정신질환의 진단분류에 대한 정신과 의사의 관점에 대한 연구

The Viewpoints of Psychiatrists on Psychiatric Classification in East Asian Countries

Objectives Though both International Classfication of Disease (ICD) and Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition (DSM-IV) are currently in use for psychiatric diagnosis in practice, education, research and reimbursement of medical fees in Asian countries, there seem to be few studies about similarities and differences among them in terms of viewpoints on psychiatric classification. Methods A questionnaire which has been developed to investigate the views of psychiatrists on their requirements of a classification system, and their opinions on those currently in use was translated into each language and adopted as survey tool in four East Asian countries. The total number of responses obtained was 703 (Korea, n=154；Japan, n=124；China, n=192, and Taiwan, n=233) although the method of data collection varied across all 4 countries. Since the response rate varied in these countries depending upon the convenience of sampling procedures, we compared percentages of responses to each of the questions instead of conducting a statistical analysis across them. Results The comparison of surveyed data revealed diversity in the utilization, preferences and opinions for further revision of the DSM and the ICD classification systems in East Asia. Psychiatrists in China and Japan routinely used the ICD, while those in Korea and Taiwan favored the DSM. The majority of Asian psychiatrists expressed the view that reliable inter-clinician communication is considered the main purpose of a classification system. Psychiatrists seemed to prefer classifications with 30-100 diagnostic options. Conclusion Though there was limitation in terms of representation due to sampling methods, East Asian psychiatrists showed different pattern on the use of DSM and ICD across countries and had negative viewpoints on current diagnostic classification systems in terms of transcultural use.