Li Mingchao, Cao Yulin, Wang Xiaojun, Li Lihua, Wu Chunxi, Yi Xianyun, Wang Kechu, Zheng Haibo, Liu Yi, Xiong Zijun, Gong Jifen, Ji Qiuming
Department of Psychiatry, Wuhan Mental Health Center, Wuhan City, People's Republic of China.
Department of Psychiatry, Wuhan Wudong Hospital, Wuhan City, People's Republic of China.
J Multidiscip Healthc. 2025 Apr 16;18:2185-2192. doi: 10.2147/JMDH.S506609. eCollection 2025.
Currently, there are situations where there is discordance between the identified diagnosis and the previous clinical diagnosis for psychiatric identification, causing extensive discussion. Therefore, the purpose of this study is to systematically analyze the consistency between forensic psychiatric identification diagnosis (referred to as identification diagnosis) and previous psychiatric diagnosis (referred to as previous diagnosis) in criminal cases.
Using a retrospective study design, 78 criminal cases evaluated as having no mental illness by the Forensic Evaluation Department of Wuhan Mental Health Center in 2021-2022 were selected as research subjects. Diagnostic agreement was evaluated using the kappa coefficient.
(1) Among 78 cases, 43 had a history of mental illness, with a prevalence rate of 55.13%; (2) The evaluation diagnosis was consistent with the previous diagnosis in 12 cases (27.91%) and inconsistent in 31 cases (72.09%), with Kappa=0.243 (P<0.05), indicating poor consistency; (3) Schizophrenia (21 cases, 48.84%) and mood disorders (14 cases, 32.56%) were the most common in previous diagnoses; (4) Evaluation diagnoses were mainly no mental illness (38 cases, 48.72%) and physiological passion (8 cases, 10.26%).
In criminal cases where the forensic evaluation diagnosis is no mental illness, the consistency between the evaluation diagnosis and the previous diagnosis is low, which is closely related to the differences in thinking patterns and assessment focus between forensic evaluation and clinical diagnosis. It is recommended to strengthen the standardized construction of forensic evaluation and improve the quality of evaluation.
目前，在精神疾病司法鉴定中，存在鉴定诊断与既往临床诊断不一致的情况，引发广泛讨论。因此，本研究旨在系统分析刑事案件中法医精神病鉴定诊断（以下简称鉴定诊断）与既往精神病诊断（以下简称既往诊断）之间的一致性。
采用回顾性研究设计，选取2021 - 2022年武汉市精神卫生中心法医鉴定科评定为无精神疾病的78例刑事案件作为研究对象。采用kappa系数评估诊断一致性。
（1）78例中，有精神疾病史者43例，患病率为55.13%；（2）评定诊断与既往诊断一致者12例（27.91%），不一致者31例（72.09%），Kappa = 0.243（P < 0.05），一致性较差；（3）既往诊断中最常见的是精神分裂症（21例，48.84%）和心境障碍（14例，32.56%）；（4）评定诊断主要为无精神疾病（38例，48.72%）和生理性激情（8例，10.26%）。
在法医评定诊断为无精神疾病的刑事案件中，评定诊断与既往诊断的一致性较低，这与法医评定与临床诊断的思维方式和评估重点差异密切相关。建议加强法医评定的规范化建设，提高评定质量。
