常重要，特别是在紧急情况下。直觉推理通常是必要的，因为根据ICD-10或DSM-IV标准的标准化分类不适合这些复杂且经常变化的环境。经验丰富的精神病学家以直觉的方式识别特定的精神分裂症结构的过程被荷兰精神病学家Rumke于1941年命名为“早发性感觉”。抽样与方法：为了评价这种直观的临床方法的诊断质量，我们调查了67例以前未知的患者。所有患者均表现出急性精神病症状，如偏执妄想和幻觉，属于精神分裂症谱系。经验丰富的精神科医生的第一次采访仅包括目前的精神病理学状况。后来，由其他不了解调查目的的独立工作人员对精神分裂症的病程或药物治疗或家族史进行了研究。“早发感”的强度分为四个等级：不存在-轻度-中度-高度。在住院期结束时，由独立评估者根据ICD-10和DSM-IV分类进行标准化诊断分类。结果如下：与标准化诊断分类相比，直观推理的精确度非常高，根据所使用的标准化系统，灵敏度约为0.85，特异性约为0.80，阳性预测能力约为0.90，阴性预测能力约为0.65。认知障碍、情感障碍、自我知觉障碍和沟通能力下降都与早发性感觉的强度相关。序贯回归分析显示，单一变项“情绪困扰”对“早发感”的影响最大。此外，高强度的“早发感”与精神分裂症的遗传易感性密切相关。无论是精神疾病的严重程度，还是药物的锥体外系副作用，都与“早发性感觉”的强度无关。结论：我们的工作可能有助于反思我们的诊断实践，并有助于使建立诊断所涉及的各种因素变得明显。版权所有（c）2006 S. Karger AG，巴塞尔。
Background. The early identification of schizophrenia is important in establishing an adequate therapeutic intervention, especially in emergency situations. Intuitive reasoning is often necessary because a standardized classification according to ICD-10 or DSM-IV criteria is not suitable in these complex, and often changing, settings. The process of recognizing the specific schizophrenic structure in an intuitive way by an experienced psychiatrist was named 'praecox feeling' by the Dutch psychiatrist Rumke in 1941. Sampling and Methods: To evaluate the diagnostic quality of this kind of intuitive clinical approachwe investigated 67 previously unknown patients. All patients displayed acute psychotic symptoms like paranoid delusions and hallucinations belonging to the schizophrenic spectrum. The first interview by an experienced psychiatrist included only the present state psychopathology. Data referring to the course of the illness or medication or family history of schizophrenia were explored later by other independent staff members who were blind to the aim of the investigation. The intensity of the 'praecox feeling' was rated in four degrees: not present - mild - moderate - high. At the end of the inpatient period a standardized diagnostic classification according to ICD-10 and DSM-IV classification was carried out by independent raters. Results: Compared to the standardized diagnostic classification the precision of the intuitive reasoning was remarkably high with a sensitivity of about 0.85, a specificity of about 0.80, a positive predictive power of about 0.90, and a negative predictive power of about 0.65 depending on the standardized system used. Cognitive impairment, affective disturbances, disturbed self-perception, and reduced communication skills all correlated with intensity of 'praecox feeling'. The single variable 'affective disturbances' had the highest impact on the intensity of 'praecox feeling' in an ordinal regression analysis. Furthermore a high intensity of 'praecox feeling' strongly correlated with a hereditary predisposition to schizophrenia. Neither the severity of the mental illness nor extrapyramidal side effects of the medication correlated with the intensity of 'praecox feeling'. Conclusion: Our work can possibly help in contributing to reflection on our diagnostic practices and help to make the various factors involved in establishing diagnoses apparent. Copyright (c) 2006 S. Karger AG, Basel.