Martynikhin Ivan A
Consort Psychiatr. 2021 May 25;2(2):35-44. doi: 10.17816/CP69. eCollection 2021.
In order to assess the specifics of practical use of the ICD-10 Diagnostic Guidelines by Russian psychiatrists, official national statistics on the prevalence of a number of mental disorders in Russia in 2019 were compared with the results of meta-analyses of international epidemiological studies of these disorders. In addition, a number of items in the online psychiatrists' survey, relating to the diagnosis of schizophrenia, were analysed; 807 Russian psychiatrists took part in the online survey.
Analysis of national statistics showed that domestic clinicians diagnose some mental disorders significantly less often than might be expected, according to data obtained by international epidemiological studies. The number of cases of bipolar affective disorder registered in Russia is 90-150 times less than that for the prevalence of this disorder, according to meta-analyses of epidemiological studies; for depression, the result is 50-70 times; for anxiety disorders, the number is 25-50 times, and for autism, it is 30 times. Instead of the above disorders, diagnoses of organic non-psychotic mental disorders and schizophrenia might have been used unreasonably often. Between 2005 and 2019, diagnosis of childhood autism changed significantly (an increase of more than 100%), while the frequency of diagnosing other mental disorders remained unchanged. The results of the online survey also showed largely perfunctory use of the ICD-10 Diagnostic Guidelines, with a third of respondents reporting never checking the diagnostic schedules, and another third doing so from time to time. In addition, the low estimates given by survey participants regarding practical utility of the ICD-10 Diagnostic Guidelines, along with a large percentage of respondents who do not directly use diagnostic criteria in their work, indicate the need to improve the clinical usefulness of the diagnostic guidelines in the latest revision of the ICD, including convenience of use in practice.
The results of analysis of the Russian national mental health service statistic indicate that at least some diagnostic categories are not used by Russian psychiatrists exactly as ICD-10 suggests. The revealed discrepancy between the principles of diagnostics observed by domestic clinicians and international criteria may interfere with the use of evidence-based treatment algorithms, negatively affecting the quality of psychiatric care. In light of the upcoming transition to ICD-11 and in order to unify approaches to the diagnosis of mental disorders in our country, it is necessary to update and improve educational programmes for psychiatrists.
为评估俄罗斯精神科医生实际应用《国际疾病分类第十版（ICD - 10）诊断指南》的具体情况，将2019年俄罗斯官方全国关于多种精神障碍患病率的统计数据与这些障碍的国际流行病学研究的荟萃分析结果进行了比较。此外，对在线精神科医生调查中与精神分裂症诊断相关的一些项目进行了分析；807名俄罗斯精神科医生参与了此次在线调查。
对国家统计数据的分析表明，根据国际流行病学研究获得的数据，国内临床医生对某些精神障碍的诊断频率明显低于预期。根据流行病学研究的荟萃分析，俄罗斯登记的双相情感障碍病例数比该障碍的患病率低90 - 150倍；抑郁症的结果是低50 - 70倍；焦虑症是低25 - 50倍，自闭症是低30倍。可能不合理地频繁使用了器质性非精神病性精神障碍和精神分裂症的诊断，而不是上述这些障碍的诊断。2005年至2019年期间，儿童自闭症的诊断有显著变化（增加了100%以上），而其他精神障碍的诊断频率保持不变。在线调查结果还显示，对ICD - 10诊断指南的使用大多敷衍了事，三分之一的受访者表示从未查看诊断表，另有三分之一的人只是偶尔查看。此外，调查参与者对ICD - 10诊断指南实际效用的评价较低，以及很大比例的受访者在工作中不直接使用诊断标准，这表明在ICD的最新修订版中需要提高诊断指南的临床实用性，包括在实践中的易用性。
对俄罗斯国家精神卫生服务统计数据的分析结果表明，俄罗斯精神科医生对至少一些诊断类别的使用并非完全按照ICD - 10的建议。国内临床医生所遵循的诊断原则与国际标准之间存在的差异可能会干扰循证治疗算法的使用，对精神科护理质量产生负面影响。鉴于即将向ICD - 11过渡，为了统一我国精神障碍诊断方法，有必要更新和改进针对精神科医生的教育项目。
