健康问题与疾病定量测试法逻辑判别系统对精神分裂症的多轴诊断及其效度

目的探讨健康问题与疾病定量测试法逻辑判别系统(RTHD-LVS)对偏执型和未定型精神分裂症的多轴诊断及其效度。方法运用RTHD对临床符合中国精神障碍分类与诊断标准第三版(CCMD-3)诊断为精神分裂症偏执型和未定型的患者106例进行半定式评估,然后运用RTHD-LVS科研版和临床版对这些病例进行再诊断。以临床诊断作为金标准,比较两种版本诊断与临床诊断的符合率及两种版本诊断的一致性。结果①轴l诊断:RTHD-LVS科研版轴l诊断与临床诊断符合者99例(93.4%),RTHD-LVS临床版轴l诊断与临床诊断符合者100例(94.3%)。RTHD-LVS两种版本对于偏执型和未定型精神分裂症的诊断一致性均较好(Kappa值分别为0.83和0.92)。②其他轴:本组患者中内向人格特征突出73例(68.8%)。病前1年内有肯定的精神刺激作为诱因者20例(18.9%)。最重社会功能损害稍差或更差者106例(100.0%),目前功能稍差或更差者81例(76.4%)。目前评为无效或恶化者40例(37.7%)。结论RTHD-LVS对精神分裂症患者作了全面的定性与定量评估,结果表明两种版本轴1精神障碍的诊断对精神分裂症诊断效度高,且两种版本之间的一致性好。

Validation of the rating test for health and disease and its logical verdict system for patients with schizophrenia

Objective To validate the rating test for health and disease and its logical verdict system (RTHD-LVS) as a diagnostic instrument for assessing the patients with schizophrenia. Methods A total of 106 patients who met CCMD-3 criteria of paranoid or undifferentiated schizophrenia were assessed by using RTHD, and then were rediagnosed by RTHD-LVS. The logical diagnoses of research version(RV) and clinical version(CV) were compared. Results The number of patients had the RV axis I diagnosis of schizophrenia was 99(93.4%), and the number of patients had the CV axis I diagnosis of schizophrenia was 100(94.3%). As to paranoid schizophrenia, Kappa for the RV axis I diagnosis and that of CV was 0.83. As to undifferentiated schizophrenia, KAPPA for RV and CV was 0.92. RTHD-LVS also assessed other axes, the results showed: Seventy three (68.8%) patients were introverted. Twenty (18.9%) had experienced important negative life events in the prior year. Eighty one(76.4%) had grossly inadequate current functioning and 106(100%) had poor or grossly at the time of their worst episode, Forty (37.7%) had experienced no effects or deteriorated. Conclusions RTHD-LVS is a valid and reliable tool to evaluate the patients with schizophrenia. The logical diagnoses of both versions were greatly consistent with the clinical diagnoses.