Biological, life course, and cross-cultural studies all point toward the value of dimensional and developmental ratings in the classification of psychosis
Biological, life course, and cross-cultural studies all point toward the value of dimensional and developmental ratings in the classification of psychosis
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DOI：
10.1093/schbul/sbm059
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发表时间：
2007-07-01
影响因子：
6.6
通讯作者：
Murray, Robin M.
中科院分区：
文献类型：
--
作者：
Dutta, Rina;Greene, Talya;Murray, Robin M.
第四版《精神疾病诊断和统计手册》(DSM-IV1)中对精神分裂症的诊断标准是基于这样一个前提，即它是一个独立的疾病实体，特别是不同于情感性精神病。这一假设已经持续了一个多世纪，尽管被诊断为精神分裂症的患者表现出各种各样的症状和结果，而且还没有发现任何生物或心理特征与这种疾病的病因有关。然而，对这一概念的批评持续不断，而且确实越来越多。例如，十多年前，英国最老练的病因学专家之一伊恩·布罗金顿在一篇关于精神分裂症诊断的文章中告诫说：“重要的是要放松精神病学家对‘精神分裂症’这个概念的控制。精神分裂症是一个概念，其本质是模棱两可的，一个没有自然边界的病因学范畴，一个空洞的假设。(3)《精神疾病诊断和统计手册》第五版(DSM-V)应该坚持新克拉佩尔精神分裂症的概念及其所有缺陷，还是应该将精神病解构为其组成部分？在这篇文章中，我们将通过考虑两个主题来解决这个问题，第一，文化和种族在精神病诊断中的作用，第二，从生命过程的角度来理解精神病。然后，我们将讨论DSM-V是否会通过放弃熟悉的分类系统而转向同时对发育障碍和症状因子评分进行评级的维度系统来取得更大进展。然而，我们将从简要回顾精神病分类的近代史开始。
The diagnostic criteria for schizophrenia in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV1) are based on the premise that it is a discrete illness entity, in particular, distinct from the affective psychoses. This assumption has persisted for more than a century, even though patients with a diagnosis of schizophrenia show a wide diversity of symptoms and outcomes, and no biological or psychological feature has been found to be pathognomonic of the disorder. However, there has been sustained, and indeed growing, criticism of the concept. For example, writing about the diagnosis of schizophrenia more than a decade ago,(2) one of Britain's most sophisticated nosological experts, Ian Brockington, enjoined "It is important to loosen the grip which the concept of 'schizophrenia' has on the minds of psychiatrists. Schizophrenia is an idea whose very essence is equivocal, a nosological category without natural boundaries, a barren hypothesis. Such a blurred concept is 'not a valid object of scientific enquiry'."(3) Should Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition(DSM-V), persist with the neo-Kraepelinian concept of schizophrenia with all its defects, or should it deconstruct psychosis into its component dimensions? In this article, we will address the question by considering 2 main themes, firstly, the role of culture and ethnicity in the diagnosis of psychosis, and secondly, a life course approach to understanding psychosis. We will then discuss whether more progress would be achieved in DSM-V by abandoning the familiar categorical system and instead moving to a dimensional system which rates both developmental impairment and symptom factor scores. However, we will begin by briefly reviewing the recent history of the classification of the psychoses.