Subthreshold disorders in psychiatry: Clinical reality, methodological artifact, and the double-threshold problem
Subthreshold disorders in psychiatry: Clinical reality, methodological artifact, and the double-threshold problem
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DOI：
10.1016/s0010-440x(00)80001-2
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发表时间：
2000-03-01
影响因子：
7.3
通讯作者：
Linden, M
中科院分区：
文献类型：
--
作者：
Helmchen, H;Linden, M
现代可操作的精神障碍分类系统的引入导致了阈下障碍的问题。疾病的定义并不同时定义健康，例如，从 1947 年世界卫生组织 (WHO) 定义的意义上来说，不仅定义疾病而且定义健康的阈值都有待讨论。所谓的阈下疾病需要定义 2 个阈值。实证研究表明，这些“阈值之间的疾病”与残疾增加和许多其他负面后果有关。阈下疾病的部分问题本质上是方法论问题。忽略了精神病理学和精神病理学标志的格式塔特征，忽略了类别概念而不是精神病理学标志，并且使用了范畴概念而不是维度概念。因此，没有考虑到综合征和疾病之间的区别以及疾病的层次结构，并且没有解决依赖于流行病学分布的预后能力的统计问题。阈值定义的变化对个人和社会都有重要影响，无论是因为“诊断标签”的负面影响还是因为医疗保健系统的成本，尽管现代序贯治疗算法和更新的治疗方法（例如选择性血清素再摄取抑制剂[SSRI]和圣约翰草）带来了有趣的前景，但目前的治疗选择还相当不足。也是在这种背景下，自助应该成为医疗研究的重要领域。版权所有 (C) 2000 W.B.桑德斯公司。
The introduction of modern operationalized classification systems for mental disorders has led to the issue of subthreshold disorders. Definitions for illness do not at the same time define health, e.g., in the sense of the World Health Organization (WHO) definition from 1947, The threshold not only to define disorders but also to define health is open to discussion. So-called subthreshold disorders require the definition of 2 thresholds. Empirical research has suggested that these "between-threshold disorders" are associated with increased disability and many other negative consequences. Part of the problem with subthreshold disorders is methodological in nature. Psychopathology and the Gestalt characteristic of psychopathological signs are ignored,and categorical instead of psychpathological signs are ignored, and categorical instead of dimensional concepts are used. Thus, the distinction between syndromes and disorders, as well as the hierarchical structure of disorders, is not taken into account, and statistical problems with the prognostic power, which is dependent on the epidemiological distribution, are not solved. Variations in threshold definitions have important consequences for the individual and for society, be it because of the negative effects of "diagnostic labeling" or because of the costs to the health care system, Treatment options are presently rather insufficient, although modern sequential treatment algorithms and newer treatments (e.g., selective serotonin reuptake inhibitors [SSRIs] and Saint-John's-wort) promise interesting perspectives. Also in this context, self-help should become an important area of medical treatment research. Copyright (C) 2000 by W.B. Saunders Company.