精神病：DSM-V 和 ICD-11 拟议的元结构的第 3 集群。
The psychoses: cluster 3 of the proposed meta-structure for DSM-V and ICD-11.
机构信息
Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD 21228, USA.
出版信息
Psychol Med. 2009 Dec;39(12):2025-42. doi: 10.1017/S0033291709990286. Epub 2009 Oct 1.
BACKGROUND
In an effort to group mental disorders on the basis of etiology, five clusters have been proposed. Here we consider the validity of the cluster comprising selected psychotic and related disorders.
METHOD
A group of diagnostic entities classified under schizophrenia and other psychotic disorders in DSM-IV-TR were assigned to this cluster and the bordering disorders, bipolar (BD) and schizotypal personality disorders (SPD), were included. We then reviewed the literature in relation to 11 validating criteria proposed by the DSM-V Task Force Study Group.
RESULTS
Relevant comparisons on the 11 spectrum criteria are rare for the included disorders except for schizophrenia and the two border conditions, BD and SPD. The core psychosis group is congruent at the level of shared psychotic psychopathology and response to antipsychotic medication. BD and SPD are exceptions in that psychosis is not typical in BD-II disorder and frank psychosis is excluded in SPD. There is modest similarity between schizophrenia and BD relating to risk factors, neural substrates, cognition and endophenotypes, but key differences are noted. There is greater support for a spectrum relationship of SPD and schizophrenia. Antecedent temperament, an important validator for other groupings, has received little empirical study in the various psychotic disorders.
CONCLUSIONS
The DSM-IV-TR grouping of psychotic disorders is supported by tradition and shared psychopathology, but few data exist across these diagnoses relating to the 11 spectrum criteria. The case for including BD is modest, and the relationship of BD to other mood disorders is addressed elsewhere. Evidence is stronger for inclusion of SPD, but the relationship with other personality disorders along the 11 criteria is not addressed and the absence of psychosis presents a conceptual problem. There are no data along the 11 spectrum criteria that are decisive for a cluster based on etiology, and inclusion of BD and SPD is questionable.
背景
为了根据病因将精神障碍进行分组，已经提出了五个聚类。在这里，我们考虑了包含选定的精神病性和相关障碍的聚类的有效性。
方法
将 DSM-IV-TR 中分类为精神分裂症和其他精神病性障碍的一组诊断实体分配到该聚类中，并包括边缘障碍，双相情感障碍（BD）和分裂型人格障碍（SPD）。然后，我们回顾了与 DSM-V 任务组研究小组提出的 11 项验证标准有关的文献。
结果
除了精神分裂症和两种边缘疾病（BD 和 SPD）之外，所包括的疾病很少有相关的比较来验证 11 个谱标准。核心精神病组在共享精神病学病理学和抗精神病药物反应方面是一致的。BD 和 SPD 是例外，BD-II 障碍中没有典型的精神病，SPD 中排除了明显的精神病。精神分裂症和 BD 之间在危险因素、神经基质、认知和表型方面存在一定程度的相似性，但也存在关键差异。SPD 和精神分裂症之间存在更多的谱关系支持。对于其他分组来说，一个重要的验证因素是前驱气质，但在各种精神病性障碍中，对其进行的实证研究很少。
结论
DSM-IV-TR 对精神病性障碍的分组得到了传统和共享精神病理学的支持，但很少有数据可以跨这些诊断来评估 11 个谱标准。将 BD 包括在内的情况是适度的，BD 与其他心境障碍的关系在其他地方讨论。纳入 SPD 的证据更强，但与其他人格障碍在 11 个标准下的关系尚未解决，而且没有精神病的存在提出了一个概念问题。目前没有关于 11 个谱标准的决定病因聚类的决定性数据，将 BD 和 SPD 包括在内是值得怀疑的。
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