Mezzich Juan E
International Center for Mental Health, Mount Sinai School of Medicine, New York University, New York, NY 10029, USA.
Psychopathology. 2002 Mar-Jun;35(2-3):162-5. doi: 10.1159/000065138.
A discussion of the objectives of diagnosis, participants and architecture leads to the consideration of diagnostic schemas of increasing complexity. Examined first is the conventional case of single-label diagnosis. The case of multiple illness formulation is considered concerning the plurality of mental disorders as well as of general medical disorders. The formulation of a whole clinical condition where contextualized pathology and problems are described is then followed by the consideration of positive aspects of health as well as quality of life. Finally, a comprehensive diagnostic model is reviewed. It integrates a standardized multiaxial formulation (illness, disabilities, contextual factors and quality of life) and an idiographic personalized formulation (culturally informed and contextualized clinical problems, patient's assets pertinent to care, and expectations of health restoration and promotion as jointly understood by clinician, patient and family). Such integrative diagnostic schemas may offer a richer informational basis for clinical description and care as well as a more effective focus for the surveillance of population health.
对诊断目标、参与者和架构的讨论引发了对日益复杂的诊断模式的思考。首先审视的是单标签诊断的传统情况。接着考虑多种疾病表述的情况，涉及多种精神障碍以及一般医学疾病。随后在描述情境化病理学和问题的整个临床状况的表述之后，再考虑健康的积极方面以及生活质量。最后，回顾了一个综合诊断模型。它整合了标准化的多轴表述（疾病、残疾、情境因素和生活质量）和个性化的独特表述（文化背景下的临床问题、与护理相关的患者资产，以及临床医生、患者和家属共同理解的健康恢复和促进期望）。这种综合诊断模式可为临床描述和护理提供更丰富的信息基础，也可为人群健康监测提供更有效的重点关注。
