Testing the Reliability and Validity of DSM-IV-TR and ICSD-2 Insomnia Diagnoses Results of a Multitrait-Multimethod Analysis
Testing the Reliability and Validity of DSM-IV-TR and ICSD-2 Insomnia Diagnoses Results of a Multitrait-Multimethod Analysis
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DOI：
10.1001/archgenpsychiatry.2011.64
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发表时间：
2011-10-01
影响因子：
--
通讯作者：
Krystal, Andrew D.
中科院分区：
文献类型：
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作者：
Edinger, Jack D.;Wyatt, James K.;Krystal, Andrew D.
内容：失眠症诊断有不同的诊断分类方案，但最佳的失眠疾病分类尚未确定。目的：测试美国精神病学协会的DSM-IV-TR和国际睡眠障碍分类第二版（ICSD-2）中列出的失眠症诊断的可靠性和有效性。设计：多特征-多方法相关设计。设置：两个合作的大学医学中心，招募时间为2004年1月至2009年2月。参与者：352名成年志愿者（其中235名为女性）符合失眠症研究诊断标准。主要结果测量：每个患者的10个DSM-IV-TR和37个ICSD-2失眠诊断的拟合优度评级。由3对临床医生提供评级，他们使用独特的评估方法得出诊断印象。计算内和跨临床医生对的相关性被用来测试的可靠性和有效性diagnosis.Results：调查结果表明，最好的支持DSM-IV-TR失眠类别失眠相关的另一种精神疾病，失眠由于一般的医疗条件，呼吸相关的睡眠障碍，昼夜节律睡眠障碍。原发性失眠症的类别似乎有边际的信度和效度。最受支持的ICSD-2类别是由精神障碍和医疗条件引起的失眠、阻塞性睡眠呼吸暂停、不宁腿综合征、特发性失眠和昼夜节律睡眠障碍-睡眠相位延迟类型。心理生理性失眠和睡眠卫生不足得到了更多的变量支持跨网站，而矛盾性失眠的诊断是不好的supported.Conclusions：DSM-IV-TR和ICSD-2提供可行的失眠诊断，但研究结果支持从每个2疾病分类的亚型。尽管如此，关于经常使用的DSM-IV-TR诊断原发性失眠及其相关的ICSD-2亚型的研究结果表明，其可靠性和有效性差，可能是由于与共病失眠亚型的显着重叠。因此，替代诊断范式应考虑失眠分类。
Context: Distinctive diagnostic classification schemes for insomnia diagnoses are available, but the optimal insomnia nosology has yet to be determined.Objectives: To test the reliability and validity of insomnia diagnoses listed in the American Psychiatric Association's DSM-IV-TR and the International Classification of Sleep Disorders, second edition (ICSD-2).Design: Multitrait-multimethod correlation design.Setting: Two collaborating university medical centers, with recruitment from January 2004 to February 2009.Participants: A total of 352 adult volunteers (235 of whom were women) who met research diagnostic criteria for insomnia disorder.Main Outcome Measures: Goodness-of-fit ratings of 10 DSM-IV-TR and 37 ICSD-2 insomnia diagnoses for each patient. Ratings were provided by 3 clinician pairs who used distinctive assessment methods to derive diagnostic impressions. Correlations computed within and across clinician pairs were used to test reliability and validity of diagnoses.Results: Findings suggested that the best-supported DSM-IV-TR insomnia categories were insomnia related to another mental disorder, insomnia due to a general medical condition, breathing-related sleep disorder, and circadian rhythm sleep disorder. The category of primary insomnia appeared to have marginal reliability and validity. The best-supported ICSD-2 categories were the insomnias due to a mental disorder and due to a medical condition, obstructive sleep apnea, restless legs syndrome, idiopathic insomnia, and circadian rhythm sleep disorder-delayed sleep phase type. Psychophysiological insomnia and inadequate sleep hygiene received much more variable support across sites, whereas the diagnosis of paradoxical insomnia was poorly supported.Conclusions: Both the DSM-IV-TR and ICSD-2 provide viable insomnia diagnoses, but findings support selected subtypes from each of the 2 nosologies. Nonetheless, findings regarding the frequently used DSM-IV-TR diagnosis of primary insomnia and its related ICSD-2 subtypes suggest that their poor reliability and validity are perhaps due to significant overlap with comorbid insomnia subtypes. Therefore, alternate diagnostic paradigms should be considered for insomnia classification.