ICD-10의 정신장애 분류에 관한 예비적 연구 - 일부 주요 진단범주들의 적합도와 진단일치도 를 중심으로- _

A Preliminary Study on the Classification of Mental Disorders in ICD-10 ㅡFocused on the Goodness of Fit and Diagnostic Reliability of Major Diagnostic Categories in ICD-10

The authors are particpating in the field trial of ICD-10 mental disorder section which is expected to be used in early 1990’ s. WHO is conducting the world-wide field trial of ICD- 10. ICD-10 has some major innovations which have long been proposed to adopt by many researchers and clinicians. The most important one is the provision of diagnostic guidelines. ICD-10 also provides the clinical descriptions for the each diagnostic entity. The main objectives of WHO ICD-10 field trial are to test the diagnostic reliability and goodness of fit of the ICD-10 clinical descriptions and diagnostic guidelines. During taking part in the field trial the authors conducted a preliminary study to see the possibility for diagnosing validly and reliably the mental disorders by ICD-10 in Korea. The study consists of three parts. The first is to examine goodness of fit of ICD-10, the second, to measure to diagnostic reliability among multiple diagnosticians, and the third is for measuring interrater diagnostic reliability using Kappa statistics. The results are as follows. 1) The authors were able to get good goodness of fit over the major diagnostic categories. 2) Diagnostic reliability among multiple diagnosticians and that between two raters showed high level of agreement. In our study we have some limitations and draw backs. First we did not have sufficieint number of the patients included. Secondly our method of diagnosing need to be more refined and objective because our diagnostic assessments were all joint assessments. Thirdly, our study did not cover all the diagnostic categories. In this study we could only touch the some major functional mental disorders with few cases of organic mental disroders. In spite of these limitations, this preliminary study suggests that the diagnoses of the mental disorders could be made reliably and validly by ICD-10 in Korea.