International Variations in the Diagnosis of Psychiatric Illness
International Variations in the Diagnosis of Psychiatric Illness
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精神疾病诊断的国际差异
DOI：
10.1192/bjp.131.4.329
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发表时间：
1977
影响因子：
10.5
通讯作者：
J. Leff
中科院分区：
文献类型：
--
作者：
J. Leff
精神疾病的病理实验室调查的实际缺失迫使精神科医生将他的诊断牢牢地建立在临床访谈的基础上。Shepherd et at（1968）确定了精神病学访谈的四个主要组成部分：(i)精神科医生的访谈技巧；(2)对患者言语和行为的感知；（@）精神科医生根据他所感知到的情况所作的参考和决定；(4)给病人贴上特定的诊断标签。这些都是有用的区别，将用于构建本综述。然而，它们并没有严格划分，而且在实践中受到相互影响。特别是，精神病医生的诊断方案在很大程度上决定了他的面谈技术，正如我们将看到的，除了他对症状存在的判断外，还影响了他对病人言行的看法。这种普遍影响的重要性怎么估计都不为过，因为有证据表明，精神科医生在面谈的最初几分钟内就能自信地得出诊断结论（Sandifer et at）。
The virtual absence of pathognomonic labo ratory investigations for psychiatric conditions forces the psychiatrist to base his diagnosis firmly on the clinical interview. Shepherd et at (1968) identified four major components of the psychiatric interview: (i) the interviewing technique of the psychiatrist; (2) perception of the patient's speech and behaviour; (@) in ferences and decisions made by the psychiatrist on the basis of what he has perceived; (4) attachment of a particular diagnostic label to the patient. These are useful distinctions and will be employed to structure this review. However, they are not strictly compartmenta lized and in practice are subject to mutual influences. In particular, the psychiatrist's diagnostic scheme strongly determines his inter viewing technique and, as we shall see, affects his perception of what the patient says and does, in addition to his decisions about the presence of symptoms. The importance of this pervasive influence cannot be overestimated, since it has been shown that psychiatrists confidently reach a conclusion about the diagnosis within the first few minutes of the interview (Sandifer et at,