中国临床心理学杂志

心理疾病专家诊断系统的临床信度和效度评价

作者：郭田生¹ 骆晓林¹ 李新纯¹ 姚美艳² 张喜艳¹ 周晓璇¹ 朱娟娟¹ 李淑春² 李小玲¹

单位：1. 湖南省脑科医院长沙 410007
2. 湘潭市精神卫生中心湘潭 411100

关键词：精神疾病诊断试验效度信度

分类号：R395.1

出版年,卷(期):页码：2014,22(1):96-100

摘要：

目的:评价心理疾病专家诊断系统(4.0版)的信度和效度。方法:以定式临床检查病人版(SCID-P)、国际疾病分类手册第10版(ICD-10)及中国精神障碍分类与诊断标准第三版(CCMD-3)等为"金标准",评估心理疾病专家诊断系统诊断精神疾病及相关功能性疾病的信、效度。共入组835例来自湖南省脑科医院、湘潭市精神卫生中心门诊和住院的患者。每位患者由2名精神科医师根据SCID-P或CCMD-3等诊断工具进行检查。随后由2名心理测评人员用心理疾病专家诊断系统分别进行检查;间隔3~5天后再次用心理疾病专家诊断系统进行评估。以2名精神科医师诊断一致的为确诊病例。结果:心理疾病专家诊断系统评定者之间一致性和重测一致性kappa值分别为0.93~1.00(P<0.01)、0.87~1.00(P<0.01)。与SCID-P比较,心理疾病专家诊断系统诊断的抑郁症、精神分裂症等13类精神障碍的灵敏度为82.9%~97.0%,特异度96.8%~99.5%,正确指数81.3%~93.8%,平均87.38%;与CCMD-3比较,心理疾病专家诊断系统诊断神经衰弱、紧张性头痛等8类神经心理障碍的灵敏度为88.0%~96.9%,特异度95.3%~99.5%,正确指数在87.3%~92.6%之间。心理疾病专家诊断系统诊断21种疾病的阳性预测值平均85.54%(76.3%~95.7%),阴性预测值均>95%。结论:心理疾病专家诊断系统诊断精神心理疾病有较高的信度和效度,达到了临床实用的要求,可以作为临床筛查或诊断精神疾病的辅助工具。

Objective: To assess the reliability and validity of expert diagnosis system 4.0 Vision(Psychological"Computerized Tomography", PCT V4.0) for mental disorder. Methods: Authors evaluated the reliability and validity of PCT V4.0 in diagnosing mental disorder and the other functional disorders with the Structured Clinical Interview for Diagnostic and Statistical Manual(DSM)-IV-TR-Patient version(SCID-P) and International Classification of Diseases 10(ICD-10) as well as Chinese Classification and Diagnostic Criteria of Mental Disorders-3(CCMD-3) as"gold standard". There were 835 cases of patients from brain hospital of Hunan province and Mental health center of Xiangtan city checked by two psychiatrists with SCID-P and CCMD-3 first, then detected by two psychological test staffs with PCT V4.0, after 3-5days detected them again. We compared with the reliability and validity between the cases diagnosed with PCT V4.0 and the consistency cases diagnosed by two doctors. The reliability was indicated with Kappa value. Results: The kappa value of inter-rater and test-retest were 0.93~1.00(P<0.01) and 0.87~1.00(P<0.01), The diagnostic results were stable. Comparing with SCID-P in diagnosing depression and schizophrenia and the other 11 types of mental disorder, the sensitivity of PCT V4.0 was 82.9%~97.0%, the specificity was 96.8%~99.5%, Youden's index of diagnosis was 81.3%~93.8%, average Youden' s index was 87.38%. Contrasting with CCMD-3 in diagnosing of neurasthenia and tension headaches as well as the other 7 kinds of neuropsychological disorder, the sensitivity of PCT V4.0 was 88.0%~96.9%,the specificity was 95.3%~99.5%, Youden's index of diagnosis was 87.3%~92.6%. The mean positive predictive value of PCT V4.0 was 85.5%(76.3%~ 95.7%) and the negative predictive value was greater than 95% for all 21 diagnoses. The results above indicated the diagnosis consistency was very high between PCT V4.0 and"gold standard". Conclusion: There was higher reliability and validity of PCT V4.0 in diagnosing mental disorders, having reached the clinical needs, which could be act as a screening tool or an auxiliary diagnostic tool for mental disorders, worthy of popularizing in clinical use.

基金项目：

湖南省科技计划项目“中国心理疾病专家诊断系统的研制”(2008FJ3197)资助

作者简介：

参考文献：

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