DSM-IV临床定式访谈（SCID）在心理解剖研究中的应用

发布时间：2018-04-06 20:06

本文选题：SCID　切入点：心理解剖　出处：《大连医科大学》2008年硕士论文

【摘要】： 目的:本次研究主要评估SCID在心理解剖中进行精神疾病诊断时的可靠性、灵敏度和特异度问题。同时对影响心理解剖做出的SCID诊断的准确性的因素进行分析和讨论,并尝试提出提高诊断准确性的建议和方法。方法:研究对象为大连市第七人民医院的患者和辽宁省六县的社区人口。对目标人和信息人分别进行SCID访谈。对结果采用SPSS 14.0进行统计分析,计算SCID诊断的重测信度,评分者信度以及心理解剖做出的SCID诊断的灵敏度和特异度,并分析影响心理解剖做出SCID诊断的准确性的因素。结果:1.重测信度:本人SCID诊断的重测信度kappa值:酒精相关障碍1.000,分裂症0.919,双相障碍0.838,焦虑障碍:0.685,抑郁障碍0.798;心理解剖做出的SCID诊断的重测信度kappa值,酒精相关障碍1.000,分裂症0.910,双相障碍0.838,抑郁障碍0.786,焦虑障碍0.852。 2.评分者信度:本人SCID诊断的评分者信度kappa值:酒精相关障碍0.894,分裂症1.000,双相障碍0.894,抑郁障碍0.850,广泛性焦虑障碍0.814,惊恐障碍0.877;心理解剖做出的SCID诊断的评分者信度kappa值,酒精相关障碍1.000,分裂症0.894,双相障碍0.894,抑郁障碍0.814,广泛性焦虑障碍0.906,惊恐障碍0.712。 3.心理解剖做出的SCID诊断的灵敏度和特异度:心理解剖做出的诊断与本人诊断一致性较好:酒精相关障碍诊断一致性的kappa值为0.853,灵敏度为80.77%,特异度为100%;酒精滥用的kappa值最低,为0.510,灵敏度为27.78%;重性精神障碍的一致性最高,总的kappa为0.953,分裂症的kappa系数为0.930,妄想型障碍的kappa为1.000。灵敏度从分裂症的88.57%到妄想型障碍的100.00%。双相障碍的一致性的kappa值为0.881,灵敏度为88.00%;双相Ⅰ型障碍的kappa值0.859,灵敏度和特异度分别为87.50%和88.52%。抑郁障碍的一致性较低:重性抑郁的kappa值为0.652,恶劣心境的kappa只有0.623。如果把恶劣心境、重性抑郁以及非特定性抑郁障碍的诊断看做一致的话,总的抑郁障碍的kappa值为0.744,灵敏度可以提高到75.00%。焦虑障碍的kappa值最低,广泛性焦虑为0.652,惊恐障碍为0.693,灵敏度只有50.00%。如果把所有的焦虑障碍的诊断不分亚型的话,诊断一致性有所提高,但kappa值也仅为0.696。灵敏度为55.10%。影响心理解剖做出SCID诊断的因素为:信息人的类别和学历结论: 1本研究表明,在进行精神疾病诊断时,SCID具有较高的重测信度和评分者信度。 2心理解剖做出的SCID诊断具有较好的灵敏度和特异度,与本人诊断的一致性良好。 3在心理解剖研究中,使用SCID进行精神疾病的诊断,影响诊断一致性的因素为信息人类别,信息人的学历。即在信息人的选取时,尽可能选取一级亲属(父母或配偶)以及高学历者为信息的提供者。 4在心理解剖中,由信息人提供的信息构建目标人的精神疾病的诊断时,在抑郁障碍和焦虑障碍部分,我们建议可以适度的放宽诊断标准,只要信息人能够提供疾病信息,无论是域下还是阳性症状,都可以作为诊断的依据。
[Abstract]:Objective: the study of reliability evaluation of SCID diagnosis of mental illness in the psychological autopsy, sensitivity and specificity. The factors that influence the accuracy of SCID diagnosis of psychological autopsy were analyzed and discussed, and try to put forward suggestions and methods to improve the diagnostic accuracy.
Methods: We studied Seventh People's Hospital of Dalian city in six counties of Liaoning province and the population of the community. The target and information were SCID interview. SPSS 14 was used for statistical analysis of the results, the calculation of SCID in the diagnosis of test-retest reliability, rater reliability and sensitivity of SCID diagnosis of psychological autopsy and specificity, and to analyze the impact of psychological autopsy diagnosis accuracy make the SCID factor.
Results: 1. test-retest reliability: I SCID diagnosis the test-retest reliability of kappa value: 1 alcohol related disorders, schizophrenia and bipolar disorder in 0.919, 0.838, 0.685, depression and anxiety disorders: 0.798; psychological autopsy made SCID diagnosis of the test-retest reliability of kappa value, alcohol related disorders 1, 0.910 schizophrenia, bipolar disorder 0.838, 0.786 depression disorder, anxiety disorder 0.852.
2. rater reliability: I SCID diagnosis of rater reliability kappa value: 0.894 alcohol related disorders, schizophrenia and bipolar disorder in 1, 0.894, 0.850 depressive disorder, generalized anxiety disorder 0.814, 0.877 with panic disorder; psychological autopsy diagnosis of SCID made rater reliability kappa, 1 alcohol related disorders, schizophrenia 0.894 0.894, bipolar disorder, depressive disorder 0.814, 0.906 generalized anxiety disorder, panic disorder 0.712.
The sensitivity of SCID diagnosis to 3. psychological autopsy and specificity: psychological autopsy diagnosis and diagnosis to make himself better consistency: alcohol related disorder diagnostic consistency of the kappa value is 0.853, the sensitivity was 80.77%, specificity was 100%; the kappa of alcohol abuse was 0.510, the lowest value, the sensitivity was 27.78%; severe mental disorders the highest consistency, the total kappa was 0.953, kappa coefficient of schizophrenia was 0.930, paranoid disorder kappa 1.000. sensitivity consistency from 88.57% to paranoid disorder schizophrenia 100.00%. bipolar disorder kappa value was 0.881, the sensitivity was 88%; bipolar kappa value 0.859 the consistency of the sensitivity and specificity were 87.50% and 88.52%. depression low: major depression kappa value is 0.652, kappa only 0.623. dysthymia if dysthymia, depressive and non depressive disorder qualitative As the diagnosis of depression, the total kappa value is 0.744, which can improve the sensitivity to 75.00%. of anxiety disorder kappa minimum generalized anxiety panic disorder was 0.652, 0.693, a sensitivity of only 50.00%. if the diagnosis of anxiety disorder all the subtypes of words, diagnostic consistency increased, but the kappa value is only 0.696. sensitivity is 55.10%.
The factors affecting the SCID diagnosis of psychosocial anatomy are: the category and educational background of the informational person
Conclusion:
1 this study showed that SCID had a high retest reliability and a scorer reliability in the diagnosis of mental illness.
2 the SCID diagnosis made by psychosocial anatomy has good sensitivity and specificity, which is in good agreement with my diagnosis.
3, in the study of psychological anatomy, we use SCID to diagnose mental illness. The factors that affect the consistency of diagnosis are information people category and information person's educational background. That is, when information people are selected, we should select the first degree relatives (parents or spouses) and highly educated persons to be the providers of information.
4 in the psychological autopsy, diagnosis information provided by the information construction of the target of mental illness, in part of the depression and anxiety disorders, we suggest modest relaxation of diagnostic criteria, as long as the information can provide information on diseases, whether domain or positive symptoms, can be used as the basis for diagnosis.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R395

【引证文献】