한국판 진단적 면담검사들의 객관적인 신뢰도 연구

Objective Study of Reliability of Translated Psychiaric Instruments

정신과 영 역에서 임상 뿐만 아니라 연구에 미치는 중대한 문제는 현재의 진단절차의 신뢰도가 일반 적으로 낮다는 것이다. S A D S일생형 (Schedule for A ffective Disorders and S chizophrenia - L ife tim e ; S A D S - L )은 기술적 및 진단적 평가의 정 보변인을 줄이기 위해 개발되었고 여러 연구문제 중 특히 유전학, 정신생물학, 치료효과, 역학둥올 연구하는데 널리 사용 되고 있다 본 논문은 SADS 일생형의 번역판 개발 과정, S A D S 일생형과 그 번역판, Brief P sychiatric R a tin g Scale과 그 번 역관 및 Behavioral Assessment o f Mood and A ffe ct와 그 번역판들에 대한 일차적인 신뢰도 연 구를 보고한다. 여기서 제시된 자료들은 번역판들 의 신뢰도가 거의 완벽한 것으로 나타나고 있다. 우리의 연구를 포함한 최근의 신뢰도 연구와 일 반적인 결과는 고무적이며, 현계 가능한 것 이상 으로 앞으로는 더욱 민감한 신뢰도 검사를 해야 할 것이다

A crucial problem in psychiatry, affecting clinical work as well as research, is the generally low reliability of current diagnostic procedures. The Schedule for Affective Disorders and Schizophrenia- Lifetime version (SADS-L)was developed to reduce information variance in both the descriptive and diagnostic evaluation of a subject. The SADS-L is being widely used to study a variety of research issues, particularly those related to genetics, psychobiology of selected mental disorders, treatment outcome, and epidemiology. This article reports on the development of the translated instruments and initial reliability studies of the SADSL and its translations, Brief Psychiatric Rating Scale (BPRS) and its translation, and Behavior Assessment of Mood and Affect and its translation. The data presented here indicate near perfect reliability for diagnostic judgments made using the translated SADS-L. The concordance for the translated BPRS and Behavior Assessment of Mood and Affect was also very high. One of the most difficult problems in psychiatric research is the differential diagnostic assessment of subjects. Poor diagnostic reliability can generally be traced to two major sources of unreliability according to Endicott and Spitzer (1978). They are criterion variance and information variance. Criterion variance refers to differences in the inclusion and exclusion criteria that clinicians use to summarize patient data into psychiatric diagnoses. Unless the rules used for classification are the same, it is difficult for different interviewers to communicate with each other regarding their final diagnostic decision. Information variance occurs when clinicians have different amounts and kinds of information about patients.