Strain James J
Division of Behavioral Medicine and Consultation Psychiatry, Mount Sinai/NewYork University Medical Center, Box 1230, New York, New York 10029, USA.
Aust N Z J Psychiatry. 2005 Sep;39(9):764-71. doi: 10.1080/j.1440-1614.2005.01681.x.
To review the problems posed for doctors by the failure of existing taxonomies to provide a satisfactory method for deriving diagnoses in cases of physical/psychiatric comorbidity, and of relating diagnoses on multiple axes.
Review of existing taxonomies and key criticisms. The author was guided in selection by his experience as a member of the working parties involved in the creation of the American Psychiatric Association's DSM-IV.
The attempts of the two major taxonomies, the ICD-10 and the American Psychiatric Association's DSM-IV, to address the problem by use of glossaries and multiple axes are described, and found wanting. Novel approaches, including McHugh and Slavey's perspectives of disease, dimensions, behaviour and life story, are described and evaluated. The problem of developing valid and reliable measures of physical/psychiatric comorbidity is addressed, including a discussion of genetic factors, neurobiological variables, target markers and other pathophysiological indicators. Finally, the concept of depression as a systemic illness involving brain, mind and body is raised and the implications of this discussed.
Taxonomies require major revision in order to provide a useful basis for communication and research about one of the most frequent presentations in the community, physical/psychiatric comorbidity.
回顾现有分类法在为躯体/精神共病病例推导诊断以及关联多轴诊断方面未能提供令人满意方法所给医生带来的问题。
回顾现有分类法及主要批评意见。作者依据其作为参与美国精神病学会《精神疾病诊断与统计手册》第四版（DSM-IV）编制工作组成员的经验进行筛选。
描述了两种主要分类法，即国际疾病分类第十版（ICD-10）和美国精神病学会的DSM-IV，通过使用术语表和多轴来解决该问题的尝试，并发现其存在不足。描述并评估了包括麦克休和斯拉维关于疾病、维度、行为及生活经历的观点在内的新方法。探讨了制定躯体/精神共病有效且可靠测量方法的问题，包括对遗传因素、神经生物学变量、靶标标志物及其他病理生理指标的讨论。最后，提出抑郁症是一种涉及脑、心和身体的全身性疾病的概念并讨论其影响。
分类法需要进行重大修订，以便为社区中最常见的表现之一，即躯体/精神共病的交流和研究提供有用的基础。
