Dittmann V
Psychiatrische Universitätsklinik, Basel.
Schweiz Arch Neurol Psychiatr (1985). 1991;142(4):341-53.
After general "antipsychiatric" criticism and with empirical results, which demonstrated partly very low interrater reliabilities of conventional psychiatric diagnosis a new appreciation of nosological difficulties in psychiatry arose. Based on philosophical concepts of logical empiricism which had been established in philosophy at the beginning of our century the operational psychiatric diagnosis was developed. The first system, the Research Diagnostic Criteria (RDC), was used for scientifical purpose in the early seventies. Based upon this system the American Psychiatric Association (APA) introduced DSM-III in 1980, which had a very strong influence on psychiatric diagnosis and classification during the last ten years. Operational psychiatric diagnosis is demanding precise criteria for inclusion and exclusion and definite diagnostic rules. The tenth revision of the International Classification of Diseases (ICD-10) of the WHO is in preparation and will also contain an operational approach. This new instrument will be introduced from 1992 in WHO member states. As a result of a number of empirical studies an improvement of interrater reliability in psychiatric diagnosis using DSM-III, DSM-III-R and the drafts of ICD-10 as well was demonstrated. An other important innovation of modern classification systems is the multiaxial diagnosis. These approaches have a number of advantages for clinicians, for communication in health service systems as well as for epidemiological and biological psychiatric research.
在受到一般性的“反精神病学”批评并基于实证结果（这些结果部分表明传统精神病学诊断的评定者间信度非常低）之后，人们对精神病学中疾病分类学的困难有了新的认识。基于本世纪初在哲学领域确立的逻辑实证主义的哲学概念，发展出了操作性精神病学诊断。第一个系统，即研究诊断标准（RDC），在七十年代早期被用于科学目的。基于这个系统，美国精神病学协会（APA）于1980年推出了《精神疾病诊断与统计手册》第三版（DSM - III），在过去十年中它对精神病学诊断和分类产生了非常重大的影响。操作性精神病学诊断要求有精确的纳入和排除标准以及明确的诊断规则。世界卫生组织（WHO）的《国际疾病分类》第十次修订版（ICD - 10）正在筹备中，它也将包含一种操作性方法。这个新工具将于1992年在世卫组织成员国中推行。一系列实证研究的结果表明，使用DSM - III、DSM - III - R以及ICD - 10草案进行精神病学诊断时，评定者间信度有所提高。现代分类系统的另一项重要创新是多轴诊断。这些方法对临床医生、在卫生服务系统中的交流以及对流行病学和生物精神病学研究都有诸多优势。
