精神障碍诊断量表对偏执型和未定型精神分裂症患者的评定

Application of Diagnostic Schedule of Mental Disorders in schizophrenia of paranoid and undifferentiated type

目的 验证精神障碍诊断量表 (DSMD)对偏执型及未定型精神分裂症的临床诊断价值。方法 对经三级查房确诊的 332例偏执型及未定型精神分裂症住院患者 ,应用与中国精神疾病分类方案与诊断标准第 2版修订本 (CCMD 2 R)相配套的DSMD进行测评。结果 (1)偏执型组的怪异外表 (15 7% )、情感交流障碍 (5 1 2 % )、个人卫生差 (36 1% )、不合作 (2 0 5 % )的比例低于未定型组 (分别为 30 7%、78 9%、4 8 8%、31 9% ;P <0 0 1和P <0 0 5 ) ;两组感知障碍的差异无显著性 ;偏执型组情感平淡 (5 6 6 % )、情感不协调 (41 0 % )的比例低于未定型组 (84 9%、5 8 4 % ;P <0 0 1) ,而敌意则相反 (为 30 7% :19 9% ;P <0 0 5 ) ;偏执型组行为怪异的比例 (31 9% )低于未定型组 (42 8% ;P <0 0 5 )。 (2 )偏执型组的妄想观念 (92 8% )及被害妄想 (6 8 7% )等的比例高于未定型组 (分别为 79 5 %和 4 8 2 % ;P <0 0 1和P <0 0 5 )。 (3)两组患者社会功能的受损程度均较严重 ,以未定型组为著。结论 DSMD有助于对偏执型与未定型精神分裂症的鉴别诊断。

Objective To evaluate the utility of Diagnostic Schedule of Mental Disorders (DSMD) in the diagnosis of paranoid and undifferentiated schizophrenia Methods Three hundred and thirty two inpatients with schizophrenia who met with the Chinese Classification for Mental Disease (CCMD Ⅱ R) criteria for paranoid or undifferentiated type were assessed with DSMD Results The diagnostic criteria of DSMD matched well with CCMD Ⅱ R The rates and severity of odd behaviors (30 7%) and poor personal hygiene (48 8%) in undifferentiated type were higher than that in paranoid type (15 7% and 36 1%; P <0 01) The rate of delusion in paranoid type was higher than that in unclassified type (92 8% vs 79 5%, χ 2=12 3, P <0 01), and both the groups had similar occurrence rates of hallucination The social function of the patients in both groups was impaired seriously Conclusion DSMD is reliable and validate,and it can be used in clinical diagnosis and research to differentiate paranoid and undifferentiated type of schizophrenia