Mezzich Juan E
International Center for Mental Health, Mount Sinai School of Medicine, New York University, New York, NY 10029, USA.
Psychopathology. 2002 Mar-Jun;35(2-3):72-5. doi: 10.1159/000065122.
Several interesting surveys on the use of diagnostic systems have been conducted over the past two decades, initially focused on ICD-9 and DSM-III and then on more recent editions of these systems. They have reported on the extent and perceived value of their use as well as offered recommendations for future systems. The widest survey to date is that on ICD-10 and related systems recently conducted by the WHO Committee on Evaluating and Updating the ICD-10 Mental Health Component and the WPA Section on Classification and Diagnostic Assessment. It involved the participation of 205 psychiatrists from 66 different countries across all continents. Comparing the two most visible diagnostic systems, it found that ICD-10 was more frequently used and more valued for clinical diagnosis and training and that DSM-IV was more valued for research. Accessibility to diagnostic manuals and training appeared limited, particularly concerning the research criteria, primary care, and multiaxial versions of ICD-10. It also elicited structural and strategic recommendations for the elaboration of new diagnostic systems. It is suggested that it may be useful to widen the scope of future surveys, to additionally include policy makers, patients and families, and to conduct naturalistic studies of clinical care.
在过去二十年里，已经开展了几项关于诊断系统使用情况的有趣调查，最初聚焦于《国际疾病分类》第九版（ICD - 9）和《精神疾病诊断与统计手册》第三版（DSM - III），随后又针对这些系统的最新版本。这些调查报道了它们的使用范围和感知价值，并为未来的系统提供了建议。迄今为止范围最广的一项调查是世界卫生组织评估与更新《国际疾病分类》第十版（ICD - 10）心理健康部分委员会以及世界精神病学协会分类与诊断评估分会最近针对ICD - 10及相关系统开展的调查。该调查有来自六大洲66个不同国家的205名精神科医生参与。比较这两种最知名的诊断系统后发现，ICD - 10在临床诊断和培训中使用得更频繁且更受重视，而DSM - IV在研究方面更受重视。获取诊断手册和培训的机会似乎有限，尤其是关于ICD - 10的研究标准、初级保健和多轴版本。该调查还就新诊断系统的制定提出了结构和战略方面的建议。有人建议，扩大未来调查的范围可能会很有用，额外纳入政策制定者、患者及其家属，并对临床护理进行自然主义研究。
