Türk Psikiyatri Dergisi; 1999;10(3):215-227
Prototipi Kavramı Ve Tanı, Tedavi ve Belirti Şiddeti Algılarında Kurumlararası Farklılıklar
Ç Soykan, A Soykan
Amaç: Bu çalışmada DSM-III ve bunu izleyen sınıflandırmalarda yer bulan “prototipi” kavramı ve farklı kurumlarda çalışan psikiyatrlar üzerindeki etkisinin araştırılması amaçlanmıştır.
Yöntem: Ankara, Hacettepe ve İstanbul Üniversiteleri ve Bakırköy ve Numune Hastanesinde çalışan 53 psikiyatr bu çalışmada yer almışlardır. Klinisyenler ikisi epey “prototipik” ve biri pek az prototipik 3 vakanın video kayıtlarını izlemişler, bu olgulara tanı ve tedavi vermişler ve algıladıkları belirtileri ve şiddetini belirtmişlerdir. Bulgular: Daha “prototipik” özellikler gösteren ilk iki olgu arasındaki kilinisyenler ve kurumlar arası tanısal birlik, tedavi önerileri ve belirti algılara büyük benzerlik göstermiştir. Daha az prototipik özellikler gösteren üçüncü olguda ise önemli tanısal farklar ortaya çıkmış, psikiyatride kullanılan hemen her ilaç tedavide önerilmiş ve belirtilerin 1/3’ü kurumlar arasında farklı algılanmıştır.
Sonuç: Kurumlar arası tanısal birliktelik daha prototipik olgularda yüksektir. Oysa, daha az prototipik olguda kurumlar arası tanısal birlik düşmektedir. Öte yandan, kurumun teorik yöneliminin önemli olduğunu düşündürecek şeklide, daha az prototipik olguda, kurum içi tanısal birlik göreceli olarak özellikle Ankara Üniversitesi ve Bakırköy hastanesinde yüksek düzeydedir.
Prototype Concept and Institutional Differences in the Perception of Symptom Severity, Diagnosis and Treatment Choices
Objective: People as well as psychiatrists classify objects in their environment in regard with the resemblance to a general category. Prototypes are considered to be the most typical examples of a category. DSM-III and its successors, and ICD-10, provide prototypical examples of each diagnostic category. It becomes easier to diagnose a case as the case exhibits more features of a prototype. Theoretical orientation of institutions effects the development of prototypes and differences between institutions might be prominent especially in less prototypical cases. In this study, the effects of protoypes on diagnostic process were examined.
Method: Fifty-five psychiatrists from Ankara, Hacettepe and Istanbul Universities, and Bakirköy and Numune State Hospitals were asked to watch the video presentations of two highly prototypical one much less prototypical cases. They then, were requested to give a diagnosis, plan treatment and rate the severity of symptoms they observed.
Results: In first two highly prototypical cases, there were much less variations in diagnosis, treatment and symptom severity perceptions between institutions. However, in the third and much less prototoypical case, diagnoses were distributed among theree major categories of mental disorders, namely, alcohol dependency, personality disorders and affective disorders. Almost all kinds of medicine available in psychiatry were suggested for treatment and 1/3 of the symptoms were perceived differently by the psychiatrists from five institutions.
Conclusion: For highly prototoypical casses, the perceptions of five institutions were not much different and high rates of diagnostic agreement were achieved. Third case not only posed a challenge for diagnostic agreement but also supported the assumption that theoretical orientation has an impact on decision making process. Although diagnoses showed great variations when all participants were taken into account, this variability decreased when institutions were considered individually. These findings supported the impacts of theoretical orientation on diagnostic decision making processes.