Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia 23298-0126, USA.
Alcohol Clin Exp Res. 2013 Mar;37(3):443-51. doi: 10.1111/j.1530-0277.2012.01954.x. Epub 2013 Jan 24.
Proposed changes to the upcoming DSM-5 include the following: (i) combining criteria for DSM-IV alcohol abuse (AA) and alcohol dependence (AD) into 1 diagnostic category (alcohol use disorder [AUD]); (ii) exclusion of the "legal problems" (LP) criterion; and (iii) addition of a "craving" criterion. Few published studies empirically assess the potential consequences of the proposed changes.
Using a population-based sample of twins assessed for lifetime AA/AD diagnoses, we explored phenotypic differences across DSM-IV and a modified DSM-5 diagnoses without craving because of its unavailability in the data set. We used factor analysis and item response theory (IRT) to evaluate the potential consequences of excluding the LP criterion from AUD and used twin modeling to examine genetic differences between DSM-IV and the modified DSM-5 diagnoses.
The prevalence of AUD was slightly higher than that of DSM-IV diagnoses. Individuals meeting DSM-IV or DSM-5 criteria, but not both, exhibit fewer comorbid diagnoses than those meeting both sets of criteria. Individuals meeting only DSM-5 criteria were slightly less severely affected than those meeting only DSM-IV criteria. Factor analysis indicated that the LP criterion loading is the lowest of all symptoms; IRT analysis suggested that this criterion has low discriminatory power. The genetic correlation between DSM-IV and DSM-5 diagnoses was slightly but significantly lower than unity.
The proposed DSM-5 AUD criteria are unlikely to result in significant changes in prevalence of diagnosed alcohol problems. However, it is unclear whether the new criteria represent a more valid diagnosis: new cases are no more severely affected than DSM-IV-only cases. Given the psychometric properties of LP, its exclusion should not negatively impact diagnostic validity. Similarly, the stable heritability across DSM-IV and DSM-5 diagnoses suggests that the proposed changes will not have substantial negative consequences in terms of familial influences, a key validator. These results provide equivocal empirical support for the proposed DSM-5 changes for AUDs.
即将发布的《精神障碍诊断与统计手册》第五版（DSM-5）的修订建议包括以下内容：（i）将 DSM-IV 酒精滥用（AA）和酒精依赖（AD）的标准合并为 1 个诊断类别（酒精使用障碍[ AUD]）；（ii）排除“法律问题”（LP）标准；以及（iii）增加“渴望”标准。很少有已发表的研究从实证角度评估这些拟议变更的潜在后果。
我们使用对终生 AA/AD 诊断进行评估的基于人群的双胞胎样本，研究了 DSM-IV 和没有渴望标准的修改后的 DSM-5 诊断之间的表型差异，因为该标准在数据集不可用。我们使用因素分析和项目反应理论（IRT）评估从 AUD 中排除 LP 标准的潜在后果，并使用双胞胎模型检验 DSM-IV 和修改后的 DSM-5 诊断之间的遗传差异。
AUD 的患病率略高于 DSM-IV 诊断。符合 DSM-IV 或 DSM-5 标准但不符合两者标准的个体比符合两者标准的个体有更少的共病诊断。仅符合 DSM-5 标准的个体的严重程度略低于仅符合 DSM-IV 标准的个体。因素分析表明，LP 标准的负荷是所有症状中最低的；IRT 分析表明该标准的鉴别力较低。DSM-IV 和 DSM-5 诊断之间的遗传相关性略低于 1，但具有统计学意义。
拟议的 DSM-5 AUD 标准不太可能导致诊断为酒精问题的患病率发生重大变化。但是，尚不清楚新的标准是否代表更有效的诊断：新病例的严重程度与仅 DSM-IV 病例相同。鉴于 LP 的心理计量学特性，其排除不应对诊断有效性产生负面影响。同样，DSM-IV 和 DSM-5 诊断之间的稳定遗传力表明，拟议的变更在家族影响方面不会产生实质性的负面影响，家族影响是关键的验证因素。这些结果为 AUD 拟议的 DSM-5 变更提供了不确定的实证支持。
