Jäger M, Lang F U, Frasch K, Becker T
Klinik für Psychiatrie und Psychotherapie II der Universität Ulm, Bezirkskrankenhaus Günzburg.
Fortschr Neurol Psychiatr. 2012 Sep;80(9):520-6. doi: 10.1055/s-0031-1299544. Epub 2012 Sep 5.
Based on a description of the psychopathological symptoms and clinical course of three patients, the diagnostic classification of schizophrenia, schizoaffective disorder and bipolar affective disorder is discussed. The reported cases are characterised by a rapid change of cognition, affect and psychomotor domain with fluctuations in two opposite directions and an incomplete remission of symptoms between acute episodes of illness. Such cases are not adequately represented in the current diagnostic systems ICD-10 and DSM-IV. This renders both the diagnostic classification and the development of evidence-based treatment guidelines more difficult. In accordance with the historical concepts of Emil Kraepelin and Kurt Schneider, the reported patients can be considered to suffer from a subtype of schizophrenia with bipolar course. The identification of such psychopathological course types could help to develop more concise and individualised treatment guidelines. In contrast, the characterisation of the reported cases using dimensional models seems doubtful.
基于对三名患者精神病理症状及临床病程的描述，探讨了精神分裂症、分裂情感性障碍和双相情感障碍的诊断分类。报告的病例特征为认知、情感和精神运动领域迅速变化，在两个相反方向波动，且疾病急性发作之间症状不完全缓解。此类病例在当前诊断系统ICD - 10和DSM - IV中未得到充分体现。这使得诊断分类以及循证治疗指南的制定都更加困难。根据埃米尔·克雷佩林和库尔特·施奈德的历史概念，报告的患者可被认为患有双相病程的精神分裂症亚型。识别此类精神病理病程类型有助于制定更简洁、个性化的治疗指南。相比之下，使用维度模型对报告病例进行特征描述似乎存在疑问。
