幻觉、妄想在精神分裂症中的诊断价值

摘要

ObJective:To investigate the diagnostic value of the hallucinations and delusions in schizo-phrenia. Method:With the clinical epidemiologic method,the hallucinations and delusions were assessed with the half - defined and blind method two weeks after the patient's hospitalization,and patients diagnosed u-sing Chinese classification of mental disorders(CCMD-3). The reliability and validity index of hallucinations and delusions was calculated. Results:The frequency of hallucinations and delusions in schizophrenia was significantly higher than that in non schizophrenic group. With schizophrenia diagnosis based on hallucinations and delusions,Youden index was 0. 36;Kappa 0. 43;the rate of missed diagnosis 10. 4% ;and misdiagnosis rate 53. 8% . The diagnosis validity of mood incongruent delusion was slightly higher,the Youden index was 0. 62;the rate of missed diagnosis 38. 5% and misdiagnosis rate 10. 3% ,and Kappa value 0. 38. Conclusion:Diagnosis of schizophrenia based on hallucinations and delusions is not perfect. Both symptons and fol-lowing outcomes should be considered in the diagnosis of schizophrenia.%目的：探讨幻觉、妄想在精神分裂症中的诊断价值。方法：采用临床流行病学方法，在患者入院后2周内以半定式、盲法评定幻觉、妄想。分别按《中国精神障碍分类与诊断标准》第3版和幻觉、妄想进行诊断，并计算诊断的效度与信度指标。结果：幻觉、妄想出现频率精神分裂症组明显高于非精神分裂症组（P ﹤0.01）。幻觉、妄想诊断精神分裂症的 Youden 指数为0.36，Kappa 值为0.43，有10.4％漏诊率和53.8％的误诊率。其中，与心境不协调妄想的诊断效度稍好，Youden 指数为0.62，有38.5％漏诊率和10.3％的误诊率，但 Kappa 值只有0.38。结论：仅凭幻觉、妄想诊断精神分裂症较片面，主张横向症状学与纵向预后观察相结合诊断。