Bürgy M
Psychiatric Hospital, University of Heidelberg, Heidelberg, Germany.
Psychopathology. 2007;40(2):102-10. doi: 10.1159/000098490. Epub 2007 Jan 11.
The paper presented follows the hypothesis that differentiation between obsessive-compulsive disorder and schizophrenia is possible only by focusing on the single phenomenon of obsession. The statement of a nosological specificity of obsession, called obsession in the strict sense, is set against the current views of ICD-10 and DSM-IV of obsession as a ubiquitous, non-specific phenomenon appearing in comorbidities. In the succession of the paper, the historical development of these two very different views and their clinically mixing is reconstructed. The phenomenological clarification of the structure of the obsessive phenomena leads to the term of obsession in the strict sense. The distinction between obsessive-compulsive disorder and schizophrenia can take place at the psychopathological interface between obsession in the strict sense and delusional idea. The examination of the literature on the connection between obsessive-compulsive disorder and schizophrenia shows that there is no definitive connection between obsession in the strict sense and schizophrenia. Finally, some case reports are presented to sharpen clinical suspicion for other possibly wrong diagnoses.
本文提出的观点遵循这样一种假设，即只有专注于强迫观念这一单一现象，才有可能区分强迫症和精神分裂症。一种关于强迫观念的疾病分类特异性的表述，即严格意义上的强迫观念，与国际疾病分类第10版（ICD - 10）和精神疾病诊断与统计手册第四版（DSM - IV）中当前将强迫观念视为一种在共病中普遍存在的非特异性现象的观点相对立。在论文的后续部分，重构了这两种截然不同观点的历史发展及其在临床上的混淆情况。对强迫现象结构的现象学澄清引出了严格意义上的强迫观念这一术语。强迫症和精神分裂症的区分可在严格意义上的强迫观念与妄想观念之间的精神病理学界面处进行。对关于强迫症与精神分裂症之间联系的文献研究表明，严格意义上的强迫观念与精神分裂症之间不存在明确的联系。最后，给出了一些病例报告，以增强对其他可能错误诊断的临床怀疑。
