What do clinicians treat: Diagnoses or symptoms? The incremental validity of a symptom-based, dimensional characterization of emotional disorders in predicting medication prescription patterns.
What do clinicians treat: Diagnoses or symptoms? The incremental validity of a symptom-based, dimensional characterization of emotional disorders in predicting medication prescription patterns.
复制标题
DOI：
10.1016/j.comppsych.2017.04.004
复制
发表时间：
2017-11
影响因子：
7.3
通讯作者：
Kotov R
中科院分区：
文献类型：
--
作者：
Waszczuk MA;Zimmerman M;Ruggero C;Li K;MacNamara A;Weinberg A;Hajcak G;Watson D;Kotov R
尽管实践指南是基于诊断手册（如DSM）中规定的疾病，但从业者在做出治疗决定时似乎会遵循症状。精神科药物通常以转诊断的方式开处方，进一步强调症状，而不是诊断，通常指导临床实践。疾病分类学的定量方法有望提供更好的指导，因为它从维度上描述了精神病理学，其组织反映了症状之间的协变模式。研究情绪障碍的定量分类是否能比传统诊断更好地解释自然主义药物处方模式。在精神科门诊样本（N= 318，平均年龄42.5岁，59%女性，81%白人）中使用访谈评估情绪障碍的症状维度和DSM诊断以及处方药物。每种诊断都与多种药物类别的处方相关，大多数药物与多种疾病相关。这在很大程度上是由于临床诊断的异质性，狭窄，同质的维度支撑显示不同药物特征的诊断。症状维度对药物处方的预测优于DSM诊断，无论这是否在所有条件下进行了广泛的检查，还是专注于特定的疾病和药物治疗。精神科药物的处方与症状一致，而不是DSM诊断。疾病分类学的定量方法可能更好地反映治疗计划，并且比传统诊断更有效地指导药物治疗。这增加了关于定量系统在实际应用中的优越性的各种证据，并突出了其改善精神病护理的潜力。
Although practice guidelines are based on disorders specified in diagnostic manuals, such as the DSM, practitioners appear to follow symptoms when making treatment decisions. Psychiatric medication is generally prescribed in a transdiagnostic manner, further highlighting how symptoms, not diagnoses, often guide clinical practice. A quantitative approach to nosology promises to provide better guidance as it describes psychopathology dimensionally and its organization reflects patterns of covariation among symptoms. To investigate whether a quantitative classification of emotional disorders can account for naturalistic medication prescription patterns better than traditional diagnoses. Symptom dimensions and DSM diagnoses of emotional disorders, as well as prescribed medications, were assessed using interviews in a psychiatric outpatient sample (N= 318, mean age 42.5 years old, 59% female, 81% Caucasian). Each diagnosis was associated with prescription of multiple medication classes, and most medications were associated with multiple disorders. This was largely due to heterogeneity of clinical diagnoses, with narrow, homogenous dimensions underpinning diagnoses showing different medication profiles. Symptom dimensions predicted medication prescription better than DSM diagnoses, irrespective of whether this was examined broadly across all conditions, or focused on a specific disorder and medication indicated for it. Psychiatric medication was prescribed in line with symptoms rather than DSM diagnoses. A quantitative approach to nosology may better reflect treatment planning and be a more effective guide to pharmacotherapy than traditional diagnoses. This adds to a diverse body of evidence about superiority of the quantitative system in practical applications and highlights its potential to improve psychiatric care.
登录
查看更多内容
影响因子：
4.6
作者：
Eaton, Nicholas R.;Krueger, Robert F.;Markon, Kristian E.;Keyes, Katherine M.;Skodol, Andrew E.;Wall, Melanie;Hasin, Deborah S.;Grant, Bridget F.
通讯作者：
Grant, Bridget F.
DOI：
10.1007/s10488-011-0334-3
发表时间：
2011-11-01
影响因子：
2.6
作者：
Jensen-Doss, Amanda;Hawley, Kristin M.
通讯作者：
Hawley, Kristin M.
影响因子：
6.6
作者：
Gardarsdottir, H.;Heerdink, E. R.;Egberts, A. C. G.
通讯作者：
Egberts, A. C. G.
影响因子：
4.4
作者：
Carragher, Natacha;Krueger, Robert F.;Eaton, Nicholas R.;Markon, Kristian E.;Keyes, Katherine M.;Blanco, Carlos;Saha, Tulshi D.;Hasin, Deborah S.
通讯作者：
Hasin, Deborah S.
影响因子：
6.9
作者：
Kotov, R.;Perlman, G.;Watson, D.
通讯作者：
Watson, D.