Contested boundaries of bipolar disorder and the limits of categorical diagnosis in psychiatry.
Contested boundaries of bipolar disorder and the limits of categorical diagnosis in psychiatry.
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双相情感障碍的争议边界和精神病学分类诊断的局限性。
DOI：
10.1176/ajp.149.11.1473
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发表时间：
1992
期刊：
影响因子：
--
通讯作者：
Tsuang,MT
中科院分区：
文献类型：
--
作者：
Blacker,D;Tsuang,MT
作者的主要目标是概述双相情感障碍与精神分裂症、单相抑郁症和人格障碍等诊断之间界限问题的现象学、重要性和可用数据。此外，通过阐明精神病学更强有力的诊断之一的边界的许多困难，他们希望唤醒读者对当前精神病学疾病分类学的健康怀疑。对于这个范围的主题，文献综述必须是有选择性的。对于每个边界区域，只要有可能，就会包含涵盖一系列验证标准的经典论文和最新论文。如果有的话，会引用好的总结数据，以及精选的相关理论论文。审查表明，目前双相情感障碍的诊断标准总体上是合理的，但存在许多问题，其中大部分无法通过标准的改变来解决。其中值得注意的是 1) 单相情感障碍未来躁狂发作的可能性，2) 分裂情感障碍，双相情感障碍，3) 具有显着情绪波动的边缘性人格障碍。关于双相情感障碍边界的争议说明了分类诊断的局限性，这些局限性是由于诊断标准的实施、标准本身、基本的疾病分类过程以及现象本身造成的。如果要扩大这些限制，可能有必要在研究和临床实践的不同环境中探索定义精神病学诊断的替代方法。
The authors' primary objective is to outline the phenomenology, importance, and available data on issues concerning the boundaries between bipolar disorder and diagnoses such as schizophrenia, unipolar depression, and personality disorders. In addition, by illuminating the many difficulties with the boundaries of one of psychiatry's more robust diagnoses, they hope to awaken in the reader a healthy skepticism about current psychiatric nosology. For a topic of this scope, a literature review must be selective. For each boundary area, a mixture of classic and recent papers covering a range of validating criteria is included whenever possible. Good summary data are cited when available, as are a selection of relevant theoretical papers. The review indicates that current diagnostic criteria for bipolar disorder are generally reasonable, but there are many problem areas, most of which cannot be solved by changes in criteria. Notable among these are 1) the possibility of future manic episodes in unipolar disorder, 2) schizoaffective disorder, bipolar type, and 3) borderline personality disorder with prominent mood swings. The disputes concerning the boundaries of bipolar disorder illustrate the limitations of categorical diagnosis which result from the implementation of diagnostic criteria, the criteria themselves, the fundamental nosologic process, and the phenomena themselves. If these limitations are to be extended, it may be necessary to explore alternative ways of defining psychiatric diagnoses for different settings in research and clinical practice.