“指令执行”检查在司法精神病鉴定中对伪装精神病的识别  

Application of "instruction execution" method in discrimination of pseudo-psychotics in forensic psychiatric expertise

作　　者：唐安平 丁愈 木拉迪力 渠旭升 吐尔逊 陈建新 陈绍荣 陈强 

机构地区：[1]新疆精卫法医精神病司法鉴定所(新疆精神卫生中心),乌鲁木齐830002

出　　处：《中国心理卫生杂志》2013年第4期268-272,共5页Chinese Mental Health Journal

基　　金：乌鲁木齐市卫生局科技计划项目(201015)

摘　　要：目的:探讨"指令执行"检查方法在司法精神病鉴定工作中对被鉴定人伪装精神病的识别作用。方法:对306例接受司法精神病鉴定者进行指令执行检查,以临床综合评判结果为金标准,比较指令执行检查和二项必选检查对伪装精神病的识别作用。结果:指令执行检查对伪装精神病的诊断率与金标准差异无统计学意义(35.0%vs.33.7%,P>0.05),指令执行检查的敏感性(42.7%vs.53.4%)、漏诊率(57.3%vs.46.6%)与二项必选检查差异无统计学意义(均P>0.05),特异性高于二项必选检查(69.0%vs.43.8%,P<0.01),误诊率低于二项必选检查(31.0%vs.56.2%.P<0.01)。经logistic回归分析,指令执行检查中的第三项即"伸手摸脉"对诊断伪装的意义明显突出(β=0.68,P<0.001)。结论:指令执行检查在司法精神病鉴定中可以作为一种识别伪装精神病的方法使用。Objective： To investigate the application of ＂instruction execution＂ method to discriminate pseudo- psychotics in forensic psychiatric expertise. Methods： Using clinical comprehensive evaluation as golden standard, the effect of ＂instruction execution＂ and ＂binomial forced-choice＂ methods was compared in discriminating pseudo- psychotics in 306 subjects who received forensic psychiatric expertise. Results： There was no statistical difference between ＂instruction execution＂ method and golden standard in recognition rates of pseudo-psychotics （35. 0% vs. 33. 7%, P 〉 0. 05）. There was no statistical difference between ＂instruction execution＂ and ＂binomial forced- choice＂ methods in sensitivity （42. 7% vs. 53.4% ） and misdiagnosing rates （57.3% vs. 46. 6% ）. But the specificity rate of ＂instruction execution＂ method was higher （69. 0% vs. 43.8%, P 〈 0. 01） and the misdiagnosing rate （31.0% vs. 56. 2%, P 〈 0.01） was lower than that of ＂binomial forced-choice＂ method. The third item of ＂instruction execution＂ method, namely ＂touching pulse＂, was especially effective in discriminating pseudo-psychotics by logistic regression analyses （β = 0. 68, P 〈 0. 001）. Conclusion： The study shows that ＂instruction execution＂ meth- od could be used as a way to discriminate pseudo-psychotics.

关 键 词：司法精神病鉴定 伪装 二项必选 指令执行 

分 类 号：D919.3[医药卫生—法医学] R749.04[政治法律—法学]