Yutzy S H, Cloninger C R, Guze S B, Pribor E F, Martin R L, Kathol R G, Smith G R, Strain J J
Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110.
Am J Psychiatry. 1995 Jan;152(1):97-101. doi: 10.1176/ajp.152.1.97.
The purpose of this study was to evaluate for APA a proposed strategy to diagnose somatization disorder for possible inclusion in DSM-IV.
Five sites--Washington University, University of Kansas, University of Iowa, University of Arkansas, and Mount Sinai Medical Center in New York--participated in a collaborative field trial. Female subjects (N = 353) were recruited from several different services (psychiatry, internal medicine, and family practice) and were evaluated for the presence or absence of the disorder. This assessment was performed with a new instrument constructed by combining all the criteria for somatization disorder from the proposed criteria for DSM-IV, DSM-III, DSM-III-R, Perley-Guze, and proposed criteria for ICD-10.
A high level of concordance was found between the proposed diagnostic strategy for DSM-IV and the current criteria (DSM-III-R), as well as the earlier criteria (Perley-Guze and DSM-III). The ICD-10 criteria agreed poorly with all other criteria sets. The level of experience of the rater (expert versus novice) with the earlier (Perley-Guze, DSM-III) and current (DSM-III-R) criteria did not influence the identification of cases by use of DSM-IV criteria. No racial effect was introduced by any of the criteria sets.
The strategy for DSM-IV is an accurate and simpler method of diagnosing somatization disorder that does not require special expertise for proper use.
本研究旨在评估一种为美国精神病学会（APA）提议的用于诊断躯体化障碍的策略，以确定其是否可能纳入《精神疾病诊断与统计手册》第四版（DSM-IV）。
五个研究点——华盛顿大学、堪萨斯大学、爱荷华大学、阿肯色大学以及纽约的西奈山医学中心——参与了一项协作性现场试验。从多个不同科室（精神病学、内科和家庭医学）招募了女性受试者（N = 353），并对她们是否患有该疾病进行评估。这项评估使用了一种新工具，该工具是通过将来自DSM-IV提议标准、DSM-III、DSM-III-R、珀利-古兹标准以及ICD-10提议标准中所有躯体化障碍的标准组合而成。
发现DSM-IV提议的诊断策略与当前标准（DSM-III-R）以及早期标准（珀利-古兹标准和DSM-III）之间具有高度一致性。ICD-10标准与所有其他标准组的一致性较差。评估者（专家与新手）对早期（珀利-古兹标准、DSM-III）和当前（DSM-III-R）标准的熟悉程度并未影响使用DSM-IV标准来识别病例。任何标准组均未引入种族效应。
DSM-IV的诊断策略是一种准确且更简便的诊断躯体化障碍的方法，正确使用时无需特殊专业知识。
