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精神障碍的多方面分类(MACM)。解决当前国际精神障碍分类中的混乱状况的一种方法。

Multi-aspects classification of mental disorders (MACM). A solution to the present confusion in the international classification mental disorders.

作者信息

von Knorring L, Perris C, Jacobsson L, Rosenberg B

出版信息

Neuropsychobiology. 1980;6(2):101-8. doi: 10.1159/000117741.

Abstract

The international classification of mental disorders (ICD-8) presented by the WHO has not been accepted in all countries and where it is used, local adjustments are made and sometimes parallel classification models are used. The diagnostic system has also been criticized as lacking in exactness and consistency and the reliability between diagnosticians has been shown to be low. As a consequence, international communication is made difficult and research is hampered. This problem is particularly relevant in the field of biological research. In fact, it can be suspected that most inconsistencies as regards results obtained in different places might depend upon an inconsistent use of the current diagnostic labels. A possible solution of this problem can be the use of a multiaspect classification model. Such a multiaspect model (MACM) including four variables - symptomatology, severity, course and supposed etiopathogenesis - has been tested for several years at Umeå. MACM is shown to be easly to communicate both in undergraduate training and in ternational communication. The reliability between diagnosticians is found to range from 56 to 82% as compared to 22-36% as concerns ICD-8. It is also shown that fairly homogeneous groups, both regarding course, supposed etiopathogenesis and biological basis, can be formed and that MACM seems to bear temporal stability. Computer programming of MACM diagnoses is as possible as with ICD-8 diagnoses. Furthermore, when Macm is used in clinical routine work, much more information valid in administrative routines is stored than what is possible when ICD-8 is used.

摘要

世界卫生组织提出的《国际疾病分类(ICD - 8)》并未在所有国家被接受,即便在使用该分类的地方,也会进行局部调整,有时还会使用并行的分类模型。该诊断系统还因缺乏准确性和一致性而受到批评,而且诊断医师之间的可靠性已被证明很低。结果,国际交流变得困难,研究也受到阻碍。这个问题在生物学研究领域尤为突出。实际上,可以怀疑不同地方所获结果的大多数不一致情况可能取决于当前诊断标签的不一致使用。解决这个问题的一个可能办法是使用多方面分类模型。这样一个包括症状学、严重程度、病程和假定病因发病机制这四个变量的多方面模型(MACM)已在乌梅奥进行了数年测试。MACM在本科培训和国际交流中都很容易传达。与ICD - 8的22 - 36%相比,诊断医师之间的可靠性在56%至82%之间。研究还表明,可以形成在病程、假定病因发病机制和生物学基础方面都相当同质的群体,而且MACM似乎具有时间稳定性。MACM诊断的计算机编程与ICD - 8诊断一样可行。此外,当MACM用于临床日常工作时,所存储的在行政程序中有效的信息比使用ICD - 8时要多得多。

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