Rijnders C A, van den Berg J F, Hodiamont P P, Nienhuis F J, Furer J W, Mulder J, Giel R
Department of Social Medicine, Nijmegen University, The Netherlands.
Soc Psychiatry Psychiatr Epidemiol. 2000 Aug;35(8):348-52. doi: 10.1007/s001270050249.
The Schedules for Clinical Assessment in Neuropsychiatry (SCAN), the successor of the ninth version of the Present State Examination (PSE-9), is one of the latest instruments developed by the World Health Organisation for the assessment of psychiatric disorders. So far, the psychometric properties have only been established for certain sections of the instrument. The present study is the first to test the psychometric properties of SCAN-2.1 for most of the disorders covered by the SCAN, and was carried out prior to a survey conducted in the Nijmegen Health Area (the Netherlands).
Interviewers were psychology graduates with little clinical experience. Two designs were used. In one design, pairs of independent live interviews with the same respondent were compared (test-retest situation). In the other, ten videotaped interviews by experts were rated by each of the interviewers (standardized situation), and the outcomes were compared with those of the other interviewers as well as with a reference score.
In the test-retest situation the kappa coefficient for diagnostic caseness was qualified as substantial (0.62) and for diagnostic categories and diagnostic groups as moderate to good (0.24 to 0.64). In the standardized situation using videotaped interviews by experts, sensitivity as well as specificity proved to be substantial to almost perfect. The agreement per interviewer with regard to the reference diagnoses ranged from 87% (diagnostic group) to 94% (diagnostic caseness). Agreement on the syndrome level (without duration and interference criteria of DSM-IV) was excellent.
Although the instrument is traditionally used by experienced clinicians, this study shows that less experienced (but well trained) interviewers can apply SCAN reliably. Special attention should be paid to the items without explicit interview questions, as they tend to be more sensitive to neglect than the items with interview questions.
神经精神病临床评估量表（SCAN）是第九版现况检查（PSE - 9）的后续版本，是世界卫生组织开发的用于评估精神障碍的最新工具之一。到目前为止，该工具仅部分内容的心理测量特性得到了验证。本研究首次对SCAN - 2.1涵盖的大多数精神障碍的心理测量特性进行测试，且该研究在荷兰奈梅亨健康区的一项调查之前进行。
访谈者为几乎没有临床经验的心理学专业毕业生。采用了两种设计。一种设计是比较对同一受访者进行的两次独立现场访谈（重测情况）。另一种设计是让每位访谈者对专家的十次录像访谈进行评分（标准化情况），并将结果与其他访谈者的结果以及参考分数进行比较。
在重测情况下，诊断病例的kappa系数为“实质性”（0.62），诊断类别和诊断组的kappa系数为“中等至良好”（0.24至0.64）。在使用专家录像访谈的标准化情况下，敏感性和特异性均被证明为“实质性”至“几乎完美”。每位访谈者与参考诊断的一致性范围为87%（诊断组）至94%（诊断病例）。在综合征水平（不考虑DSM - IV的病程和干扰标准）上的一致性非常好。
尽管该工具传统上由经验丰富的临床医生使用，但本研究表明，经验较少（但训练有素）的访谈者也能可靠地应用SCAN。对于没有明确访谈问题的条目应给予特别关注，因为它们往往比有访谈问题的条目更容易被忽视。
