Characterization of Fatigue States in Medicine and Psychiatry by Structured Interview
Characterization of Fatigue States in Medicine and Psychiatry by Structured Interview
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DOI：
10.1097/psy.0000000000000061
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发表时间：
2014-06-01
影响因子：
3.3
通讯作者：
Lloyd, Andrew R.
中科院分区：
文献类型：
--
作者：
Bennett, Barbara Kaye;Goldstein, David;Lloyd, Andrew R.
背景：不明原因的疲劳状态很普遍，诊断界限不确定。目的：疲劳相关疾病的患者进行了调查问卷和一种新的半结构化访谈，以确定歧视性的功能。研究方法：招募了来自慢性疲劳综合征（n = 20）、癌后疲劳（PCF; n = 20）或重度抑郁症（n = 16）专科实践的女性横断面样本。此外，研究了两个纵向样本：与急性感染相关的疲劳女性，随后发生感染后疲劳综合征（n = 20）或顺利恢复（n = 21），以及接受乳腺癌辅助治疗的女性，经历治疗相关疲劳，随后发生PCF（n = 16）或顺利恢复（n = 16）。患者完成自我报告问卷，并接受过培训的访谈者应用神经衰弱半结构化临床访谈。根据临床医生指定的诊断测量访谈的接受者操作特征曲线。聚类分析进行经验分区参与者的症状特征。结果如下：访谈具有良好的内部一致性（Cronbach α“疲劳”= 83），慢性疲劳综合征（100%和83%）和重度抑郁症（100%和72%）的诊断敏感性和特异性，PCF的合理参数（72%和58%）。经验聚类的“疲劳”或“神经认知困难”项目分配给一组的大多数患者，而“情绪障碍”项目正确分类抑郁症患者。结论：神经衰弱的半结构化临床访谈提供了可靠的诊断使用评估疲劳相关的条件。疲劳和神经认知困难的症状领域是跨医学和精神病学边界共享的，而抑郁症的症状如快感缺乏则是有区别的。
Context: Unexplained fatigue states are prevalent, with uncertain diagnostic boundaries. Objective: Patients with fatigue-related illnesses were investigated by questionnaire and a novel semistructured interview to identify discriminatory features. Methods: Cross-sectional samples of women from specialist practices with chronic fatigue syndrome (n = 20), postcancer fatigue (PCF; n = 20), or major depression (n = 16) were recruited. Additionally, two longitudinal samples were studied: women with fatigue associated with acute infection who subsequently developed postinfective fatigue syndrome (n = 20) or recovered uneventfully (n = 21), and women undergoing adjuvant therapy for breast cancer experiencing treatment-related fatigue who subsequently developed PCF (n = 16) or recovered uneventfully (n = 16). Patients completed self-report questionnaires, and trained interviewers applied the Semi-structured Clinical Interview for Neurasthenia. The receiver operating characteristics curves of the interview were measured against clinician-designated diagnoses. Cluster analyses were performed to empirically partition participants by symptom characteristics. Results: The interview had good internal consistency (Cronbach alpha "fatigue" = 83), and diagnostic sensitivity and specificity for chronic fatigue syndrome (100% and 83%) and major depression (100% and 72%), with reasonable parameters for PCF (72% and 58%). Empirical clustering by "fatigue" or "neurocognitive difficulties" items allocated most patients to one group, whereas "mood disturbance" items correctly classified patients with depression only. Conclusions: The Semi-structured Clinical Interview for Neurasthenia offers reliable diagnostic use in assessing fatigue-related conditions. The symptom domains of fatigue and neurocognitive difficulties are shared across medical and psychiatric boundaries, whereas symptoms of depression such as anhedonia are distinguishing.