Heterogeneity in psychiatric diagnostic classification
Heterogeneity in psychiatric diagnostic classification
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DOI：
10.1016/j.psychres.2019.07.005
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发表时间：
2019-09-01
影响因子：
11.3
通讯作者：
Kinderrnan, Peter
中科院分区：
文献类型：
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作者：
Allsopp, Kate;Read, John;Kinderrnan, Peter
精神病学诊断的理论和实践是核心但也存在争议。本文研究了 DSM-5 中类别的异质性、这种异质性如何在诊断标准中表达，及其对临床医生、客户和诊断模型的影响。 DSM-5 的选定章节进行了主题分析：精神分裂症谱系和其他精神障碍；双相情感障碍及相关疾病；抑郁症；焦虑症；以及创伤和压力源相关的疾病。主题确定了特定诊断标准的异质性，包括症状比较、困难持续时间、严重程度指标以及用于评估困难的观点。诊断类别之间的更大差异检查了类别之间的症状重叠以及创伤的作用。跨多个诊断类别重复出现的实用标准和困难为临床医生提供了灵活性，但破坏了离散疾病类别的模型。然而，这对病因的概念化方式产生了影响，例如暗示创伤仅影响有限数量的诊断，尽管越来越多的证据表明相反的情况。诊断类别中的个人经历和特定因果路径也可能被掩盖。因此，与维持对不诚实的分类系统的承诺相比，允许承认个人经历的务实的精神评估方法可能是理解痛苦的更有效的方法。
The theory and practice of psychiatric diagnosis are central yet contentious. This paper examines the heterogeneous nature of categories within the DSM-5, how this heterogeneity is expressed across diagnostic criteria, and its consequences for clinicians, clients, and the diagnostic model. Selected chapters of the DSM-5 were thematically analysed: schizophrenia spectrum and other psychotic disorders; bipolar and related disorders; depressive disorders; anxiety disorders; and trauma- and stressor-related disorders. Themes identified heterogeneity in specific diagnostic criteria, including symptom comparators, duration of difficulties, indicators of severity, and perspective used to assess difficulties. Wider variations across diagnostic categories examined symptom overlap across categories, and the role of trauma. Pragmatic criteria and difficulties that recur across multiple diagnostic categories offer flexibility for the clinician, but undermine the model of discrete categories of disorder. This nevertheless has implications for the way cause is conceptualised, such as implying that trauma affects only a limited number of diagnoses despite increasing evidence to the contrary. Individual experiences and specific causal pathways within diagnostic categories may also be obscured. A pragmatic approach to psychiatric assessment, allowing for recognition of individual experience, may therefore be a more effective way of understanding distress than maintaining commitment to a disingenuous categorical system.