Institute of Psychiatry, King's College, London, UK.
Psychol Med. 2009 Dec;39(12):2071-81. doi: 10.1017/S0033291709990304. Epub 2009 Oct 1.
The extant major psychiatric classifications, DSM-IV and ICD-10, are purportedly atheoretical and largely descriptive. Although this achieves good reliability, the validity of a medical diagnosis is greatly enhanced by an understanding of both risk factors and clinical history. In an effort to group mental disorders on the basis of risk factors and clinical manifestations, five clusters have been proposed. The purpose of this paper is to consider the position of bipolar disorder (BPD), which could be either with the psychoses, or with emotional disorders, or in a separate cluster.
We reviewed the literature on BPD, unipolar depression (UPD) and schizophrenia in relation to 11 validating criteria proposed by the DSM-V Task Force Study Group, and then summarized similarities and differences between BPD and schizophrenia on the one hand, and UPD on the other.
There are differences, often substantial and never trivial, for 10 of the 11 validators between BPD and UPD. There are also important differences between BPD and schizophrenia.
BPD has previously been classified together with UPD, but this is the least justifiable place for it. If it is to be recruited to a 'psychotic cluster', there are several important respects in which it differs from schizophrenia, so the cluster would have a division within it. The alternative would be to allow it to be in an intermediate position in a cluster of its own.
现有的主要精神科分类，DSM-IV 和 ICD-10，据称是无理论的，主要是描述性的。虽然这达到了很好的可靠性，但对风险因素和临床病史的理解极大地增强了医学诊断的有效性。为了根据风险因素和临床表现对精神障碍进行分组，已经提出了五个集群。本文旨在考虑双相情感障碍（BPD）的位置，它可以与精神病一起，也可以与情感障碍一起，或者在一个单独的集群中。
我们回顾了与 DSM-V 工作组研究小组提出的 11 个验证标准有关的 BPD、单相抑郁（UPD）和精神分裂症的文献，然后总结了 BPD 和精神分裂症一方面与 UPD 之间的异同。
在 11 个验证器中，BPD 和 UPD 之间有 10 个存在差异，差异通常很大，绝不是微不足道的。BPD 和精神分裂症之间也存在重要差异。
BPD 以前与 UPD 一起分类，但这是最不合理的地方。如果要将其纳入“精神病集群”，它在几个重要方面与精神分裂症不同，因此集群内会有一个分支。另一种选择是允许它在自己的集群中处于中间位置。
