复合性国际诊断交谈检查核心本和神经精神病学临床评定表的测试及对比研究

Comparative study and evaluation of multicentre field trials of Composite International Diagnostic InterviewCore Version and Schedules for Clinical Assessment in Neuropsychiatry

目的对比研究计算机诊断系统复合性国际诊断交谈检查核心本（ＣＩＤＩＣ）／国际疾病分类第１０版（ＩＣＤ１０）、ＣＩＤＩＣ／美国精神障碍诊断统计手册第３版修订本（ＤＳＭⅢＲ）、神经精神病学临床评定表（ＳＣＡＮ）／ＩＣＤ１０、ＳＣＡＮ／ＤＳＭⅢＲ对精神分裂症、心境（情感）障碍、神经症诊断的信度效度。方法培训５个单位研究者对其单位中符合中国精神疾病分类方案与诊断标准第２版（ＣＣＭＤ２）标准的三类患者按入院和门诊次序顺序进行ＣＩＤＩＣ和ＳＣＡＮ测试，计精神分裂症１５６例、心境障碍５０例、神经症３０例。应用世界卫生组织提供的计算机诊断系统做出诊断；以ＣＣＭＤ２的诊断为金标准，比较它们的信度效度。结果心境障碍ＣＩＤＩＣ／ＩＣＤ１０、ＣＩＤＩＣ／ＤＳＭⅢＲ、ＳＣＡＮ／ＩＣＤ１０、ＳＣＡＮ／ＤＳＭⅢＲ诊断的信度分别为９８．０％，９８．０％，１００．０％和６４．０％，效度Ｋａｐｐａ值分别为０．８，０．８，０．８和０．６；精神分裂症诊断的信度分别为８５．３％，５５．１％，９３．０％和５７．７％；效度Ｋａｐｐａ值分别为０．８，０．５，０．９和０．５；神经症诊断的信度分别为３６．６％，３６．６％，?

Objective This study compared the reliability and the validity of Composite International Diagnostic InterviewCore Version (CIDIC)/The 10th Edition of International Classification of Diseases (ICD10), CIDIC/ The 3rd Edition Diagnostic and Statistical of Manual of Mental Disorder, Revised Edition (DSMⅢR), Schedules for clinical Assessment in Neuropsychiatry (SCAN)/ICD10 and SCAN/DSMⅢR for mental disorders. Methods Well trained raters from 5 centers interviewed 236 psychiatric patients who had consecutively admitted and met Chinese Classification and Diagnostic Criteria for Mental Disorders, the Second Revised Edition (CCMD2) for schizophrenia (156 cases), mood disorders (50 cases) and neuroses (30 cases) with CIDIC and SCAN. The diagnoses were made by the computer diagnostic system of CIDIC/ICD10、CIDIC/DSMⅢR、SCAN/ICD10 and SCAN/DSMⅢR supplied by World Health Organization (WHO), the reliability and validity were compared with CCMD2, which was used as a gold standard. Results It was found that the reliability of CIDIC/ICD10, CIDIC/DSMⅢR, SCAN/ICD10 and SCAN/DSMⅢR for mood disorders were 98.0%, 98.0%, 100.0% and 64.0% respectively, for schizophrenia were 85.3%, 55.1%, 93.0% and 57.7%. However, for neuroses were only 36.6%, 36.6%, 53.3% and 46.6%. The kappa values of the validity for mood disorders were 0.8, 0.8, 0.8 and 0.6, for schizophrenia were 0.8, 0.5, 0.9 and 0.5, and for neuroses were 0.5, 0.5, 0.7 and 0.6. Conclusion The results suggest that the reliability and validity of above four diagnostic systems for mood disorders were better than that for schizophrenia, and neuroses. The reliability and validity of SCAN/ICD10 for schizophrenia, mood disorders and neuroses were higher than those of CIDIC/IC D10, CIDIC/DSMⅢR and SCAN/DSMⅢR. SCAN/ICD10 diagnostic system should be more useful in China.