Goldman H H, Skodol A E, Lave T R
Department of Psychiatry, University of Maryland School of Medicine, Baltimore 21201.
Am J Psychiatry. 1992 Sep;149(9):1148-56. doi: 10.1176/ajp.149.9.1148.
Axis V, which uses the Global Assessment of Functioning Scale in the multiaxial system of DSM-III-R, is under review for DSM-IV. This article examines what is known about axis V and selectively reviews the literature on measures of social functioning to identify potential alternatives to the Global Assessment of Functioning Scale.
About 25 studies on the use, reliability, and validity of axis V in DSM-III and DSM-III-R are reviewed. In addition, nearly 30 measures of social functioning are reviewed and analyzed as potential substitutes for the Global Assessment of Functioning Scale. The analysis focuses on the strengths and weaknesses of each measure for assessing functioning on axis V.
Axis V measures are modestly reliable and valid but not widely used. The authors identify and discuss two particular limitations of the Global Assessment of Functioning Scale: 1) the combination of measures of symptoms and measures of social functioning on a single axis and 2) the exclusion of physical impairments from the rating of functioning.
None of the measures of social functioning reviewed is clearly superior to the Global Assessment of Functioning Scale for use on axis V. A modified version of the Global Assessment of Functioning Scale, separating the measures of social and occupational functioning from the measures of symptoms and psychological functioning, is proposed for field testing, along with a new set of instructions permitting the rating of limitations due to both physical and mental impairments.
轴V在《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）的多轴系统中使用功能总体评定量表，目前正接受《精神疾病诊断与统计手册》第四版（DSM-IV）的审查。本文探讨了关于轴V的已知情况，并选择性地回顾了社会功能测量方面的文献，以确定功能总体评定量表的潜在替代方法。
回顾了约25项关于轴V在DSM-III和DSM-III-R中的使用、信度和效度的研究。此外，对近30种社会功能测量方法进行了回顾和分析，作为功能总体评定量表的潜在替代方法。分析重点在于每种测量方法在评估轴V功能方面的优缺点。
轴V测量方法的信度和效度一般，但使用并不广泛。作者确定并讨论了功能总体评定量表的两个特殊局限性：1）在单一轴上症状测量与社会功能测量的结合；2）功能评定中排除身体损伤因素。
所回顾的社会功能测量方法中，没有一种在用于轴V时明显优于功能总体评定量表。建议对功能总体评定量表进行修订，将社会和职业功能测量与症状和心理功能测量分开，进行现场测试，并给出一套新的指导说明，允许对身体和精神损伤造成的限制进行评定。
