中国精神障碍分类与诊断标准第3版与国际疾病分类第10版的比较

论述中国精神障碍分类与诊断标准第3版（CCMD-3）与国际疾病分类第10版在各自的历史、主要精神障碍分类和诊断标准的异同点,侧重于CCMD．3中具有我国文化特色的障碍及其相关研究的进展。     

中国精神障碍分类与诊断标准第3版孤独症诊断标准的临床研究

目的 比较中国精神障碍分类与诊断标准第3版（CCMD-3）与中国精神疾病分类方案与诊断标准第2版修订本（CCMD-2-R）和国际疾病分类第10版（ICD-10）儿童孤独症诊断标准的一致性及症状出现率。方法 采用临床面谈和定式工具收集病史和评估症状，先依据CCMD-2-R对117例患儿进行初次诊断，然后按照CCDM-3和ICD-10进行再诊断。结果 （1）CCMD-3与ICD-10诊断的一致率为100.0%（Kappa值=1.000),CCMD-2-R与ICD-10的一致率为95.8%（Kappa值=0.915)。（2）孤独症组在三种诊断标准中8项相同症状的出现率为79.4%-100.0%。14项不同相同症状的出现率为27.0%-98.4%;CCMD-3,CCMD-2-R和ICD-10中出现率≤50%的症状分别有2项，3项和1项，结论CCMD-3较CCMD-2-R与ICD-10诊断一致性高，但少数症状出现率仍偏低。     

对《中国精神障碍分类与诊断标准,第3版》(CCMD-3)的讨论(四)CCMD-3在编写中存在的问题

中国精神障碍分类与诊断标准第 3版 (CCMD 3)于 2 0 0 1年 4月出版。CCMD 3的制订对推动我国精神医学事业的发展起到积极的作用 ,但在编制过程和文本中还存在不少问题。分析和认识这些问题 ,有助于我们更好的使用CCMD 3,也有助于精神医学的进一步发展。1　CCMD 3有 5项编写原则 ,“注意与国际接轨” ,“具有中国特色 ,符合中国国情” ,以及“继承《CCMD》以前版本的优点”分别是其中的 3项。在大体上 ,CCMD 3的编写是在向国际疾病分类第 10版 (ICD 10 )靠拢 ,只是保留了CCMD系统以前版本中的某些精神障碍和亚型 ,如神经症、复…     

关于《中国精神障碍分类与诊断标准第三版》的几点不同看法

《中国精神障碍分类与诊断标准第三版》(CCMD 3)出版后 ,已成为我国精神科医师必备的工具书。它简明实用 ,便于操作。但由于CCMD 3需与《国际疾病分类第 10版》(ICD 10 )接轨 ,故出现一些值得商榷之处。第一 ,在中华精神科杂志 2 0 0 2年第 1期第 6页 ,陈彦方医师在“对‘关于《中国精神障碍分类与诊断标准第三版》编码使用的商榷’的答复”中指出 :“脑外伤所致精神障碍的脑外伤人格改变 ,在不能分清系脑震荡或脑挫裂伤所致时 ,应编码为 0 2 4 0 31”。显然 ,如果能明确系由脑挫裂伤所致 ,则编码应是 0 2 4 2 31。这样就出现以下错…     

对《中国精神障碍分类与诊断标准第三版》酒精所致震颤谵妄诊断编码的商榷

20 0 1年 4月出版的《中国精神障碍分类与诊断标准第三版》[1] (CCMD 3)对精神障碍亚型、综合征的划分更加细致。如将癔症与神经症分离 ,使神经症的概念与内涵更趋一致 ;器质性精神障碍的分类更注意了与临近学科的衔接 ,使精神疾病的诊断更趋规范与合理[2 ] 。然而 ,在实际运用CCMD 3中 ,我们也遇到分类方面的困惑 ,现提出与同道商讨。患者 ,30岁 ,业务员 ,平素身体健康。饮酒史 6～ 7年 ,每天午、晚餐各饮酒 2 5 0ml,有时睡前饮酒助眠。 2 0 0 1年 9月 2日出差 ,因工作繁忙而未饮酒 ,当晚出现手抖 ,不能点燃香烟 ,头晕、出汗、呕吐。测…     

对《中国精神障碍分类与诊断标准第三版》有关问题及一些热点问题的答复

首先 ,我们很高兴地看到《中国精神障碍分类与诊断标准第三版》(CCMD 3)出版 2年来 ,得到了广大医务工作者的注意和实际应用。其次 ,尽管CCMD 3工作组在编写过程中曾努力减少文本差错 ,但在具体应用过程中仍然出现了一些问题。我们为这些差错给广大读者带来的不便 ,再次深表歉意。现就以上各位医生提出的问题及相关问题一并答复如下。王继红等医生在对《中国精神障碍分类与诊断标准第三版》(CCMD 3)酒精所致震颤谵妄分类编码的商榷中 ,指出了CCMD 3工作组对该综合征分类编码阐述的不足之处。就其所提供的病例而言 ,是在多年饮酒过程…     

关于《中国精神障碍分类与诊断标准第三版》的几个问题

目前 ,国际上常用的精神障碍分类与诊断标准是由世界卫生组织 (ＷＨＯ)组织编写的《国际疾病分类第 10版》[1] (ＩＣＤ 10 )与《美国的精神障碍诊断与统计手册第 4版》[2 ] (ＤＳＭ ＩＶ)。这两种分类和诊断系统的制定者在编写新的版本以前 ,均是在既往版本的基础上 ,针对具体应用中发现和新近产生的问题 ,开展多中心协作的前瞻性研究。这使新版本的ＩＣＤ和ＤＳＭ具有更好的效度和信度 ,其实用价值也得以明显提高。中华医学会精神病学分会鉴于在《中国精神疾病分类方案与诊断标准第 2版修订本》[3] (ＣＣＭＤ 2 Ｒ)编写和应用过程中存在的…     

美国精神障碍诊断与统计手册第5版的变化要点

介绍美国精神障碍诊断与统计手册第5版(DSM-5)的变化要点.     

精神障碍的分类与诊断标准研究进展(二)

5．1CCMD-3的相关前瞻性现场测试 我国精神疾病分类正式公布是在1981年,1989年公布了《中国精神疾病分类与诊断标准》第2版(CCMD-2),随着20世纪90年代ICD-10及DSM—Ⅳ出版,于1995年又出版了修订版CCMD-2-R。中华精神科学会鉴于CCMD-2R编写和应用过程中存在的-些争议以及与国际接轨的需要,在1995年成立CCMD-3工作组,在1996～2000年的科研期间,全国有41个单位的114位主要研究人员分为成人组(67位)和儿童组(47位),对17种成人及7种儿少精神障碍分类与诊断标准进行现场测试。     

精神障碍诊断量表对阿尔茨海默病的现场测试

目的 通过现场测试阿尔茨海默病（AD）,对中国精神疾病分类方案与诊断标准第3版（CCMD－3）中AD诊断标准的制订提出建议。方法 应用与CCMD－2配套的精神障碍诊断量表（DSMD）对71例AD患者进行现场测试,并进行1年随访。用Hachinski缺血指数量表（HISA）排除血管性痴呆。结果 71例AD均完成现场测试,其中完成1年随访者34例,均符合中国精神疾病分类方案与诊断标准第2版修订本（CCMD－2－R）的AD诊断标准。部分AD患者伴有思维症状和情感症状等精神病性症状。CCMD－2－R有较好的预测效度。结论 建议CCMD－3中AD诊断标准按症状标准、严重程度标准、病程标准和排除标准四项进行制定。     

The Classification of Anxiety and Fear-Related Disorders in the ICD-11

Anxiety disorders are highly prevalent worldwide and engender substantial economic costs and disability. The World Health Organization is currently developing the Eleventh Revision of the International Classification of Diseases and Related Health Problems (ICD-11), which represents the first opportunity to improve the validity, clinical utility, and global applicability of the classification in more than 25 years. This article describes changes in the organization and diagnostic guidelines for anxiety and fear-related disorders proposed by the ICD-11 Working Group on the Classification of Mood and Anxiety Disorders and the rationale and evidence base for the proposals. In ICD-11, anxiety and fear-related disorders that manifest across the lifespan are brought together under a new grouping, and are partly distinguished by their focus of apprehension. The focus of apprehension is the stimulus or situation that triggers the fear or anxiety and may be highly specific as in specific phobia or relate to a broader class of situations as in social anxiety disorder. The guidelines also clarify the relationship between panic disorder and agoraphobia and a qualifier is provided for panic attacks in the context of other disorders. A standardized format emphasizing essential features of anxiety disorders is intended to improve clinical utility. Guidelines will be further refined based on findings from two types of field studies: those using a case-controlled vignette methodology disseminated via the Internet to practitioners worldwide ( http://gcp.network ) and clinic-based field trials implemented globally at participating field study centers.     

One-year prevalence and incidence of depression among first-year university students in Japan: a preliminary study

A structured interview was used to examine the 1-year incidence and prevalence of depression among 116 first-year university students. While 24 of the subjects (20.7%) met the Diagnostic and Statistical Manual of Mental Disorders 4th ed. (DSM-IV) criteria for Major Depressive Episode (MDE), 62 (53.4%) met the Diagnostic and Statistical Manual of Mental Disorders 3rd ed. Revised (DSM-III-R) criteria for MDE, and 27 (23.3%) also met the Research Diagnostic Criteria (RDC) for Major Depressive Disorder (MDD) for the 12 months prior to the interview. Moreover, 23 of the subjects (19.8%) had onset of the DSM-IV criteria for MDE, 54 (46.6%) had onset of the DSM-III-R criteria for MDE, 24 (20.7%) had onset of the RDC for MDD, during the same time period. These high rates of depression may be explained by the students' difficulties in and by their readjustment after entering university.     

Continued clinical validation of dementia diagnosed in the community using the Cambridge Mental Disorders of the Elderly Examination

We describe the outcome 2 years later of elderly Cambridge residents who had been diagnosed as demented using the Cambridge Mental Disorders of the Elderly Examination. Mortality rates were high but diagnoses were confirmed for all of the 43 moderate and severe cases who survived for this period, and for 51 of the 56 subjects who had been rated initially as mildly demented; 28 of the 56 mildly demented subjects progressed to more severe levels of impairment. As many as 12 of the 24 original minimally demented cases showed evidence of intellectual deterioration, which lends weight to the validity of this experimental category.     

Diagnostic specificity of the insular cortex abnormalities in first-episode psychotic disorders

Volume reductions of the insular cortex have been described in schizophrenia, but it remains unclear whether other psychotic disorders such as affective psychosis also exhibit insular cortex abnormalities. In this study, we used magnetic resonance imaging to investigate the gray matter volume of the anterior (short) and posterior (long) insular cortices in 162 first-episode patients with various psychotic disorders (46 schizophrenia, 57 schizophreniform disorder, 34 affective psychosis, and 25 other psychoses) and 62 age- and gender-matched healthy comparison subjects. Patients with schizophrenia showed bilateral volume reduction of the anterior and posterior insular cortices compared with controls, but the remaining first-episode psychosis subgroups had normal insular volumes. The volumes of these insular subregions were significantly smaller in schizophrenia patients than in patients with schizophreniform disorder or affective psychoses. There was no association between the insular cortex volume and daily dosage or type of antipsychotic medication in any patient group. These findings suggest that the widespread volume reduction of the insular cortex is specific to established schizophrenia, implicating its role in the neurobiology of clinical characteristics associated with schizophrenia.     

Zonisamide produces weight loss in psychotropic drug-treated psychiatric outpatients

This study examined the long-term effectiveness and tolerability of zonisamide for weight control in psychiatric outpatients using various psychotropic medications. We conducted a systematic chart review of 82 psychiatric outpatients with unwanted weight gain after the introduction of psychotropic drugs between January 2008 and September 2009 at Korea University Ansan Hospital. The primary outcome measure was the effect of zonisamide on body mass index (BMI). Additional outcome measures included safety and tolerability as assessed by the clinical global impression-severity of illness scale (CGI-S) and discontinuation rate. The mean final dose of zonisamide was 124.6 ± 53.4 mg/day and ranged from 50 mg/day to 300 mg/day. The mean BMI reduction was 0.8 ± 1.7 kg/m² and ranged from − 2.9 kg/m² to 4.7 kg/m² (p < 0.001). We also observed a significant reduction in CGI-S scores from the baseline (3.8 ± 0.9) to the endpoint (3.3 ± 0.8; p < 0.001). Twelve patients (14.6%) discontinued their zonisamide treatment due to its side effects. Patients treated with zonisamide showed significant weight loss. Furthermore, its treatment was generally safe and well tolerated with few negative effects on patients' overall psychiatric symptoms. Additional research is required to confirm these results and to investigate whether patients have rebound weight gains after discontinuing zonisamide.