精神科住院病人診斷的改變－追踪研究

台大醫院精神科住院病患有1,768人次，其中95人（5.7%）住院二次以上，而95人中的15人（15.8%）在另一次的住院有診斷的改變。深入的臨床研究分析，顯示診斷的改變主要在於：（1）個案：一個個案可以同時有多種的疾病和診斷，引起臨床的複雜性。（2）消息：未從多個層面－情感、行為、認知和一般生理狀態，判斷個案的精神病理。（3）觀察：記錄未標準化，而且所用症狀描述的詞語定義不清。（4）時間：過於重視橫斷面的變化，忽略縱的臨床過程。（5）準則：太過強調思考障礙此類症狀，造成診斷的偏頗。

Keywords

診斷的改變；精神科病患

Parallel abstracts

The total number of psychiatric inpatients admitted to National Taiwan University hospital from 1972 to 1982 is 1768, of which 95 (5.7%) are multiple admission. Diagnostic changes occur in 15 of the 95 patients, that is 15.8%. According to original diagnoses, these 15 cases may be divided into four groups. In Group A, 5 were schizophrenia, of which 4 were re-diagnosed to be manic-depressive psychosis (MDP), and 1 to be atypical psychosis. In Group B, 3 were MDP, 2 of which became schizophrenia, and 1 atypical psychosis. Group C had 2 neurosis cases, which were changed to schizophrenia and MDP. In Group D, 5 received the diagnosis of ”other psychosis,” of which 2 turned out to be schizophrenia, 2 MDP, and 1 paranoid state. Upon close clinic analysis, five major causes for the alteration in diagnosis were found.1. Subject: A case may have multiple illnesses, the fact that complicates diagnosis.2. Information: The psychopathology does not have wide enough coverage to include multiple factors such as affect, behavior, cognition, and drive.3. Observation: The description in the case records is often imprecise.4. Time: Apparently too much emphasis was placed on the cross-section changes and not enough on the changes in clinical course.5. Criteria: An over-emphasis on thought disorder often led to inaccurate diagnosis.

Parallel keywords

Diagnostic changes ； Psychiatric inpatient

Read-around

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