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首页> 外文期刊>The Australian and New Zealand journal of psychiatry >A clinical staging approach to improving diagnostics in anxiety disorders: Is it the way to go?
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A clinical staging approach to improving diagnostics in anxiety disorders: Is it the way to go?

机译：提高焦虑症诊断的临床分期方法：是去的方式吗？

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Background: Clinical staging is a paradigm in which stages of disease progression are identified; these, in turn, have prognostic value. A staging model that enables the prediction of long-term course in anxiety disorders is currently unavailable but much needed as course trajectories are highly heterogenic. This study therefore tailored a heuristic staging model to anxiety disorders and assessed its validity. Methods: A clinical staging model was tailored to anxiety disorders, distinguishing nine stages of disease progression varying from subclinical stages (0, 1A, 1B) to clinical stages (2A-4B). At-risk subjects and subjects with anxiety disorders (n = 2352) from the longitudinal Netherlands Study of Depression and Anxiety were assigned to these nine stages. The model's validity was assessed by comparing baseline (construct validity) and 2-year, 4-year and 6-year follow-up (predictive validity) differences in anxiety severity measures across stages. Differences in depression severity and disability were assessed as secondary outcome measures. Results: Results showed that the anxiety disorder staging model has construct and predictive validity. At baseline, differences in anxiety severity, social avoidance behaviors, agoraphobic avoidance behaviors, worrying, depressive symptoms and levels of disability existed across all stages (all p-values < 0.001). Over time, these differences between stages remained present until the 6-year follow-up. Differences across stages followed a linear trend in all analyses: higher stages were characterized by the worst outcomes. Regarding the stages, subjects with psychiatric comorbidity (stages 2B, 3B, 4B) showed a deteriorated course compared with those without comorbidity (stages 2A, 3A, 4A). Conclusion: A clinical staging tool would be useful in clinical practice to predict disease course in anxiety disorders.
机译：背景：临床分期是一种范例，其中鉴定了疾病进展的阶段;这些反过来具有预后价值。一种阶段模型，使能焦虑症的长期课程预测目前是不可用的，但在课程轨迹是高度异质的时，需要很多。因此，这项研究量身定制了启发式分期模型，以焦虑症并评估其有效性。方法：临床分期模型针对焦虑症定制，区分九个阶段的疾病进展从亚临床阶段（0,1a，1b）到临床阶段（2a-4b）。从纵向荷兰的抑郁症和焦虑的抑制和焦虑研究的患有焦虑症（n = 2352）的风险受试者被分配到这九个阶段。通过比较基线（构建有效性）和2年，4年和6年的后续（预测有效性）差异跨阶段的焦虑严重程度措施来评估模型的有效性。抑郁严重程度和残疾的差异被评估为次要结果措施。结果：结果表明，焦虑症分期模型具有构建和预测的有效性。在基线，焦虑严重程度，社会避税行为，恐怖症避免行为，令人担忧，抑郁症状和残疾水平的差异（所有p值<0.001）。随着时间的推移，在6年的随访之前，阶段之间的这些差异仍然存在。跨阶段的差异在所有分析中进行了线性趋势：较高阶段的特征是最糟糕的结果。关于阶段，与无合并率的那些（阶段2a，3a，4a）相比，具有精神病合并率（阶段2b，3b，4b）的受试者显示出劣化的路线（阶段2a，3a，4a）。结论：临床分期工具可用于临床实践，以预测焦虑症的疾病课程。

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