Aboraya Ahmed, France Cheryl, Young John, Curci Kristina, Lepage James
All from Department of Behavioral Medicine and Psychiatry, Robert C. Byrd Health Sciences Center of West Virginia University, Morgantown, West Virginia.
Psychiatry (Edgmont). 2005 Sep;2(9):48-55.
The authors reviewed the types and phases of validity of psychiatric diagnosis. In 1970, Robins and Guze proposed five phases to achieve valid classification of mental disorders: clinical description, laboratory study, exclusion of other disorders, follow-up study, and family study.
The objectives of this paper are to review what has been learned since Robins and Guze's influential article as well as examine the impact of the new discoveries in neurosciences and neuroimaging on the practicing clinician.
The authors reviewed the literature on the concept of validity in psychiatry with emphasis on the role of clinical training, the use of structured interviews and rating scales, and the importance of the new discoveries in neurosciences.
Robins and Guze's phases have been the cornerstone of construct validity in psychiatry at the level of researchers. In the absence of the gold standard of psychiatric diagnosis, Spitzer proposed the "LEAD," which is an acronym for longitudinal evaluation, and is done by expert clinicians utilizing all the data available. The LEAD standard is construct validity at the level of experts; however, guidelines are lacking to improve the validity skills of the practicing clinicians.
The authors propose the acronym DR.SEE, which stands for data, reference definitions, rating scales, clinical experience, and external validators. The authors recommend that clinicians use the DR.SEE paradigm to improve the validity of psychiatric diagnoses.
作者回顾了精神疾病诊断有效性的类型和阶段。1970年，罗宾斯和古泽提出了五个阶段以实现精神障碍的有效分类：临床描述、实验室研究、排除其他疾病、随访研究和家族研究。
本文的目的是回顾自罗宾斯和古泽发表具有影响力的文章以来所学到的知识，并研究神经科学和神经影像学的新发现对临床执业医生的影响。
作者回顾了关于精神病学有效性概念的文献，重点关注临床培训的作用、结构化访谈和评定量表的使用以及神经科学新发现的重要性。
罗宾斯和古泽提出的阶段一直是研究人员层面精神病学建构效度的基石。在缺乏精神疾病诊断金标准的情况下，斯皮策提出了“LEAD”，这是纵向评估的首字母缩写，由专家临床医生利用所有可用数据进行。LEAD标准是专家层面的建构效度；然而，缺乏提高临床执业医生效度技能的指南。
作者提出了首字母缩写DR.SEE，代表数据、参考定义、评定量表、临床经验和外部验证者。作者建议临床医生使用DR.SEE范式来提高精神疾病诊断的有效性。
