AN EMPIRICAL-COMPARISON OF DIAGNOSES AND RELIABILITIES IN ICD-10 AND DSM-III-R
AN EMPIRICAL-COMPARISON OF DIAGNOSES AND RELIABILITIES IN ICD-10 AND DSM-III-R
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DOI：
10.1007/bf02189965
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发表时间：
1993-03-01
影响因子：
4.7
通讯作者：
VONZERSSEN, D
中科院分区：
文献类型：
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作者：
HILLER, W;DICHTL, G;VONZERSSEN, D
精神病分类系统ICD-10和DSM-III-R进行了比较，应用两套诊断标准，以同一样本的患者患有情感和精神病性障碍。四个独立的评估者根据两个系统对100个以传统标准格式编写的书面病例记录进行诊断评估。采用国际诊断检查表（IDCL）评定相关精神病理学体征和症状，并应用诊断决策规则。结果表明，ICD-10对除双相情感障碍外的所有主要精神障碍的信度普遍较高。根据DSM-III-R的诊断的总体可靠性为kappa = 0.53，根据ICD-10的诊断为0.59。情感性精神障碍的一致性最好，精神分裂症的一致性中等，情感性精神障碍的一致性不可接受。在这两个系统中，在一侧的情感障碍与另一侧的精神分裂症和双相情感障碍之间都发现了不足的界限。精神分裂症的不同持续时间标准，DSM-III-R中为6个月，ICD-10中为1个月，在典型的临床环境中，这往往对精神分裂症的发生率有相当大的影响。
The psychiatric classification systems ICD-10 and DSM-III-R were compared by applying both sets of diagnostic criteria to the same sample of patients suffering from affective and psychotic disorders. Four independent raters assessed diagnoses according to both systems to 100 written case records which had been prepared in a traditional, standard format. The International Diagnostic Checklists (IDCL) were employed to rate relevant psychopathological signs and symptoms and to apply diagnostic decision rules. The results showed that ICD-10 yielded a generally higher reliability for all main disorders except for bipolar disorder. Overall reliability was kappa = 0.53 for diagnoses according to DSM-III-R and 0.59 for diagnoses according to ICD-10. Agreement was best for affective disorders, moderate for schizophrenia and inacceptable for schizoaffective disorder. Insufficient boundaries were found in both systems between schizoaffective disorder on one side and schizophrenia and bipolar disorder on the other side. The different duration criteria for schizophrenia of six months in DSM-III-R and one month in ICD-10 tend to have considerable consequences for frequency rates of schizophrenia in a typical clinical setting.