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未来精神疾病诊断的研究规划。

Research planning for the future of psychiatric diagnosis.

机构信息

American Psychiatric Institute for Research and Education, Division of Research, American Psychiatric Association, 1000 Wilson Boulevard, Suite 1825, Arlington, VA 22209, USA.

出版信息

Eur Psychiatry. 2012 Oct;27(7):553-6. doi: 10.1016/j.eurpsy.2009.11.013. Epub 2011 Jun 14.

Abstract

More than 10 years prior to the anticipated 2013 publication of DSM-5, processes were set in motion to assess the research and clinical issues that would best inform future diagnostic classification of mental disorders. These efforts intended to identify the clinical and research needs within various populations, examine the current state of the science to determine the empirical evidence for improving criteria within and across disorders, and stimulate research in areas that could potentially provide evidence for change. In the second phase of the revision process, the American Psychiatric Institute for Research and Education (APIRE) recently completed the 5-year international series of 13 diagnostic conferences convened by APA/APIRE in collaboration with the World Health Organization and the National Institutes of Health (NIH), under a cooperative grant funded by the NIH. From these conferences, the DSM-5 Task Force and Work Groups have developed plans for potential revisions for DSM-5, including the incorporation of dimensional approaches within and across diagnostic groups to clarify heterogeneity, improve diagnostic validity, and enhance clinical case conceptualization. Use of dimensions for measurement-based care has been shown to be feasible in psychiatric and primary care settings and may inform monitoring of disorder threshold, severity, and treatment outcomes. The integration of dimensions with diagnostic categories represents an exciting and potentially transformative approach for DSM-5 to simultaneously address DSM-IV's clinical short-comings and create novel pathways for research in neurobiology, genetics, and psychiatric epidemiology.

摘要

早在 2013 年出版 DSM-5 之前的 10 多年前,就已经开始着手评估最能为未来精神障碍的诊断分类提供信息的研究和临床问题。这些努力旨在确定不同人群中的临床和研究需求,检查当前科学的状况,以确定在障碍内和跨障碍改善标准的经验证据,并在可能提供变革证据的领域激发研究。在修订过程的第二阶段,美国精神病学研究所(APIRE)最近完成了 APA/APIRE 与世界卫生组织和美国国立卫生研究院(NIH)合作,根据 NIH 资助的合作协议,进行的为期 5 年的 13 次国际诊断会议系列。从这些会议中,DSM-5 工作组制定了 DSM-5 可能进行修订的计划,包括在诊断组内和跨诊断组采用维度方法,以澄清异质性,提高诊断有效性,并增强临床病例概念化。在精神病学和初级保健环境中,使用维度进行基于测量的护理已被证明是可行的,并且可以为监测障碍阈值、严重程度和治疗结果提供信息。将维度与诊断类别相结合,为 DSM-5 提供了一种令人兴奋且具有潜在变革性的方法,可以同时解决 DSM-IV 的临床缺陷,并为神经生物学、遗传学和精神流行病学研究开辟新途径。

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