From mental disorder to shared understanding: a non-categorical approach to support individuals with distress in primary care.
From mental disorder to shared understanding: a non-categorical approach to support individuals with distress in primary care.
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从精神障碍到共同理解：支持初级保健中遇到困难的个人的非绝对方法。
DOI：
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
C. Dowrick
中科院分区：
文献类型：
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作者：
R. Byng;Nora Groos;C. Dowrick
本文认为，与其以精神病学诊断为目标，在初级保健以及其他医院和社区环境中工作的多面手专业人员在遇到痛苦时，应该使用非诊断性框架。精神病学诊断系统的概念和经验局限性以及心理现象是多维的证据表明，有必要采取替代办法；这种办法也可能解决过度诊断和过度用药的问题。
目前的《诊断统计手册》(DSM)和《国际疾病分类》(ICD)的精神病学分类系统存在三个关键问题。这一过程可能会让人蒙羞；诊断不能充分反映现实；它们不足以为个性化的管理计划提供信息。目前的分类诊断系统鼓励患者将他们的痛苦理解为一种疾病，而不是对当前问题、遗传和过去的创伤、丧失和有问题的依恋的经历的可理解的反应。虽然一些患者对标签感到欣慰，但我们建议，更科学有效和个性化的评估可以提供更深层次的理解、被理解的感觉，以及在需要时获得专门服务和好处的机会。
在20世纪，精神病学家通过密切相关的ICD和DSM系统创造了相对统一的实践。尽管有明显的例外，如Balint2和最近的Dowrick，但3位全科医生普遍主张在RCGP的课程和良好的指导下所体现的精神病学模式。然而，专业人士的态度更为复杂。实践研究表明，诊断并不总是提供的，而且全科医生的谈话通常遵循患者的观点，即情绪困扰可能与社会问题有关。
精神病学诊断系统的糟糕表现表明，诊断是…的不充分模型
This article argues that, rather than aiming for a psychiatric diagnosis, generalist professionals such as those working in primary care, as well as in other hospital and community settings, should use a non-diagnostic framework when encountering distress. The conceptual and empirical limitations of the psychiatric diagnostic system and evidence that psychological phenomena are dimensional suggest the need for an alternative approach; one that might also address problems of overdiagnosis and overmedication.1
There are three key problems with the current Diagnostic Statistical Manual (DSM) and International Classification of Diseases (ICD) systems of psychiatric classification. The process can be stigmatising; diagnoses are not adequate representations of reality; and they are inadequate for informing an individualised management plan. The current categorical diagnostic system encourages the patient to understand their distress as a disease, rather than as an understandable response to current problems, genetic inheritance, and past experience of trauma, loss, and problematic attachments. Although some patients are comforted by labels, we propose that a more scientifically valid and individualised assessment can provide a deeper understanding, a sense of being understood, and access to specialised services and benefits if required.
During the 20th century, psychiatrists created a relatively unified practice through the closely related ICD and DSM systems. Despite notable exceptions, such as Balint2 and more recently Dowrick,3 GPs have generally advocated the psychiatric model that is enshrined in the RCGP’s curriculum and in NICE guidance. Attitudes of professionals, however, are more mixed. Studies of practice show how diagnoses are not always offered, and that GPs’ talk often follows the patient’s view that the emotional distress might be related to social problems.4
The poor performance of the psychiatric diagnostic system demonstrates how diagnoses are inadequate models of …