Eells T D, Kendjelic E M, Lucas C P
Department of Psychiatry and Behavioral Sciences, University of Louisville, Kentucky, USA.
J Psychother Pract Res. 1998 Spring;7(2):144-53.
A case formulation content coding method is described and applied to the formulation section of 56 intake evaluations randomly selected from an outpatient psychiatric clinic. The coding manual showed good reliability (mean kappa = 0.86) across content and quality categories. Although 95% of the formulations included descriptive information, only 37% addressed hypothesized predisposing life events accounting for the individual's presenting problems, and 16% included a precipitating stressor. Only 43% inferred a psychological mechanism, 2% inferred a biological mechanism, and 2% mentioned sociocultural factors. Formulations were more descriptive than inferential, more simple than complex, and moderately precise in use of language. In sum, clinicians used the formulation primarily to summarize descriptive information rather than to integrate it into a hypothesis about the causes, precipitants, and maintaining influences of an individual's problems.
描述了一种病例构想内容编码方法，并将其应用于从一家门诊精神科诊所随机抽取的56份入院评估的构想部分。编码手册在内容和质量类别上显示出良好的信度（平均kappa系数 = 0.86）。尽管95%的构想包含描述性信息，但只有37%涉及解释个体当前问题的假定诱发生活事件，16%包含促发应激源。只有43%推断出心理机制，2%推断出生物学机制，2%提及社会文化因素。构想更多是描述性而非推断性的，更简单而非复杂的，并且在语言使用上适度精确。总之，临床医生使用构想主要是为了总结描述性信息，而不是将其整合为关于个体问题的原因、促发因素和持续影响的假设。
