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Psychiatry is considered by some authors as a medical speciality that has most developed in the last years. This has been possible because of great progress on diagnostic methods used in Psychiatry. The modern systems are based on specific criteria of inclusion and exclusion as diagnostic guidelines, thus criteria increase diagnosis reliability. The World Health Organization has accepted this method in the tenth Revision of the International Classification of Diseases (ICD-10), Chapter V (F): Mental and Behavioural Disorders. In consequence, there is an increasing need to train physicians to diagnose correctly according to the most recent classification criteria, particularly in the area where diagnosis must be selected from a large number of complex alternatives. In the present work we describe a project on computer-aided education in Psychiatry, using a case generator/solver. The programme developed by the authors is a software which produces clinical cases of depressive disorders and proposes them to the user, who should try to make the right diagnosis. The programme can produce a large number of different cases, because it randomly selects a certain numbers of criteria. We have used 124 diagnostic criteria which comprise ten different systems for the classification of depressions, named LICET-D10 (Liste Integreé de Critéres D'Evaluation Taxonomiques des Depressions).
With the help of a decision making system based on a complex decision tree, the programme is able to make the correct diagnosis itself, based on the selected criteria. These criteria are then shown to the user, who analyze them and tries to propose a suitable diagnosis, according to ICD-10. When then clinical case is produced, the user selects anamnesis data available in the following categories: symptomatology, personality, duration, antecedents, associated factors and others. Anamnesis data can be requested as many times as it is deemed necessary by the user, until the diagnostic hypothesis has been made. Diagnostic possibilities appear in the computer screen and the user just selects the diagnosis he considers most appropriate. When the user makes the right diagnosis, the programme asks him to complete the diagnosis, for example, by specifying whether a depressive episode is with or without somatic symptoms, the episode's severity, etc. To help the training, the programme can show at any moment the diagnostic criteria for any given depressive disorder or go back to anamnesis data, in order to confirm the diagnosis or clear up diagnostic doubts. Moreover, there are some hypertext facilities embedded in the programme, to improve the understanding and learning of the technical terms used in ICD-10 classification of depressive disorders. The programme has been developed in Visual Basic (Microsoft Inc., USA) with all enhanced resources of Windows 3, for IBM-PC compatible microcomputers with EGA or VGA video graphics.
The programme described here is easy to use, based on a powerful graphical user interface, which is that of Microsoft Windows 3. Thus, the time to train the students on how to use the programme is considerably reduced. The depressive cases generated by the programme are usually very realistic, with varying degrees of diagnostic difficulty. In our assessment, the programme can be very useful for teaching diagnostic problem solving in Psychiatry according to the ICD-10 classification criteria.
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