精神障碍诊断标准的应用现状调查

Investigation on the application status of diagnostic criteria for mental disorders

目的：调查多种精神障碍诊断标准的应用情况.方法通过自编问卷？关于精神科诊断标准应用的现状调查？,对364所不同级别精神卫生机构进行调查,共调查400名不同职称医师.根据受访者所在医院的级别分别统计数据,了解3种精神障碍诊断标准的使用情况、精神科临床医师对诊断标准的了解程度、满意度,以及对诊断标准的看法和期望.结果实际发放调查问卷400份,有效回执239份,回执问卷来自29个地区112个城市的183家医院.截止到2013年3月31日,临床使用 CCMD－3的医院占54．1％,住院首页（包括疾病编码）中 ICD－10使用率66．7％.57．3％的受访者认为诊断标准为“较满意”；三级医院对 CCMD－3、DSM－Ⅳ、ICD－103种诊断标准的了解程度优于二级及以下医院,差异有统计学意义（P ＜0．05）；40．6％的受访者认为 ICD－10在临床使用中更加合理,其次为CCMD－3和 DSM－Ⅳ；17．6％的临床医师认为这3种诊断标准均欠妥.结论临床中有半数以上机构使用 CCMD－3,DSM 诊断系统被广泛应用于临床科研中.病案首页的填写普遍使用 ICD－10,近半数受试者认为 ICD－10是目前合适的诊断标准.在精神卫生法实施后,全国亟须使用统一的精神障碍诊断标准.

Objective To investigate the application of diagnostic criteria for mental disorders in China.Methods The self-designed questionnaires on “Application of the Diagnostic Criteria for Mental Disorders”were sent to 364 different levels of mental health institutions and 400 different levels of psy-chiatrist were participants .We analyzed the data according to the degree of hospital,to know the appli-cation of the three diagnostic criteria,and psychiatrist’s attitude towards the diagnostic criteria including acquaintance,satisfaction as well as the views and expectations.Results Totals of 239 questionnaires （400 questionnaires were sent）were collected.The questionnaires were from 29 provinces and municipal-ity directly under the central government which covered 1 12 cities and 183 institutions.By March 31, 2013,CCMD-3 diagnostic criteria was used in 99 hospitals,accounting for 54.1%,and the usage rate of ICD-10 in the cover page of case report form （including diseases encoding ）was 67%,The overall satisfaction of the clinicians to the diagnostic standard was “fair”（57.3%）;doctors in three-level hos-pitals were better than that in the two-level and one-level hospitals on the understanding degree of the CCMD-3,ICD-10,and DSM-Ⅳ.ICD-10 was considered the most suitable clinical diagnostic crite-ria,followed by CCMD- 3,1 7.6% thought “inappropriate”,1 6.7% of respondents believed that the DSM-Ⅳ.Conclusions CCMD-3 is used over half in the clinical settings of institutions.DSM diagnosis system is widely used in clinical research.ICD- 10 is general used in cover page of case report form, over half clinicians believed ICD-10 is currently the appropriate diagnostic criteria.There is urgent need for consensus criteria for mental disorders after the issued Mental Health Act.