法医学杂志

法医学杂志 ›› 2020, Vol. 36 ›› Issue (3): 333-336，340.DOI: 10.12116/j.issn.1004-5619.2020.03.007

• 案例分析 • 上一篇    下一篇

1369例司法精神病学鉴定诊断与临床诊断的一致性分析

高滢1， 张增2， 苗庆山2， 陈敏2， 李宝花2， 张金响2， 苏中华2   

  1. 1. 苏州市广济医院，江苏 苏州 215137； 2. 济宁医学院第二附属医院精神科，山东 济宁 272051
  • 发布日期:2020-06-25 出版日期:2020-06-28
  • 通讯作者: 苏中华，男，主任医师，博士，主要从事临床精神病学研究；E-mail：zhonghuasu@163.com
  • 作者简介:高滢（1991—），女，硕士研究生，主要从事精神病学研究；E-mail：351000316@qq.com
  • 基金资助:
    山东省医药卫生科技发展计划资助项目（2013WS0053）

Analysis of Consistency between Forensic Psychiatry Identification Diagnosis and Clinical Diagnosis of 1 369 Cases

GAO Ying1, ZHANG Zeng2, MIAO Qing-shan2, CHEN Min2, LI Bao-hua2, ZHANG Jin-xiang2, SU Zhong-hua2   

  1. 1. Suzhou Psychiatric Hospital, Suzhou 215137, Jiangsu Province, China; 2. Department of Psychiatry, the Second Affiliated Hospital of Jining Medical University, Jining 272051, Shandong Province, China
  • Online:2020-06-25 Published:2020-06-28

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摘要： 目的 探讨进行司法精神病学鉴定的精神障碍患者的鉴定诊断与鉴定前临床诊断的一致性。 方法 利用自编调查资料整理表回顾性收集济宁医学院第二附属医院司法鉴定所2014—2017年进行刑事责任能力鉴定的1 369例被鉴定人的鉴定资料，将鉴定意见的精神障碍诊断结果和既往临床诊断进行比较分析。 结果 1 369例被鉴定人中，鉴定诊断有精神障碍者964例（70.4%），无精神障碍者405例（29.6%）。前者有临床诊断者为63.3%（610例），高于后者的43.2%（175例，P<0.05）。鉴定诊断的各类精神障碍中，癔症、应激、神经症类患者有临床诊断的比例最高（86.7%），而精神发育迟滞患者有临床诊断的比例最低（9.6%）。鉴定诊断与临床诊断总体一致率最高为精神分裂症类（98.4%），人格与行为障碍（33.3%）最低。有精神障碍组临床诊断与鉴定诊断的总体一致率为84.1%，Kappa值为0.759。相比门诊诊断，住院诊断和鉴定诊断的一致率（85.9%）更高（P<0.05）。 结论 在能提供既往临床诊疗资料的司法精神病学鉴定中，被鉴定诊断为有精神障碍者，其鉴定诊断与临床诊断的一致性较高，临床诊断（尤其是住院诊断）对司法精神病学鉴定有较好的参考价值。

关键词: 司法精神病学, 精神障碍, 刑事责任能力, 诊断, 案例分析

Abstract: Objective To explore the consistency between identification diagnosis and pre-identification clinical diagnosis of patients with mental disorder undergoing forensic psychiatry identification. Methods The identification data of 1 369 appraised individuals who underwent criminal responsibility identification carried out by the Forensic Institute of Second Affiliated Hospital of Jining Medical University from 2014 to 2017 were collected retrospectively using self-designed investigation data sorting table. A comparative analysis of the mental disorder diagnosis results of expert opinion and past clinical diagnosis results was made. Results Among 1 369 appraised individuals, 964 cases （70.4%） were identified and diagnosed with mental disorder and 405 cases （29.6%） without mental disorder. Among the former, 63.3% （610 cases） were clinically diagnosed, which was higher than 43.2% （175 cases, P<0.05） in the latter. Among the various mental disorders that had been identified and diagnosed, patients with hysteria, stress, and neurosis had the highest proportion of clinical diagnoses （86.7%）, while patients with mental retardation had the lowest proportion of clinical diagnoses （9.6%）. Schizophrenia had the highest overall consistency rate of identification diagnosis and clinical diagnosis （98.4%）, while personality and behavior disorder had the lowest （33.3%）. The overall consistency rate between clinical diagnosis and identification diagnosis of the mental disorder group was 84.1%, and the Kappa value was 0.759. Compared with clinical diagnosis, the consistency rate between inpatient diagnosis and identification diagnosis was higher （85.9%, P<0.05）. Conclusion In forensic psychiatry identification that provides data of past clinical diagnosis and treatment, a high consistency between identification diagnosis and clinical diagnosis of the appraised individual who is identified and diagnosed with mental disorder exists. Clinical diagnosis （especially the inpatient diagnosis） has a relatively good reference value for forensic psychiatry identification.

Key words: forensic psychiatry, mental disorder, criminal responsibility, diagnosis, cases analysis