Diagnosis of schizophrenia
Diagnosis of schizophrenia
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精神分裂症的诊断
作者：
S. Rose
关于5号染色体上精神分裂症易感位点的定位或非定位的论文（参考文献3A）的谨慎欣快的领先文章“和新闻和观点项目”值得评论。尽管1900年代和20世纪70年代的极端反精神病学倾向。其主要倡导者。莱恩和萨斯你在你的主要文章中引用。唯物主义者对诊断为精神分裂症的病症的解释不能怀疑它一定与脑生物化学和生理学的合理的具体变化有关。还有那个在特定环境中。某些基因型可能更有可能表达这种变化。问题所在几十年的神经化学精神病学已经揭示了这一点。是区分那些必然的变化。与精神分裂症的诊断完全相关诊断本身的不确定性无助于这项任务。流行病学证据表明，它在当今欧洲和美国的阶级和种族分布严重倾斜。因此，肯尼迪等人的相关性。的结论，目前看来，有不同的位点。可能导致不同的神经生理异常。导致了最后的共同途径”表型为sehizophila.最好把它改为复数形式。精神分裂症的表型”，并已经这样做了。认识到（a）在特定的基因型和特定的异常行为（如精神分裂症）之间并不存在一一对应的关系。和（B）与其对”模仿”其他遗传条件的表型条件调用表型复制的概念（如Lander所做的），不如将有时可能与特定表型性状相关的遗传条件称为基因复制。她希望“精神科医生最终有可能考虑在5号染色体连锁可以可靠建立的家庭中进行遗传咨询”。为这些家庭提供有意义的建议。有必要知道有多少5号染色体连锁的精神分裂症病例没有发生。那是而Kennedy等人已经表明这种联系对于精神分裂症不是必需的。Sherrington等人并没有证明这是足够的--这是有用的遗传咨询的先决条件。而且。你的主要文章和兰德的评论太容易接受这样的观点，即遗传研究使人们能够扭转传统的临床方法，在这种方法中，疾病是通过其表型（在这种情况下是行为）表现来诊断的，
Sm-The cautiously euphoric leading article'and the News and Views item'on papers on the localization or non-localization of a susceptibility locus for schizophrenia on chromosome 5 (refs 3A) merit comment. Despite the extremes of the· anti-psychiatry· tendencies of the l% Os and 1970s. whose major exponents. Laing and Szasz. you cite in your leading article. no materialist account of the condition (s) diagnosed as schizophrenia could doubt that it (they) must be associated with reasonably specific changes in brain biochemistry and physiology. and that. in particular environments. certain genotypes may well be more likely to express such changes. The problem. as many decades of neurochemical psychiatry has revealed. is to distinguish those changes which are necessarily. sufficiently and exclusively related to the schizophrenic diagnosis. This task is not helped by uncertainties in the diagnosis itself. and the epidemiological evidence which points to its sharply skewed class and ethnic distribution in Europe and the United States today. Hence the relevance of Kennedy ct al.· s conclusion that at present it seems that there are different loci. possibly leading to different neurophysiological abnormalities. resulting in a final common pathway" phenotype for sehizophrenia... One might better amend this to read in the plural.·· phenotypes for schizophrenias" and having done so. to recognize that (a) there is not a one-for-one correspondence between particular genotypes and particular abnormal behaviours such as schizophrenia. and (b) rather than invoke the concept of phenocopy for a phenotypic condition which" mimics" an otherwise genetic condition (as Lander does) it would be better to refer to the genetic conditions which may sometimes be associated with particular phenotypic traits as genocopies.It is this uncertainty that diminishes the strength of Sherrington et al.· s hope that" it may eventually be possible for psychiatrists to consider genetic counselling in families where chromosome 5 linkage can be reliably established". For genetic counselling to give meaningful advice to such families. it would be necessary to know in how many cases of chromosome 5 linkage schizophrenia does not occur. That is. while Kennedy et al. have shown that such linkage is not necessary for schizophrenia. Sherrington et al. have not shown that it is sufficient- a prerequisite for useful genetic counselling. Moreover. your leading article and Lander's review accept too easily the view that the genetic studies enable one to reverse the traditional clinical method in which a disorder is diagnosed by its phenotypic (in this case behavioural) manifesta-