本文選題：SCID　切入點：心理解剖　出處：《大連醫(yī)科大學(xué)》2008年碩士論文

【摘要】： 目的:本次研究主要評估SCID在心理解剖中進行精神疾病診斷時的可靠性、靈敏度和特異度問題。同時對影響心理解剖做出的SCID診斷的準確性的因素進行分析和討論,并嘗試提出提高診斷準確性的建議和方法。 方法:研究對象為大連市第七人民醫(yī)院的患者和遼寧省六縣的社區(qū)人口。對目標人和信息人分別進行SCID訪談。對結(jié)果采用SPSS 14.0進行統(tǒng)計分析,計算SCID診斷的重測信度,評分者信度以及心理解剖做出的SCID診斷的靈敏度和特異度,并分析影響心理解剖做出SCID診斷的準確性的因素。 結(jié)果:1.重測信度:本人SCID診斷的重測信度kappa值:酒精相關(guān)障礙1.000,分裂癥0.919,雙相障礙0.838,焦慮障礙:0.685,抑郁障礙0.798;心理解剖做出的SCID診斷的重測信度kappa值,酒精相關(guān)障礙1.000,分裂癥0.910,雙相障礙0.838,抑郁障礙0.786,焦慮障礙0.852。 2.評分者信度:本人SCID診斷的評分者信度kappa值:酒精相關(guān)障礙0.894,分裂癥1.000,雙相障礙0.894,抑郁障礙0.850,廣泛性焦慮障礙0.814,驚恐障礙0.877;心理解剖做出的SCID診斷的評分者信度kappa值,酒精相關(guān)障礙1.000,分裂癥0.894,雙相障礙0.894,抑郁障礙0.814,廣泛性焦慮障礙0.906,驚恐障礙0.712。 3.心理解剖做出的SCID診斷的靈敏度和特異度:心理解剖做出的診斷與本人診斷一致性較好:酒精相關(guān)障礙診斷一致性的kappa值為0.853,靈敏度為80.77%,特異度為100%;酒精濫用的kappa值最低,為0.510,靈敏度為27.78%;重性精神障礙的一致性最高,總的kappa為0.953,分裂癥的kappa系數(shù)為0.930,妄想型障礙的kappa為1.000。靈敏度從分裂癥的88.57%到妄想型障礙的100.00%。雙相障礙的一致性的kappa值為0.881,靈敏度為88.00%;雙相Ⅰ型障礙的kappa值0.859,靈敏度和特異度分別為87.50%和88.52%。抑郁障礙的一致性較低:重性抑郁的kappa值為0.652,惡劣心境的kappa只有0.623。如果把惡劣心境、重性抑郁以及非特定性抑郁障礙的診斷看做一致的話,總的抑郁障礙的kappa值為0.744,靈敏度可以提高到75.00%。焦慮障礙的kappa值最低,廣泛性焦慮為0.652,驚恐障礙為0.693,靈敏度只有50.00%。如果把所有的焦慮障礙的診斷不分亞型的話,診斷一致性有所提高,但kappa值也僅為0.696。靈敏度為55.10%。 影響心理解剖做出SCID診斷的因素為:信息人的類別和學(xué)歷 結(jié)論: 1本研究表明,在進行精神疾病診斷時,SCID具有較高的重測信度和評分者信度。 2心理解剖做出的SCID診斷具有較好的靈敏度和特異度,與本人診斷的一致性良好。 3在心理解剖研究中,使用SCID進行精神疾病的診斷,影響診斷一致性的因素為信息人類別,信息人的學(xué)歷。即在信息人的選取時,盡可能選取一級親屬(父母或配偶)以及高學(xué)歷者為信息的提供者。 4在心理解剖中,由信息人提供的信息構(gòu)建目標人的精神疾病的診斷時,在抑郁障礙和焦慮障礙部分,我們建議可以適度的放寬診斷標準,只要信息人能夠提供疾病信息,無論是域下還是陽性癥狀,都可以作為診斷的依據(jù)。
[Abstract]:Objective: the study of reliability evaluation of SCID diagnosis of mental illness in the psychological autopsy, sensitivity and specificity. The factors that influence the accuracy of SCID diagnosis of psychological autopsy were analyzed and discussed, and try to put forward suggestions and methods to improve the diagnostic accuracy.
Methods: We studied Seventh People's Hospital of Dalian city in six counties of Liaoning province and the population of the community. The target and information were SCID interview. SPSS 14 was used for statistical analysis of the results, the calculation of SCID in the diagnosis of test-retest reliability, rater reliability and sensitivity of SCID diagnosis of psychological autopsy and specificity, and to analyze the impact of psychological autopsy diagnosis accuracy make the SCID factor.
Results: 1. test-retest reliability: I SCID diagnosis the test-retest reliability of kappa value: 1 alcohol related disorders, schizophrenia and bipolar disorder in 0.919, 0.838, 0.685, depression and anxiety disorders: 0.798; psychological autopsy made SCID diagnosis of the test-retest reliability of kappa value, alcohol related disorders 1, 0.910 schizophrenia, bipolar disorder 0.838, 0.786 depression disorder, anxiety disorder 0.852.
2. rater reliability: I SCID diagnosis of rater reliability kappa value: 0.894 alcohol related disorders, schizophrenia and bipolar disorder in 1, 0.894, 0.850 depressive disorder, generalized anxiety disorder 0.814, 0.877 with panic disorder; psychological autopsy diagnosis of SCID made rater reliability kappa, 1 alcohol related disorders, schizophrenia 0.894 0.894, bipolar disorder, depressive disorder 0.814, 0.906 generalized anxiety disorder, panic disorder 0.712.
The sensitivity of SCID diagnosis to 3. psychological autopsy and specificity: psychological autopsy diagnosis and diagnosis to make himself better consistency: alcohol related disorder diagnostic consistency of the kappa value is 0.853, the sensitivity was 80.77%, specificity was 100%; the kappa of alcohol abuse was 0.510, the lowest value, the sensitivity was 27.78%; severe mental disorders the highest consistency, the total kappa was 0.953, kappa coefficient of schizophrenia was 0.930, paranoid disorder kappa 1.000. sensitivity consistency from 88.57% to paranoid disorder schizophrenia 100.00%. bipolar disorder kappa value was 0.881, the sensitivity was 88%; bipolar kappa value 0.859 the consistency of the sensitivity and specificity were 87.50% and 88.52%. depression low: major depression kappa value is 0.652, kappa only 0.623. dysthymia if dysthymia, depressive and non depressive disorder qualitative As the diagnosis of depression, the total kappa value is 0.744, which can improve the sensitivity to 75.00%. of anxiety disorder kappa minimum generalized anxiety panic disorder was 0.652, 0.693, a sensitivity of only 50.00%. if the diagnosis of anxiety disorder all the subtypes of words, diagnostic consistency increased, but the kappa value is only 0.696. sensitivity is 55.10%.
The factors affecting the SCID diagnosis of psychosocial anatomy are: the category and educational background of the informational person
Conclusion:
1 this study showed that SCID had a high retest reliability and a scorer reliability in the diagnosis of mental illness.
2 the SCID diagnosis made by psychosocial anatomy has good sensitivity and specificity, which is in good agreement with my diagnosis.
3, in the study of psychological anatomy, we use SCID to diagnose mental illness. The factors that affect the consistency of diagnosis are information people category and information person's educational background. That is, when information people are selected, we should select the first degree relatives (parents or spouses) and highly educated persons to be the providers of information.
4 in the psychological autopsy, diagnosis information provided by the information construction of the target of mental illness, in part of the depression and anxiety disorders, we suggest modest relaxation of diagnostic criteria, as long as the information can provide information on diseases, whether domain or positive symptoms, can be used as the basis for diagnosis.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2008
【分類號】：R395

【引證文獻】

相關(guān)博士學(xué)位論文 前1條

1 方樂;心理解剖在農(nóng)村青年自殺身亡者中的應(yīng)用研究[D];山東大學(xué);2009年

相關(guān)碩士學(xué)位論文 前2條

1 叢文;農(nóng)村高低計劃自殺死亡者不同特點的心理解剖研究[D];大連醫(yī)科大學(xué);2011年

2 劉慧;農(nóng)村不同自殺意圖水平自殺未遂危險因素研究[D];山東大學(xué);2012年

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本文編號：1718682