GENERALIZED ANXIETY DISORDER AND THE PROPOSED ASSOCIATED SYMPTOMS CRITERION CHANGE FOR DSM-5 IN A TREATMENT-SEEKING SAMPLE OF ANXIOUS YOUTH
GENERALIZED ANXIETY DISORDER AND THE PROPOSED ASSOCIATED SYMPTOMS CRITERION CHANGE FOR DSM-5 IN A TREATMENT-SEEKING SAMPLE OF ANXIOUS YOUTH
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DOI：
10.1002/da.21999
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发表时间：
2012-12-01
影响因子：
7.4
通讯作者：
Hofmann, Stefan G.
中科院分区：
文献类型：
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作者：
Comer, Jonathan S.;Pincus, Donna B.;Hofmann, Stefan G.
目前DSM-5广泛性焦虑障碍（GAD）定义的建议是从相关症状列表中删除疲劳、注意力难以集中、易怒和睡眠障碍，并要求存在两种保留症状（坐立不安或肌肉紧张）之一进行诊断。对青年进行的支持这种改变的相关评价很少。方法本研究评估模式和相关的DSM-IV GAD相关症状在一个大型门诊样本的焦虑青年（N类似= 650），经验性地考虑如何提出的诊断变化可能会影响儿童GAD的患病率和样本组成。结果Logistic回归分析发现，易怒与广泛性焦虑的相关性最高，躁动与广泛性焦虑的相关性最低。疲劳、难以集中注意力和睡眠障碍，由于在抑郁症中普遍存在，因此被认为是GAD的非特异性症状，即使在考虑了抑郁症和注意力问题之后，它们也与GAD有相当大的关联。在GAD青年中，10.9%的人不符合拟议的DSM-5相关症状标准。这些儿童在临床严重程度、神经病学和功能方面与符合拟定标准的GAD青少年相当。结论：如果采用GAD相关症状标准，DSM-5可能会对相当大比例的过度焦虑、临床损害性焦虑的青少年进行未分类。尽管支持成人样本中拟议的标准变化，但目前的研究结果表明，在儿童中，它可能会增加假阴性率。这就提出了一个问题，即拟议的相关症状标准是否是定义儿童广泛性焦虑症的最佳标准。抑郁和焦虑29：994-1003，2012. (C)2012 Wiley Periodicals，Inc.
Background A current proposal for the DSM-5 general anxiety disorder (GAD) definition is to remove fatigue, difficulty concentrating, irritability, and sleep disturbance from the list of associated symptoms, and to require the presence of one of two retained symptoms (restlessness or muscle tension) for diagnosis. Relevant evaluations in youth to support such a change are sparse. Methods The present study evaluated patterns and correlates of the DSM-IV GAD associated symptoms in a large outpatient sample of anxious youth (N similar to= 650) to empirically consider how the proposed diagnostic change might impact the prevalence and sample composition of GAD in children. Results Logistic regression found irritability to be the most associated, and restlessness to be the least associated, with GAD diagnosis. Fatigue, difficulty concentrating, and sleep disturbanceswhich have each been suggested to be nonspecific to GAD due to their prevalence in depressionshowed sizable associations with GAD even after accounting for depression and attention problems. Among GAD youth, 10.9% would not meet the proposed DSM-5 associated symptoms criterion. These children were comparable to GAD youth who would meet the proposed criteria with regard to clinical severity, symptomatology, and functioning. Conclusions A substantial proportion of youth with excessive, clinically impairing worry may be left unclassified by the DSM-5 if the proposed GAD associated symptoms criterion is adopted. Despite support for the proposed criterion change in adult samples, the present findings suggest that in children it may increase the false negative rate. This calls into question whether the proposed associated symptoms criterion is optimal for defining childhood GAD. Depression and Anxiety 29: 994-1003, 2012. (C) 2012 Wiley Periodicals, Inc.