Diagnostik psychischer Störungen: „Gold”- oder „Blech”-Standard?

Zusammenfassung

In einer Stichprobe psychosomatischer Patienten fanden Becker et al. [1] eine geringe Übereinstimmung zwischen klinischen Routinediagnosen und computergestützten DSM-IV-Diagnosen, die durch ein weltweit etabliertes standardisiertes diagnostisches Interview (CIDI, Composite International Diagnostic Interview) erstellt wurden. Sie schlussfolgern, dass eine unzureichende Validität des CIDI im psychosomatischen Kontext vorliege. Der aktuelle Beitrag kommt zu dem Ergebnis, dass die Ergebnisse von Becker et al. eine derartige Schlussfolgerung nicht rechtfertigen. Neben erheblichen methodischen Mängeln wird insbesondere die Annahme der Autoren infrage gestellt, dass klinische Routinediagnosen im psychosomatischen Kontext einen Goldstandard darstellen.

Abstract

In a convenience sample of psychosomatic inpatients, Becker et al. [1] reported poor diagnostic congruence between clinical diagnoses from routine examinations and DSM-IV diagnoses derived from the use of a computer-assisted standardized diagnostic interview (CIDI). The authors conclude that there is insufficient validity of such interviews in psychosomatic settings. This paper emphasizes that the results of Becker et al. do not justify this conclusion. Aside from substantial methodological deficits, we question the authors' assumption that clinical diagnoses could be regarded as an appropriate „gold standard”.

Key words

CIDI - gold-standard - validity - standardized diagnostic

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