等级诊断和多轴诊断体系在人格障碍诊断中的应用  

Applications of unity-axial and multiaxial diagnostic system in the diagnosis of personality disorder

作　　者：张天宏[1] 王兰兰[1] 肖泽萍[1] 戴云飞 张海音[1] 仇剑崟[1] 王振[1] 俞峻翰 吴艳茹[1] 蒋文晖 

机构地区：[1]上海交通大学医学院附属精神卫生中心,上海200030

出　　处：《中国神经精神疾病杂志》2011年第4期214-217,共4页Chinese Journal of Nervous and Mental Diseases

基　　金：国家高技术研究发展计划(编号:2007AA02Z420);上海市科委重点科技攻关项目(编号:074119520);上海市优秀学科带头人计划项目(编号:08XD14036)

摘　　要：目的了解等级诊断和多轴诊断体系在人格障碍诊断中的应用。方法对随机抽样的3075例精神科门诊患者进行人格障碍调查。以人格障碍诊断问卷为筛查工具,采用美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)配套的轴Ⅱ人格障碍临床访谈(SCID-Ⅱ)对筛查阳性者进行面检并作出诊断。同时,根据中国精神障碍分类与诊断标准(CCMD-3)对患者的PD患病情况作出临床诊断。结果根据DSM-IV多轴诊断体系,3075例门诊患者中982例(31.93%)符合人格障碍诊断标准,以回避型(8.10%)和强迫型(7.58%)人格障碍最为常见,其中44.40%(436/982)合并两种或以上人格障碍。而根据CCMD-3诊断体系明确诊断人格障碍的仅9例(0.3%)。结论精神专科医院门诊患者中人格障碍较为常见,DSM-Ⅳ诊断体系对人格障碍的诊断较国内目前的临床诊断体系敏感。Objective To explore the applications of unity-axial and multiaxial diagnostic system in the diagnosis of personality disorder（PD） in psychiatric outpatient clinics in China.Methods Three thousand seventy five patients were randomly sampled from psycho-counselling and psychiatric clinics in Shanghai.PDs were assessed by using personality diagnostic questionnaire（PDQ4＋） and structured clinical interview for DSM-IV Axis II（SCID-II）.The clinical diagnoses of outpatients were made according to the CCMD-3 diagnosis criterion.Results According to DSM-IV,the prevalence of PD was 31.93%（982 subjects）,and avoidant（8.10%） and obsessive-compulsive（7.58%） PD were the most prevalent types.44.40%（436/982） outpatients had more than two types of PD,while only 9 outpatients had PD diagnosed by CCMD-3.Conclusions There is higher prevalence rate of DSM-IV PDs in psychiatric outpatients,suggesting that DSM-IV diagnostic system may be more sensitive than CCMD-3 in identifying PDs in outpatient clinics.

关 键 词：人格障碍 DSM-Ⅳ 精神科门诊患者 

分 类 号：R749.91[医药卫生—神经病学与精神病学]