Pincus Harold Alan, Tew James D, First Michael B
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
World Psychiatry. 2004 Feb;3(1):18-23.
With each successive revision of the DSM and ICD, psychiatric comorbidity has become more prevalent. The 'atheoretical' approaches of the DSM and ICD explicitly encourage multiple diagnoses with few exclusionary hierarchies, in the hope that all clinically relevant information will be captured. However, the current strategy of diagnosing 'maximal' comorbidity may not reflect 'optimal' comorbidity. Many clinicians and health information systems, particularly those in developing countries, have a limited capacity for capturing this diagnostic information, and fail to characterize additional diagnoses that are present. This article will address the evolution of our current diagnostic system as a way of understanding the emergence of comorbid psychiatric diagnoses. Alternative diagnostic approaches (a dimensional system, diagnostic hierarchies, and mixed diagnostic categories) that could be used to address the emergence of comorbid psychiatric diagnoses are considered. Future challenges for the next evolution of DSM and ICD are presented.
随着《精神疾病诊断与统计手册》（DSM）和《国际疾病分类》（ICD）的不断修订，精神疾病共病现象变得愈发普遍。DSM和ICD的“无理论”方法明确鼓励进行多重诊断，且几乎没有排他性等级划分，以期涵盖所有临床相关信息。然而，当前诊断“最大程度”共病的策略可能无法反映“最佳”共病情况。许多临床医生和健康信息系统，尤其是发展中国家的此类系统，收集这种诊断信息的能力有限，并且无法对存在的其他诊断进行特征描述。本文将探讨我们当前诊断系统的演变，以此作为理解共病精神疾病诊断出现的一种方式。文中还考虑了可用于应对共病精神疾病诊断出现的替代诊断方法（维度系统、诊断等级划分和混合诊断类别）。最后提出了DSM和ICD未来进一步演变所面临的挑战。
