网络成瘾临床诊断标准的制定

A proposed criterion for clinical diagnosis of internet addiction

目的针对因过度使用网络而影响社会功能并出现精神行为异常的患者制定网络成瘾临床诊断标准(以下简称"标准"),为该疾病发病机制的研究、治疗及预防提供指导。方法应用标准草案对以"沉溺于网络,明显影响学习、工作或人际交往"为主诉就医的110例患者进行症状调查,根据症状出现率及症状关联情况草拟标准初稿-1。对使用初稿-1诊断为网络成瘾的408例患者于出院后1年内进行随访,统计诊断符合率与复发率,并据此调整初稿-1,草拟初稿-2。由全国多家医院精神科医师采用初稿-2对以上述相同主诉就诊的150例患者进行现场测试。根据测试结果决定是否对初稿-2的语言描述作调整,最后确定诊断标准定稿。结果症状标准共7条,概括为①对使用网络的渴求;②减少或停止使用后的戒断;③耐受;④对网络的使用难以控制;⑤不顾危害性后果;⑥放弃其他活动;⑦逃避问题或缓解不良情绪。确诊须具备①和②2条核心症状及后5条附加症状中的任意1条。病程标准为平均每天非工作学习目的连续上网≥6h、符合症状标准≥3个月。随访观察发现,网络成瘾患者出院1年时复发率为70.6%,诊断符合率96.1%。两评定员间各症状条目一致性为89.3%~98.0%,Kappa值为0.73~0.87(P<0.01)。不同技术职称评定员间症状诊断一致性为96.2%~98.8%,Kappa值为0.89~0.95(P<0.01)。结论本标准制定过程符合循证医学要求、评定者间一致性高、可操作性强,适合临床应用。

Objective To establish a clinical diagnostic criterion （referred as criterion hereinafter） for patients with social dysfunction and abnormal mental behaviors caused by internet addiction, so as to provide guidance in future mechanism study, treatment and prevention for such disorder. Methods A rough draft of symptom parameters was used to evaluate the symptoms among the patients with a chief complaint of wallowing in intemet which caused damned influence on study, work and interpersonal communication. The 1st draft of the criteria was drawn up according to the incidence and correlation of the symptoms. 408 patients with intemet addiction （IA） diagnosed according to the 1st draft were followed up for 12 months after being discharged from hospital, and the diagnostic coincidence and recurrence rate were calculated and analyzed, based on which the 1st draft was then revised and the 2nd draft was established. Clinical tests were per- formed on 150 patients with the same chief complaints by psychiatrists from many mental hospitals in China. Descriptions in the 2nd draft were not n-~xtified based on the test findings and the final draft was formulated. Results The proposed criterion for IA symptom included the following 7 items： （1） craving for using intemet; （2） withdrawal reactions after internet use reduced or stopped; （3） tolerance;（4） unable to control the intention of using internet; （5）regardless of hazardous consequences; （6） pay no attention to other activities; and （7） avoidance or alleviation of unhealthy emotions. Items （1） and （2） combined with any one of the remains made the final diagnosis of IA. The criterion for illness duration was suggested as greater than or equal to 6 hours of continuous internet use one day in average and 3 months at least af- ter meeting the criteria for IA symptonx It was found by followin^up that one year recurrence rate among the discharged patients from hospital was 70. 6%, and the diagnostic coincidence was 96. 1%. The diagnostic consistency on symptom evaluation between two psychiatric raters was 89. 3%- 98. 0% （Kappa 0. 73- 0. 87, P〈0. 01）, while among the psychiatric raters with different technical titles was 96. 2%--98. 8% （Kappa 0. 89--0.95, P〈0. 01）. Conclusion The criterion herewith proposed is worked out accordingly with the principles of evidence-based medicine, with high consistency on evaluations made by psychiatric raters, and with operational convenience. The criterion, therefore, may fit the clinical application.