McCormick Laurie M, Flaum Michael
Iowa Consortium for Mental Health, Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA.
Curr Psychiatry Rep. 2005 Aug;7(4):311-5. doi: 10.1007/s11920-005-0086-4.
Since the introduction of the third edition of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition in 1980, schizophrenia has been widely diagnosed with good to excellent levels of reliability. This is no small feat, as prior to the 1970s the reliability of this diagnosis over time and place was very poor. Although there have been some changes in the diagnostic algorithm for schizophrenia with subsequent revisions of the Diagnostic and Statistical Manual of Mental Disorders, there has been little change in the overall classification scheme. However, there has also been relatively little movement toward enhancing the validity of this diagnosis. Although there is broad consensus that what we now call schizophrenia is probably very heterogeneous with respect to underlying etiology and pathophysiology, attempts to identify more valid subtypes or dimensions have not progressed to the point that they are likely to be incorporated into diagnostic systems any time soon. The limited progress in defining more valid disease categories has increasingly important clinical implications as the field moves more and more to treatment by preset algorithms that are typically driven by diagnosis.
自1980年《精神疾病诊断与统计手册》第三版问世以来，精神分裂症的诊断可靠性一直很高。这绝非易事，因为在20世纪70年代之前，这种诊断在不同时间和地点的可靠性非常低。尽管随着《精神疾病诊断与统计手册》的后续修订，精神分裂症的诊断算法有了一些变化，但总体分类方案几乎没有改变。然而，在提高这种诊断的有效性方面也进展相对较小。尽管人们普遍认为，我们现在所说的精神分裂症在潜在病因和病理生理学方面可能非常异质，但识别更有效的亚型或维度的尝试尚未取得进展，以至于不太可能在短期内纳入诊断系统。随着该领域越来越多地转向由诊断驱动的预设算法进行治疗，在定义更有效的疾病类别方面取得的有限进展具有越来越重要的临床意义。
