中华全科医师杂志
中華全科醫師雜誌
중화전과의사잡지
CHINESE JOURNAL OF GENERAL PRACTITIONERS
2008年
4期
231-234
,共4页
陆峥%朱俊娟%蔡军%李玉珊%施慎逊%史以珏%王崇顺%蒋有倩%季建林%朱荣申%韩宏毅%丁素菊
陸崢%硃俊娟%蔡軍%李玉珊%施慎遜%史以玨%王崇順%蔣有倩%季建林%硃榮申%韓宏毅%丁素菊
륙쟁%주준연%채군%리옥산%시신손%사이각%왕숭순%장유천%계건림%주영신%한굉의%정소국
抑郁症%诊断%治疗结果%精神病科,医院
抑鬱癥%診斷%治療結果%精神病科,醫院
억욱증%진단%치료결과%정신병과,의원
Depressive disorder%Diagnosis%Treatment outcome:Psychiatric department,hospital
目的 比较综合性医院精神科门诊中专科和非专科医生对抑郁症的不同识别情况及治疗效果,分析影响抑郁症识别的相关因素.方法 对就诊于上海市9所综合性医院精神科门诊的680例初诊患者使用复合式国际诊断检查(CIDI)抑郁标准进行筛查,与首诊医师诊断进行比较.共收集抑郁症患者297例,并对这些患者进行汉密顿抑郁量表24项(HAMD)、汉密顿焦虑量表(HAMA)的评估,利用"上海市综合医院精神科门诊非专科医师基本情况调查表"对非专科医师进行调查.结果 680例初诊患者中,专科医师正确识别337例,非专科医师正确识别216例,两者对抑郁症的识别率差异有统计学意义(χ2=30.73,P=0.000).专科医师对抑郁症的识别能力高于非专科医师,专科医师与CIDI及专家复核诊断的一致性高,Kappa值为0.774,非专科医师与CIDI及专家复核诊断的一致性偏低,Kappa值为0.439.专科组的治疗效果优于非专科组,在治疗后第4周、第8周、第12周随访时HAMD总分及各因子分比较差异均有统计学意义(P＜0.05或P＜0.01).非专科医师从事精神科工作的年限和每年接受精神科知识培训的时间,对抑郁症的识别有显著影响(P＜0.05).结论 综合医院精神科中的非专科医师对抑郁症的识别和治疗能力偏低,接受精神卫生专科知识培训不足,需加强对综合医院精神卫生科室服务质量的管理.
目的 比較綜閤性醫院精神科門診中專科和非專科醫生對抑鬱癥的不同識彆情況及治療效果,分析影響抑鬱癥識彆的相關因素.方法 對就診于上海市9所綜閤性醫院精神科門診的680例初診患者使用複閤式國際診斷檢查(CIDI)抑鬱標準進行篩查,與首診醫師診斷進行比較.共收集抑鬱癥患者297例,併對這些患者進行漢密頓抑鬱量錶24項(HAMD)、漢密頓焦慮量錶(HAMA)的評估,利用"上海市綜閤醫院精神科門診非專科醫師基本情況調查錶"對非專科醫師進行調查.結果 680例初診患者中,專科醫師正確識彆337例,非專科醫師正確識彆216例,兩者對抑鬱癥的識彆率差異有統計學意義(χ2=30.73,P=0.000).專科醫師對抑鬱癥的識彆能力高于非專科醫師,專科醫師與CIDI及專傢複覈診斷的一緻性高,Kappa值為0.774,非專科醫師與CIDI及專傢複覈診斷的一緻性偏低,Kappa值為0.439.專科組的治療效果優于非專科組,在治療後第4週、第8週、第12週隨訪時HAMD總分及各因子分比較差異均有統計學意義(P＜0.05或P＜0.01).非專科醫師從事精神科工作的年限和每年接受精神科知識培訓的時間,對抑鬱癥的識彆有顯著影響(P＜0.05).結論 綜閤醫院精神科中的非專科醫師對抑鬱癥的識彆和治療能力偏低,接受精神衛生專科知識培訓不足,需加彊對綜閤醫院精神衛生科室服務質量的管理.
목적 비교종합성의원정신과문진중전과화비전과의생대억욱증적불동식별정황급치료효과,분석영향억욱증식별적상관인소.방법 대취진우상해시9소종합성의원정신과문진적680례초진환자사용복합식국제진단검사(CIDI)억욱표준진행사사,여수진의사진단진행비교.공수집억욱증환자297례,병대저사환자진행한밀돈억욱량표24항(HAMD)、한밀돈초필량표(HAMA)적평고,이용"상해시종합의원정신과문진비전과의사기본정황조사표"대비전과의사진행조사.결과 680례초진환자중,전과의사정학식별337례,비전과의사정학식별216례,량자대억욱증적식별솔차이유통계학의의(χ2=30.73,P=0.000).전과의사대억욱증적식별능력고우비전과의사,전과의사여CIDI급전가복핵진단적일치성고,Kappa치위0.774,비전과의사여CIDI급전가복핵진단적일치성편저,Kappa치위0.439.전과조적치료효과우우비전과조,재치료후제4주、제8주、제12주수방시HAMD총분급각인자분비교차이균유통계학의의(P＜0.05혹P＜0.01).비전과의사종사정신과공작적년한화매년접수정신과지식배훈적시간,대억욱증적식별유현저영향(P＜0.05).결론 종합의원정신과중적비전과의사대억욱증적식별화치료능력편저,접수정신위생전과지식배훈불족,수가강대종합의원정신위생과실복무질량적관리.
Objective The study is designed to evaluate the difference in identification for depression and clinical effectiveness of its treatment between psychiatrists and non-psychiatric Dhysieians at out-patient departments of general hospitals and to analyze its related factors.Methods Totally,680 patients who visited psychiatric clinics in nine general hospitals of Shanghai at first time were screened by psychiatrists using Composite International Diagnostic Interview(CIDI)for depression and the screening resuhs were compared to the diagnosis made by non-psychiatric physicians as goal-keepers there.Altogether 297 patients with depression were recruited and assessed using Hamilton Depression Rating Scale(HAMD)and Hamilton Anxiety Rating Scale(HAMA).A self-made questionnaire for basic information was used to assess the ability for identification of depression in non-psychiatric physicians of general hospitals.Results Psychiatrists identified depression correctly in 337 of 680 patients who visited psychiatric clinics in general hospitals at their first visit,but non-psychiatric physicians only identified 216 patients,with statistically significant difference(χ2=30.73,P=0.000).A consistent agreement on depression diagnosis between the findings by psychiatrists and by CIDI was reached with Kappa of 0.774,but Kappa for that between the findings by non-psychiatric physicians and CIDI was 0.439.Effectiveness of treatment for depression by psychiatrists was better than that by non-psychiatric physicians,with higher total score and scores for each item of HAMD four,eight and 12 weeks after treatment,respectively(P＜0.05 or P＜0.01).Length of professional work of non-psychiatric physicians and annual time for professional training in management of mental disorders associated with their ability of identification for depression(P＜0.05).Conclusion Ability of non-psychiatric physicians to identify alQd cope with depression in the psychiatric department of general hospitals was insufficient,suggesting that more importance should be attached to the management of service quality at psychiatric department of general hospitals.
