Division of Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267-0559, USA.
World Psychiatry. 2011 Oct;10(3):181-6. doi: 10.1002/j.2051-5545.2011.tb00046.x.
There is considerable debate over whether bipolar and related disorders that share common signs and symptoms, but are currently defined as distinct clinical entities in DSM-IV and ICD-10, may be better characterized as falling within a more broadly defined "bipolar spectrum". With a spectrum view in mind, the possibility of broadening the diagnosis of bipolar disorder has been proposed. This paper discusses some of the rationale for an expanded diagnostic scheme from both clinical and research perspectives in light of potential drawbacks. The ultimate goal of broadening the diagnosis of bipolar disorder is to help identify a common etiopathogenesis for these conditions to better guide treatment. To help achieve this goal, bipolar researchers have increasingly expanded their patient populations to identify objective biological or endophenotypic markers that transcend phenomenological observation. Although this approach has and will likely continue to produce beneficial results, the upcoming DSM-IV and ICD-10 revisions will place increasing scrutiny on psychiatry's diagnostic classification systems and pressure to re-evaluate our conceptions of bipolar disorder. However, until research findings can provide consistent and converging evidence as to the validity of a broader diagnostic conception, clinical expansion to a dimensional bipolar spectrum should be considered with caution.
目前，DSM-IV 和 ICD-10 将具有共同症状和体征但被定义为不同临床实体的双相及相关障碍定义为更广泛的“双相谱”范围内的疾病存在相当大的争议。基于谱系观点，有人提出扩大双相障碍诊断的可能性。本文从临床和研究角度讨论了扩大诊断方案的一些基本原理，同时考虑了潜在的缺点。扩大双相障碍诊断的最终目标是帮助确定这些病症的共同病因，以更好地指导治疗。为了实现这一目标，双相障碍研究人员已经越来越多地扩大了患者群体，以确定超越现象学观察的客观生物学或内表型标志物。尽管这种方法已经并可能继续产生有益的结果，但即将进行的 DSM-IV 和 ICD-10 修订将对精神病学的诊断分类系统进行更严格的审查，并对我们对双相障碍的概念施加压力，需要重新评估。然而，在研究结果能够提供更广泛诊断概念有效性的一致和趋同证据之前，应谨慎考虑向维度双相谱的临床扩展。
