"病理性上网"诊断标准的初步制订

目的:初步制订"病理性上网"的诊断标准,为全国测查及完善该标准提供依据.方法:检索文献中常用的与"病理性上网"有关的 "诊断标准"或筛选标准,据此建立"病理性上网"的诊断标准条目库及初步诊断标准.测查中,由每两名具有高级职称的精神科医生(共8名)组成一组,根据"病理性上网"操作性定义,以本文制定的初步诊断标准为检查提纲,交替对79名因上网问题住院的受试者及其家属进行访谈,独立评定并作出诊断.另外,方便选取某高中一年级2个班的全体男生,共44人,由评定者单独访谈、评定.两名评定者均作出诊断时方可确诊,否则排除诊断.结果:123名受试者中"病理性上网"者为54名.两名专家的诊断一致性Kappa=0.812(P<0.001).条目库中12条症状有2条评定者间一致性差,4条对诊断贡献小.在保留的6个条目中,4条以上阳性时,诊断的灵敏度为78.9%,特异度为95.3%.严重程度标准偏严格.确定诊断者的病程90.7%为3个月以上,77.7%为6个月以上.结论:修订后的初步诊断标准包括6项症状标准,3项严重程度标准,1项病程标准,以及排除标准.本标准评定者间一致性高、可操作性强,可作为下一步制定"病理性上网"操作性诊断标准的基础.

Preliminarily Proposed Diagnostic Criteria of Pathological Internet Use

Objective:To establish a preliminary diagnostic criteria of pathological internet use for field test in China.Methods:Through searching common "pathological internet use" diagnostic criteria or screen criteria in literature,a diagnostic criteria items pool and a preliminary diagnostic criteria of "pathological internet use" were established .According to the diagnostic criteria,each 2 senior professional psychiatrists in turn interviewed 79 patients and their parents,and then made diagnosis respectively. In addiction,44 high school students were each evaluated by one psychiatrist.The definite diagnosis was made when 2 evaluators make the same diagnosis for one patient.Result:In 123 patients,54 were pathological internet use.For diagnosis,the value of kappa for inter-rater reliability was 0.812( P<0.001).In the 12 criteria items,2 for poor inter-rater reliability and 4 for little contribution to diagnosis were eliminated.In the reserved 6 items,if 4 items(or more)were positive,the diagnostic sensitivity was 78.9% and specificity was 95.3%.Functional impairment criteria were made strictly.In the patients who were made the definite diagnosis,90.7% had duration of illness above 3 months,and 77.7% above 6 months.Conclusion:The preliminary diagnostic criteria of pathological internet use after revised includes 6 symptom criteria,3 functional impairment criteria,duration of illness and exclusive criteria.The criteria proposed is with high consistency on evaluations made by psychiatric raters,and with operational convenience.The criteria,after further revised,may fit the clinical application.