| 【Objective】To develop an autonomic neurological function scale with fewer entries and more convenient clinical application;and to explore the symptoms of autonomic dysfunction in patients with emotional disorders through the evaluation of patients by the scale.In order to provide a new tool and the scientific basis for the diagnosis,identification,evaluation and targeted treatment of patients with emotional disorders.【Methods】1.We created the Autonomic Function Scale.Identify the goals and dimensions of the scale.Create an entry pool and filter entries.By expert assessment and pre-survey,preliminary preparation of the Autonomic Function Scale.2.Validity and reliability testing of Autonomic Function Scale.Patients who were admitted to the Psychiatry Department of the Zhongda Hospital Southeast University from January 2018 to December 2018,diagnosed with depressive disorder,generalized anxiety disorder,and panic disorder(100).Patients who were admitted to the Endocrinology Department and Rheumatology Department of the Zhongda Hospital Southeast University from October 2018 to December 2018,diagnosed with diabetes(32)and rheumatic diseases(29).Collected students from Nanjing Health School(121).Subjects completed the Autonomic Function Scale(AFS)and 31 Composite Autonomic Symptom Scale(Compass31).The reliability and validity of AFS are tested by item analysis,reliability analysis,and validity analysis..3.Autonomic dysfunction studies in patients with mood disorders.Patients who were admitted to the Psychiatry Department of the Zhongda Hospital Southeast University from January 2018 to December 2018,diagnosed with depressive disorder,generalized anxiety disorder,and panic disorder(100).In this study,patients with emotional disorders were assessed using Patient Health Questionnaire-9(PHQ-9)and Generalized Anxiety Disorder 7(GAD-7).Autonomic Function Scale(AFS),31 Composite Autonomic Symptom Scale(Compass31),Heart Rate Variability(HRV),Sympathetic Skin Response(SSR)assesses patients autonomic function.【Results】1.The self-edited Autonomic Function Scale(AFS)contains 10 items,which are “1 flustered or heartbeat increased”,“2 sudden blood pressure fluctuations or dizziness,fainting”,“3 chest tightness,asthma or difficulty breathing”,“4 loss of appetite,upper abdominal discomfort or indigestion”,“5 diarrhea or constipation”,“6 mouth dry,dry eyes or saliva”,“7 become more intolerant of noise or glare”,“8 cold,Excessive sweat or pale skin”,“9 urinary difficulty or frequent urination urgency”,“10 decreased sexual desire,impotence or sexual pain”.2.AFS item analysis: The discrete trend method shows that each item has a CV value >15%.The entry decision value method showed that the scores of each item in the high group were higher than the low group,and the difference was statistically significant.3.AFS correlation analysis: The scores of the items in the emotional disorder group and the normal control group were linearly positively correlated with the total score(r1 value was0.444-0.652,P<0.05,r2 value was 0.361-0.708,P< 0.05);the scores of the items in the emotional disorder group and the normal control group were linearly positively correlated with their corresponding common factors(r1 value was 0.658-0.799,P<0.05,r2 value was 0.308-0.804,P<0.05);emotion The correlation coefficient between the factors in the disorder group was0.400-0.435,P<0.05.The correlation coefficient between each factor and the total score was0.712-0.764,P<0.05.The correlation coefficient between the factors in the normal control group was 0.502-0.600.P<0.05,the correlation coefficient between each factor and the total score was0.739-0.786,P<0.05.4.AFS validity analysis: structural validity: KMO value is 0.709,Bartlett’s spherical testχ~2=213.049,P<0.001,suggesting that exploratory factor analysis can be performed and the maximum variance orthogonal rotation is performed,with the characteristic value >1 combined The stone map extracts three factors(factor 1 includes entries 2,6,and 7,factor 2 includes entries 5,8,and 9,and factor 3 includes entries 1,3,4,and 10),explaining a total of 57.340% of the variance,and each The commonality of the entries is 0.429-0.738,and the load value is 0.461-0.882.Calibration validity: using the Compass31 as the calibration scale,the total score of the autonomic function assessment scale and the total score of the Compass31 scale of the emotional disorder group,the diabetes group,the rheumatic disease group,and the normal control group were 0.420,respectively.0.446,0.834,0.605,P < 0.05.Discriminant validity: The autonomic function assessment scale of patients with emotional disorders is significantly different from the autonomic neurological scale of patients with normal control and rheumatic diseases,excluding mixed factors such as gender,age,education level,and marriage.There is significant difference between the existence and the autonomic nerve function assessment scale of diabetic patients,but the differences are not significant after excluding the mixed factors such as gender,age,education level and marriage.5.AFS reliability analysis : The Cronbach’s α coefficients of the emotional disorder group,the diabetic group,the rheumatic disease group,and the normal control group were 0.767,0.816,0.658,and 0.685,respectively.The test-retest reliability is 0.770.6.Relationship between autonomic nervous function and anxiety and depression in patients with emotional disorders: The correlation coefficients of the AFS and the total scores of PHQ-9 and GAD-7 for patients with mood disorders were 0.462 and 0.438,P <0.05;Corpass31 and PHQ-9,GAD-7 total score correlation coefficient were 0.504,0.452,P <0.05.There was a significant negative correlation between AFS total score,GAD-7 and SSR upper limb amplitude,and the correlation coefficients were-0.440,-0.431 and-0.612,-0.485,P<0.05.7.The number and percentage of each score in each item of the pre-treatment autonomic function assessment scale of the emotional disorder were counted.The results showed that the total percentage of the 1,2,and 3 score options exceeded 70%.Heartbeat increases,item 2 “Blood pressure fluctuations or dizziness,fainting when suddenly standing(sitting)”,item 3 “chest tightness,wheezing or difficulty breathing”,item 4 “decreased appetite,upper abdominal discomfort or indigestion”,item 5 “diarrhea or constipation”,item 6 “dry mouth,dry eyes or saliva”,item 8 “fear cold,sweaty or pale skin”.8.The scores of the AFS of patients with emotional disorders before and after treatment decreased,and the scores of subscales and total scores decreased before and after treatment,and there were significant differences before and after treatment.9.The correlation coefficient between AFS reduction rate and PHQ-9 and GAD-7 reduction rate before and after treatment was 0.448,0.530,all P<0.05.The correlation coefficient between Compass31 reduction rate and PHQ-9 and GAD-7 reduction rate before and after treatment was0.391,0.352,all P < 0.05.【Conclusion】1.The Autonomic Function Scale(AFS)consists of 10 entries in 3 dimensions.The scale basically meets the requirements of psychometrics,has good reliability and validity,and can be applied in clinical practice as an evaluation tool for autonomic function.2.Patients with emotional disorders have heavier autonomic dysfunction,and are closely related to the severity of anxiety and depression.After antidepressant treatment,the autonomic nervous function symptoms are also improved with the improvement of anxiety and depression. |
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