정신질환의 진단분류에 대한 정신과 의사의 관점에 대한 연구 - 동 아시아 4개국을 대상으로 -
The Viewpoints of Psychiatrists on Psychiatric Classification in East Asian Countries
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본 연구는 현재 정신과에서 사용되고 있는 진단분류체계 인 DSM-Ⅳ-TR과 ICD-10의 개정을 앞두고 동아시아 4개국인 한국, 일본, 중국, 대만의 정신과 의사를 대상으로 현재 및 향후 진단분류체계에 대한 관점을 비교하기 위하 여 시행되었다. DSM과 ICD의 사용빈도가 나라마다 차이 가 있었으며, 이는 교육 환경과 밀접한 연관이 있었다. 문 화적인 다양성을 반영하고 있느냐에 대해서는 중국을 제외 한 3개국에서 부정적인 시각을 가지고 있었다. 그러나 대부 분의 경우에 현재 체계의 문제점 및 향후의 개선 방향에 대 해서는 비슷한 관점을 공유하기도 했다. 향후 보다 체계적 이고 광범위한 공동 연구를 통하여 아시아의 문화적인 요소 가 진단분류체계에 반영될 수 있기를 기대한다.
Abstract
ObjectivesZZThough 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. MethodsZZA 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. ResultsZZThe 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. ConclusionZZThough 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.
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