Abstract: Objective　To investigate the diagnostic reliability of the Central Government Support for the Local Management and Treatment of Severe Mental Illnesses Project（686 Project） for severe mental disorders patients aged 15 or over in Hunan Province. Methods　This epidemiological survey of severe mental disorders was carried out between February and June 2015. By use of multistage stratified cluster sampling，72 999 permanent community-dwelling residents aged 15 or over were recruited from 123 counties/districts of Hunan Province and 720 of them were found with severe mental disorders. The diagnostic results of such populations by the 686 Project were collected from the Internet-based information system of the project. The epidemiological results were used as the gold standard for evaluating the diagnostic reliability of the 686 Project. Results　Of the 720 patients with severe mental disorders found by the survey，349（48.5%） were under the management of the 686 Project，345 of them were registered as severe mental disorders in the 686 Project，so the diagnostic rate by the project was 47.9%（345/720）. The overall diagnostic consistency rate between the 686 Project and the survey was 39.4%（284/720）. The diagnostic consistency rates of schizophrenia，paranoid psychosis，bipolar disorder，schizophrenic psychosis，mental disorder caused by epilepsy and mental retardation with mental disorder were 50.6%（273/539），0，2.7%（2/75），12.5%（1/8），16.7%（4/24） and 6.2%（4/64），respectively. The diagnostic consistency rates of severe mental disorders between the survey and the 686 Project showed no significant differences across different counties/districts（χ2=16.83，P=0.21）. Conclusion　The diagnostic consistency rates of severe mental disorders between the survey and the 686 Project demonstrated no obvious differences between different counties/districts in Hunan Province. The rate of such patients under the management by the 686 Project and the diagnostic reliability of this project carried out in Hunan need to be improved further.

Key words: Mental disorders, Disease management, Diagnosis, Hunan

摘要： 目的　了解湖南省15岁及以上严重精神障碍患者在国家重性精神障碍管理治疗项目中的诊断可靠性。方法　于2015年2—6月，采用多阶段、分层、整群抽样的方法，针对湖南省14个市包括123个县区72 999名15岁及以上社区常住人群开展严重精神障碍患者流行病学调查，以现场流行病学调查发现的720例严重精神障碍患者的诊断结果为金标准，评价国家重性精神障碍管理治疗项目中湖南省患者诊断结果的一致性。结果　720例患者中目前已纳入国家重性精神障碍管理治疗项目中的有349例（48.5%），其中345例患者在项目中被确诊为严重精神障碍，严重精神障碍患者识别率为47.9%（345/720）。国家重性精神障碍管理治疗项目中的严重精神障碍诊断符合率为39.4%（284/720），其中精神分裂症、偏执性精神障碍、双相情感障碍、分裂情感性精神障碍、癫痫所致精神障碍、严重精神发育迟滞的诊断符合率分别为50.6%（273/539）、0、2.7%（2/75）、12.5%（1/8）、16.7%（4/24）、6.2%（4/64）。湖南省各地区严重精神障碍的诊断符合率比较，差异无统计学意义（χ2=16.83，P=0.21）。结论　湖南省严重精神障碍患者管理率和诊断符合率有待提高，不同地区诊断符合率差别不高。国家重性精神障碍管理治疗项目除提高社区患者的管理率外，诊断可靠性也亟待提高。

关键词: 精神障碍, 疾病管理, 诊断, 湖南