目的：研究精神障碍患者病史可信度的影响因素。方法选取2011年8月1日-2013年5月30日在深圳市康宁医院选取就诊编号尾数为双数的就诊患者及司法鉴定案例的病史提供者，共入组600例确诊或疑似精神障碍患者的病史提供者，依据提供病史的可信度及有效性分为不太可信、部分可信和基本可信组三组。由病史提供者完成简易精神症状自评量表（SBPS），并收集病史提供者对患者的了解程度、病前是否存在经济纠纷或利益冲突、反映病史时的表现等资料。结果①不太可信组鉴定案例多于门诊或住院患者（78例 vs.23例，P <0.01），三组病例来源的分布差异有统计学意义（χ2=59.5，P <0.01）；②不太可信、部分可信和基本可信组三组的 SBPS 总评分分别为（13.98±5.50）分、（6.22±5.70）分和（1.67±1.60）分，差异有统计学意义（F =220.8，P <0.01）；③不太可信、部分可信和基本可信三组在病史提供者对被评定者的了解程度、病前是否存在经济纠纷或利益冲突、病史提供者在反映病史时的表现方面的各项临床表现差异均有统计学意义（P 均<0.01）。结论病例来源、对患者的了解程度、病前是否存在经济或利益纠纷、病史提供者在反映病史时的表现均可能影响病史提供的可信度，不同可信度病史提供者的主观夸大精神症状及其夸大程度有所差异。%Objective To explore factors influencing the reliability of medical history in patients with mental disorder. Methods A total of 600 participants(providers)who provided the medical history of patients(outpatient and hospitalized patients) and appraised cases from Shenzhen Kangning Hospital were included in the sutdy. According to the reliability and validity of provided medical history,the providers were divided into three groups,including unreliable group,partially reliable group and reliable group. All providers were tested by Self - report scale of brief psychopathological symptoms(SBPS). Clinical features including the level of understanding of providers for the patients,whether there were economic disputes or conflicts of interest before their illness,the performance when participants provided the medical history of patients were collected. Results ①The appraised cases were more than outpatients and inpatients in unreliable group(P < 0. 01),the sources of case in three groups were different(χ2 = 59. 5,P < 0. 01).②There were significant differences among three groups in the total score of SBPS[(13.98 ±5.50)vs.(6.22 ±5.70)vs.(1.67 ±1.60), F = 220. 8,P < 0. 01]. ③The clinical features above - mentioned showed significantly differences among three groups(P < 0. 01). Conclusion The different source of case and above clinical features may influence the reliability of medical history. The degree of camouflage among three groups are different.
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