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Abstract：
BACKGROUND: Clinicians vary in their ability to elicit and interpret hallucinatory symptoms in patients with Parkinson\'s disease (PD). There is limited evidence for informant-report measures of PD hallucinations as adjuncts to clinician-rated scales.
OBJECTIVE: To determine the utility of an informant version of the validated Psychosis and Hallucinations Questionnaire (PsycH-Q) for assessing the presence and severity of hallucinations in PD; and, to evaluate accuracy of clinician judgements by comparison with informant report and self-report.
METHODS: One hundred sixty-three PD patient-informant dyads completed self- and informant-report versions of PsycH-Q and three common questionnaire measures: Neuropsychiatric Inventory Questionnaire; Parkinson\'s Psychosis Questionnaire; and Scales for Outcomes in Parkinson\'s disease-Psychiatric Complications. We compared self-ratings and informant ratings across analogous subscales for the presence of hallucinations with clinician interview ratings on MDS-UPDRS as a diagnostic standard.
RESULTS: There was a low level of agreement between dyads (average κ = 0.39; κ range = 0.32-0.47; P < 0.001), and patients indicated the highest prevalence of hallucinations compared to informant or clinician estimates. Clinician interview missed 32% of PsycH-Q hallucinators identified by dyads. Relative to the sample, 22 patients with exclusively clinician-appraised hallucinations had poorer overall quality of life measured by the Parkinson\'s Disease Questionnaire.
CONCLUSIONS: The sole use of clinician-rated scales may underestimate prevalence of PD hallucinations, and there is room for introducing self- and informant-report tools. Nonetheless, clinician appraisals are critical in cases when informant and patient insight might be affected by the impact of illness on quality of life.
OBJECTIVE: To determine the utility of an informant version of the validated Psychosis and Hallucinations Questionnaire (PsycH-Q) for assessing the presence and severity of hallucinations in PD; and, to evaluate accuracy of clinician judgements by comparison with informant report and self-report.
METHODS: One hundred sixty-three PD patient-informant dyads completed self- and informant-report versions of PsycH-Q and three common questionnaire measures: Neuropsychiatric Inventory Questionnaire; Parkinson\'s Psychosis Questionnaire; and Scales for Outcomes in Parkinson\'s disease-Psychiatric Complications. We compared self-ratings and informant ratings across analogous subscales for the presence of hallucinations with clinician interview ratings on MDS-UPDRS as a diagnostic standard.
RESULTS: There was a low level of agreement between dyads (average κ = 0.39; κ range = 0.32-0.47; P < 0.001), and patients indicated the highest prevalence of hallucinations compared to informant or clinician estimates. Clinician interview missed 32% of PsycH-Q hallucinators identified by dyads. Relative to the sample, 22 patients with exclusively clinician-appraised hallucinations had poorer overall quality of life measured by the Parkinson\'s Disease Questionnaire.
CONCLUSIONS: The sole use of clinician-rated scales may underestimate prevalence of PD hallucinations, and there is room for introducing self- and informant-report tools. Nonetheless, clinician appraisals are critical in cases when informant and patient insight might be affected by the impact of illness on quality of life.
摘要：
背景：临床医生在诱发和解释帕金森病（PD）患者的幻觉症状方面的能力各不相同。关于PD幻觉的线人报告措施作为临床医生评估量表的辅助手段的证据有限。
目的：确定经过验证的精神病和幻觉问卷（PsycH-Q）的信息版本用于评估PD中幻觉的存在和严重程度的实用性；和，通过与举报人报告和自我报告的比较来评估临床医生判断的准确性。
方法：一百六十三个PD患者-线人完成了PsycH-Q的自我和线人报告版本以及三种常见的问卷调查方法：神经精神调查问卷；帕金森氏精神病问卷；以及帕金森氏病-精神病并发症的结果量表。我们比较了类似子量表中存在幻觉的自我评分和线人评分，并将MDS-UPDRS的临床医生访谈评分作为诊断标准。
结果：二元组之间的一致性水平较低（平均κ=0.39；κ范围=0.32-0.47；P<0.001），与举报人或临床医生的估计相比，患者的幻觉患病率最高。临床医生的访谈错过了dyads识别的PsycH-Q幻觉的32％。相对于样本，通过帕金森病问卷测量，22例仅有临床医生评估的幻觉患者的总体生活质量较差。
结论：仅使用临床医生评定的量表可能会低估PD幻觉的患病率，并且有引入自我和线人报告工具的空间。尽管如此，在疾病对生活质量的影响可能会影响信息提供者和患者的洞察力的情况下，临床医生的评估至关重要。
目的：确定经过验证的精神病和幻觉问卷（PsycH-Q）的信息版本用于评估PD中幻觉的存在和严重程度的实用性；和，通过与举报人报告和自我报告的比较来评估临床医生判断的准确性。
方法：一百六十三个PD患者-线人完成了PsycH-Q的自我和线人报告版本以及三种常见的问卷调查方法：神经精神调查问卷；帕金森氏精神病问卷；以及帕金森氏病-精神病并发症的结果量表。我们比较了类似子量表中存在幻觉的自我评分和线人评分，并将MDS-UPDRS的临床医生访谈评分作为诊断标准。
结果：二元组之间的一致性水平较低（平均κ=0.39；κ范围=0.32-0.47；P<0.001），与举报人或临床医生的估计相比，患者的幻觉患病率最高。临床医生的访谈错过了dyads识别的PsycH-Q幻觉的32％。相对于样本，通过帕金森病问卷测量，22例仅有临床医生评估的幻觉患者的总体生活质量较差。
结论：仅使用临床医生评定的量表可能会低估PD幻觉的患病率，并且有引入自我和线人报告工具的空间。尽管如此，在疾病对生活质量的影响可能会影响信息提供者和患者的洞察力的情况下，临床医生的评估至关重要。
