Department of Psychiatry, Columbia University, New York, New York, USA.
Curr Opin Psychiatry. 2011 Jan;24(1):1-9. doi: 10.1097/YCO.0b013e328340b594.
The Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 revision is underway. The review examines draft proposals for changes in mood disorders (posted February 2010 on DSM-5 web site), explains their rationale, and considers relative costs vs. benefits.
Proposals covered include recommendation for a comorbid anxiety dimension; addition of a new disorder, mixed anxiety depression; replacement of mixed manic episodes with a 'mixed features' specifier applicable to manic, hypomanic, and major depressive episodes; addition of severity dimensions for manic and major depressive episodes; and removal of the bereavement exclusion in major depressive episode. Although some proposals (particularly the anxiety dimension and the use of Patient Health Questionnaire-9 (PHQ-9) as depression severity dimension) may improve clinical and research utility, others have a high potential for false positives (e.g., addition of mixed anxiety depression, removal of bereavement exclusion), unclear clinical utility (e.g., mixed features specifier for depressive episodes), or problematic implementation (e.g., use of Clinical Global Impression (CGI), which requires prior experience of treating bipolar patients, for rating manic episode severity).
A cost-benefit analysis of mood proposals yields mixed results, with some having significant benefits and others carrying the risk of significant problems. Only proposals in which benefits outweigh costs should be included in the final DSM-5.
《精神障碍诊断与统计手册》（DSM-5）修订版正在进行中。本文回顾了心境障碍修订草案（2010 年 2 月发布于 DSM-5 网站），解释了其基本原理，并考虑了相对成本效益。
涵盖的建议包括：在共病焦虑维度方面的建议；新增混合性焦虑抑郁障碍；用“混合特征”指标替代混合性躁狂发作，适用于躁狂、轻躁狂和重性抑郁发作；增加躁狂和重性抑郁发作的严重程度维度；去除重性抑郁发作的丧亲除外标准。虽然有些建议（特别是焦虑维度和使用患者健康问卷-9（PHQ-9）作为抑郁严重程度维度）可能会提高临床和研究的实用性，但其他建议可能会导致假阳性（如新增混合性焦虑抑郁障碍，去除丧亲除外标准）、临床实用性不明确（如抑郁发作的混合特征指标）或实施困难（如使用需要治疗双相患者经验的临床总体印象量表（CGI）来评定躁狂发作严重程度）。
对心境障碍提案进行成本效益分析得出的结果喜忧参半，一些提案有显著的益处，而另一些提案则存在显著问题的风险。只有那些收益大于成本的提案才应被纳入最终的 DSM-5。
