中医癫狂辨证与西医重性精神障碍诊断匹配性研究

Study on Matching of Dementedness' tcm Syndrome Differentiation and Severe Mental Disorder's Diagnosis in Western Medicine

目的研究中医癫狂辨证后运用《社区精神病人诊断与公共安全风险评估软件》进行诊断,研究中医辨证与西医精神障碍的匹配情况。方法以200名中医癫狂或重型功能性精神障碍患者为招募研究对象,患者中医癫狂诊断要求,同时符合我国社区重性精神障碍诊断线索之一为纳入标准。两名精神科专业中医师按中医方法诊断为癫狂,并参考《中医内科学》辨证方法,然后当事人和知情人的进行软件问卷测试,得到西医精神障碍的诊断结果。结果①200名招募者完成有效测验184名,完成率92%.184名中医癫狂诊断患者软件提示相应西医诊断:精神分裂症占54.89%,双向障碍占20.11%,持续性妄想障碍占14.13%,抑郁症占8.15%,分裂情感障碍占2.72%,另有6.67%的患者不能得出重型功能性精神障碍西医诊断。②西医重性功能性精神障碍诊断下中医辨证:痰气郁结型占27.22%,痰火内扰型20%,心脾两虚型16.11%,火盛伤阴型11.11%,瘀热互结型6.67%,其他补充证型占14.44%,无证型的占6.67%.③各种重性功能性精神障碍的辨证,精神分裂症以痰气郁结型为主,持续性妄想障碍和分裂情感障碍以痰火内扰型更多,双向障碍以火盛伤阴和痰火内扰型多见,与其他证型存在统计学意义(P<0.05),抑郁障碍以心脾两虚型常见但统计学意义不突出(P>0.05)。结论通过人工辨证和《社区精神病人诊断与公共安全风险评估软件》诊断,认为中医癫狂和西医功能性重型精神障碍的概念总体上有一致性,但癫狂概念范围更大,同时有20%的西医重型精神障碍不能被癫狂覆盖,概念之间具有差异性,难以完全替代。

Objective To investigate the matching of dementedness’TCM syndrome differentiation and severe mental disorders’diagnosis in western medicine with The Software on The Diagnosis and Public Safety Risks Evaluation of Psychiatric Patients in Community after TCM syndrome differentiation. Methods 200 demented patients or severe mental disorders who meet the criteria of TCM and has one description of community severe psychiatric disorders index is recruited. Two psychiatrists of TCM practitioners diagnose them and differentiate their disease according the clinical manifestation and tongues and pulses with reference to internal TCM,then testing of the software questionnaire to the persons concerned and persons in the know. Results ①184 of 200 recruits had completed effective test and the completion rate is 92%. The result of software testing to 184 demented patients after the diagnosis of TCD shows following percentage：schizophrenia 54. 89%,bipolar disorder 20. 11%,persistent delusional disorder 14. 13%,depression 8. 15%,schizoaffective disorder 2. 72%,and the other 6. 67% are not severe FMDs. Dementedness’tcm syndrome differentiation to the FMDs shows the following percentage：stagnation of phlegm and QI 27. 22%,interior disturbance of the phlegm-heat 20%,insufficiency of heart and spleen 16. 11%,Fire Yin 11. 11%,Stagnated heat 6. 67%,the rest syndrome type 14. 44%,and no syndrome 6. 67%. ②TCM syndrome differentiation of severe mental disorders,schizophrenia represents stagnation of phlegm and QI,most patients of persistent delusional disorder and schizoaffective disorder show interior disturbance of the phlegm-heat,bipolar disorder people have the characteristics of either Fire Yin or interior disturbance of the phlegm-heat,above disease have statistical significance （P〈0. 05）,but the patients of depression have less statistical significance although they have the disease of insufficiency of heart and spleen （P〉0. 05）. Conclusion By the comparision between personal TCM syndrome differentiation and the diagnosis of The Software on The Diagnosis and Public Safety Risks Evaluation of Psychiatric Patients in Community,we are sure that dementedness’tcm syndrome differentiation is in large matching to severe mental disorder in western medicine,but the scope of concept ot dementedness is larger than that of severe mental disorder and the 20% patients of severe mental disorder are not demented. Thus these two concepts are different and cannot replace each other.