Lewy Colleen, Sells C Wayne, Gilhooly Jennifer, McKelvey Robert
Psychiatry at Oregon Health & Sciences University, 3181 SW Sam Jackson Park Rd., GH249, Portland, OR 97239-3098, USA.
Acad Psychiatry. 2009 Sep-Oct;33(5):389-93. doi: 10.1176/appi.ap.33.5.389.
The authors aim to determine whether pediatric residents used DSM-IV criteria to diagnose major depressive disorder and how this related to residents' confidence in diagnosis and treatment skills before and after clinical training with depressed adolescents.
Pediatric residents evaluated two different standardized patients portraying major depressive disorder before and after learning about adolescent depression. Residents' interactions with standardized patients were observed, and checklists containing DSM-IV criteria for major depressive disorder and other pertinent information, such as comorbidities, were completed for each interaction. After the encounter, residents completed a survey asking about the "patient's" diagnosis and the residents' confidence in their clinical skills.
Residents assessed significantly more checklist items in the second encounter with a standardized patient. Residents' confidence in treatment was significantly higher after the rotation, while confidence in diagnostic skills was unchanged, remaining high. Even after the rotation, residents did not use all DSM-IV criteria for major depressive disorder in their diagnoses.
Major depressive disorder is a common adolescent psychiatric disorder. Pediatricians must be equipped with appropriate interpersonal and diagnostic skills to detect this and other psychiatric disorders. Standardized patients represent one useful way to teach and assess these skills. This study suggests that residents' interpersonal and diagnostic skills can improve with practice. Although resident scores improved, post-encounter checklists showed that residents were still not asking all the necessary questions for a DSM-IV diagnosis, concluding prematurely that the standardized patients had major depressive disorder before satisfying all diagnostic criteria. The majority did not consider other depressive conditions or comorbid disorders.
作者旨在确定儿科住院医师是否使用《精神疾病诊断与统计手册》第四版（DSM-IV）标准来诊断重度抑郁症，以及这与住院医师在对抑郁青少年进行临床培训前后对诊断和治疗技能的信心有何关联。
儿科住院医师在学习青少年抑郁症之前和之后，对两名表现为重度抑郁症的不同标准化患者进行评估。观察住院医师与标准化患者的互动情况，并针对每次互动完成包含DSM-IV重度抑郁症标准及其他相关信息（如共病情况）的清单。互动结束后，住院医师完成一项调查，询问对“患者”的诊断以及对自身临床技能的信心。
住院医师在第二次与标准化患者互动时评估的清单项目明显更多。轮转后住院医师对治疗的信心显著提高，而对诊断技能的信心未变，仍保持较高水平。即使在轮转之后，住院医师在诊断中也未使用所有DSM-IV重度抑郁症标准。
重度抑郁症是一种常见的青少年精神疾病。儿科医生必须具备适当的人际沟通和诊断技能，以识别这种及其他精神疾病。标准化患者是教授和评估这些技能的一种有用方式。本研究表明，住院医师的人际沟通和诊断技能可通过实践得到提高。尽管住院医师的分数有所提高，但互动后的清单显示，住院医师在进行DSM-IV诊断时仍未询问所有必要问题，在满足所有诊断标准之前就过早得出标准化患者患有重度抑郁症的结论。大多数人没有考虑其他抑郁状况或共病疾病。
