三种诊断标准对精神分裂症和心境障碍的诊断比较

为了解国内的精神疾病诊断标准与国际标准间的异同，使用美国精神障碍诊断与统计手册第３版修订本定式临床检查提纲（ＳＣＩＤ－Ｐ），作为国际疾病分类第１０版（ＩＣＤ－１０）、中国精神疾病分类方案与诊断标准第２版修订本（ＣＣＭＤ－２－Ｒ）和美国精神障碍诊断与统计手册第４版（ＤＳＭ－ＩＶ）的症状评定工具，对临床初步诊断为精神分裂症的１１４例患者及心境障碍的８２例患者进行上述３种诊断系统间的诊断比较。结果表明：３种标准对精神分裂症的诊断一致性差（Ｐ＜０．０５），差异原因与各标准病程规定不同有关；两两标准间的诊断一致性好。３种诊断标准对心境障碍的诊断一致性较好（Ｐ＞０．０５）；两两标准间的诊断一致性亦好。以ＩＣＤ－１０作为“金标准”，用ＣＣＭＤ－２－Ｒ及ＤＳＭ－ＩＶ诊断两种疾病均具有较好的敏感性和特异性；ＣＣＭＤ－２－Ｒ诊断精神分裂症和ＤＳＭ－ＩＶ诊断心境障碍更加准确。另外，本研究还显示ＳＣＩＤ－Ｐ及３种诊断标准具有较高的信度。提示ＣＣＭＤ－２－Ｒ，ＤＳＭ－ＩＶ均已向ＩＣＤ－１０靠拢。

Comparison of three diagnostic criteria for the diagnosis of schizophrenia and mood disorders

Using the structured clinical interview for DSM III R(SCID P)as an instrument, with this study the relative terms were compared with the diagnosis in the 10th edition of International Classification of Diseases (ICD 10)published by World Health Organization, in the 4th edition of Diagnostic and Statistical Manual of Mental Disorders (DSM IV) and in the 2nd revised edition of the Chinese Classification and Diagnostic Criteria of Mental Disorders (CCMD 2 R) for 114 patients which were likely to be with schizophrenia and 82 with mood disorders. The results indicated that the positive percentages of agreement for diagnosing schizophrenia among the three criteria showed significant differences ( P <0.05). The disagreements were in relation with the different disease courses defined in the different diagnotic criteria . The diagnostic agreement between two criteria were good. The positive percentages agreement for diagnosing mood disorders among the three criteria and the diagnostic agreements between any two criteria for this kind of disorders were good. Using ICD 10 as the "Gold Standard", the diagnosing either schizophrenia or mood disorders with CCMD 2 R and DSM IV all yielded relatively high sensitivity and specificity, where as the diagnosing of schizophrenia with CCMD 2 R and that of mood disorders with DSM IV were even more accurate. Besides, this study also showed that the SCID P and the three diagnostic criteria had comparatively high reliabilities. This tended to point out that CCMD 2 R and DSM IV had been drawing close to ICD 10.