The transdiagnostic dimension of psychosis: implications for psychiatric nosology and research.
The transdiagnostic dimension of psychosis: implications for psychiatric nosology and research.
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DOI：
10.11919/j.issn.1002-0829.215041
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发表时间：
2015-04-25
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影响因子：
--
通讯作者：
VAN Os, Jim
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文献类型：
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作者：
VAN Os, Jim
如果精神病是一个跨诊断维度，其表达受到一组动态的背景和情感因素的支配，而这些因素是可以接受治疗的，那么精神病学病因学和治疗研究的当前方法可能需要修改。到目前为止，最主要的方法是在临床和概念上将精神病症状置于精神分裂症的结构中。然而，精神分裂症的终生患病率为1%，只代表了更广泛的精神障碍中的不良结局部分，后者的终生患病率为3.5%。因此，精神分裂症的研究结果可能反映了预后的机制，而不是与精神病和其他症状领域本身的根本联系。同样，发现多达30%的非精神病常见精神障碍患者具有亚阈值精神病症状，这些症状使他们处于精神病的跨诊断维度--并影响临床严重程度和治疗反应--表明“精神病”和“非精神病”之间的严格区分阻碍了临床实践和研究。精神病学的诊断手册将受益于跨诊断维度的系统，包括精神病的跨诊断维度。跨诊断维度的引入允许一个系统将一般的(即，特定于组的)分类诊断与特定(即，特定于个人的)维度得分的组合相结合。这样一个系统的优点是，它鼓励人们考虑在精神病理网络中症状是如何动态相互作用的，以及这个网络是如何受到社会世界的影响的。
If psychosis is a transdiagnostic dimension, the expression of which is governed by a dynamic set of contextual and emotional factors that are amenable to treatment, current approaches in psychiatric nosology and therapeutic research may need to be revised. The dominant approach to date is to clinically and conceptually situate psychotic symptoms in the construct of schizophrenia. However, schizophrenia, which has a lifetime prevalence of 1%, only represents the poor outcome fraction of a much broader spectrum of psychotic disorders which have a lifetime prevalence of 3.5%. Therefore, research findings in schizophrenia may reflect mechanisms of prognosis rather than fundamental associations with psychosis and other symptom domains per se. Similarly, the discovery that up to 30% of individuals with non-psychotic common mental disorders have subthreshold psychotic symptoms that situate them on the transdiagnostic dimension of psychosis - and which impact clinical severity and treatment response - indicates that the rigid separation between 'psychotic' and 'non-psychotic' hampers both clinical practice and research. Diagnostic manuals in psychiatry would benefit from a system of transdiagnostic dimensions, including a transdiagnostic dimension of psychosis. Introduction of transdiagnostic dimensions allows for a system combining a nomothetic (i.e., group-specific) categorical diagnosis with an idiographic (i.e., person-specific) combination of dimensional scores. The advantage of such a system is that it encourages consideration of how symptoms dynamically interact with each other in a network of psychopathology, and of how this network is impacted by the social world.