Sensitivity of psychiatric diagnosis based on the best estimate procedure.
Sensitivity of psychiatric diagnosis based on the best estimate procedure.
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基于最佳估计程序的精神病学诊断的敏感性。
DOI：
10.1176/ajp.149.9.1225
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发表时间：
1992
期刊：
影响因子：
--
通讯作者：
Rounsaville Bj
中科院分区：
文献类型：
--
作者：
Therese A. Kosten;Rounsaville Bj
客观化
“最佳估计”诊断是专家临床医生根据另一名临床医生直接访问的诊断信息加上医疗记录和家庭成员报告中的信息而作出的诊断。作者提出的问题是，最佳估计程序是否可以提高直接访谈受试者的精神诊断分类。
方法
475名受试者被直接采访：201名从大学诊所寻求治疗的阿片成瘾先证者，以及他们的配偶和/或一级亲属。受试者由训练有素的临床评估员根据情感障碍和精神分裂症量表进行访谈，并根据研究诊断标准进行分类。两位心理学家通过应用最佳估计程序独立地诊断了相同的受试者。计算了严重和轻微抑郁障碍、反社会人格、酗酒和药物滥用的终生发生率。仅根据直接面谈作出的诊断率与根据最佳估计程序作出的诊断率进行了比较。
结果
当应用最佳估计程序时，所有四种疾病的诊断率都高于仅使用直接访谈的情况；最佳估计程序也导致最小的假阳性率。
结论
基于最佳估计程序的较高诊断率可能代表精神病学诊断准确性的提高或错误诊断的增加。作者认为第二种可能性不太可能。
OBJECTIVE
A "best estimate" diagnosis is one made by expert clinicians on the basis of diagnostic information from direct interview conducted by another clinician plus information from medical records and from reports of family members. The authors address the question of whether the best estimate procedure can enhance the classification of psychiatric diagnoses of subjects who are interviewed directly.
METHOD
Four hundred seventy-five subjects were interviewed directly: 201 opiate-addicted probands who sought treatment from a university-based clinic and 274 of their spouses and/or first-degree relatives. Subjects were interviewed by trained clinical assessors using the Schedule for Affective Disorders and Schizophrenia and classified according to Research Diagnostic Criteria. Two psychologists independently diagnosed the same subjects by applying the best estimate procedure. Lifetime rates of major and minor depressive disorder, antisocial personality, alcoholism, and drug abuse were calculated. The rates of diagnoses made on the basis of direct interviews alone were compared with the rates of diagnoses made according to the best estimate procedure.
RESULTS
Higher rates of diagnoses of all four disorders were made when the best estimate procedure was applied than when direct interview alone was used; the best estimate procedure also resulted in a minimal rate of false positives.
CONCLUSIONS
The higher rate of diagnoses based on the best estimate procedure may represent an enhancement in the accuracy of psychiatric diagnoses or an increase in erroneous diagnoses. The authors consider the second possibility less likely.
终生精神病诊断的最佳估计：方法学研究。
影响因子：
--
作者：
Leckman,JF;Sholomskas,D;Thompson,WD;Belanger,A;Weissman,MM
通讯作者：
Weissman,MM