Department of Psychology, Emory University, Atlanta, Georgia 30322, USA.
JAMA Psychiatry. 2013 Feb;70(2):140-8. doi: 10.1001/jamapsychiatry.2013.270.
CONTEXT With growing recognition that most forms of psychopathology are best represented as dimensions or spectra, a central question becomes how to implement dimensional diagnosis in a way that is empirically sound and clinically useful. Prototype matching, which involves comparing a patient's clinical presentation with a prototypical description of the disorder, is an approach to diagnosis that has gained increasing attention with forthcoming revisions to both the DSM and the International Classification of Diseases. OBJECTIVE To examine prototype diagnosis for mood and anxiety disorders. DESIGN, SETTING, AND PATIENTS In the first study, we examined clinicians' DSM-IV and prototype diagnoses with their ratings of the patients' adaptive functioning and patients' self-reported symptoms. In the second study, independent interviewers made prototype diagnoses following either a systematic clinical interview or a structured diagnostic interview. A third interviewer provided independent ratings of global adaptive functioning. Patients were recruited as outpatients (study 1; N = 84) and from primary care clinics (study 2; N = 143). MAIN OUTCOME MEASURES Patients' self-reported mood, anxiety, and externalizing symptoms along with independent clinical ratings of adaptive functioning. RESULTS Clinicians' prototype diagnoses showed small to moderate correlations with patient-reported psychopathology and performed as well as or better than DSM-IV diagnoses. Prototype diagnoses from independent interviewers correlated on average r = .50 and showed substantial incremental validity over DSM-IV diagnoses in predicting adaptive functioning. CONCLUSIONS Prototype matching is a viable alternative for psychiatric diagnosis. As in research on personality disorders, mood and anxiety disorder prototypes outperformed DSM-IV decision rules in predicting psychopathology and global functioning. Prototype matching has multiple advantages, including ease of use in clinical practice, reduced artifactual comorbidity, compatibility with naturally occurring cognitive processes in diagnosticians, and ready translation into both categorical and dimensional diagnosis.
随着越来越多的人认识到，大多数形式的精神病理学最好被表示为维度或谱系，一个核心问题是如何以经验为基础且具有临床实用性的方式实施维度诊断。原型匹配，即比较患者的临床表现与疾病的典型描述，是一种诊断方法，随着 DSM 和国际疾病分类的修订，它越来越受到关注。
检查情绪和焦虑障碍的原型诊断。
设计、设置和患者：在第一项研究中，我们检查了临床医生的 DSM-IV 和原型诊断，以及他们对患者适应功能和患者自我报告症状的评分。在第二项研究中，独立访谈者根据系统临床访谈或结构化诊断访谈进行原型诊断。第三位访谈者提供了对整体适应功能的独立评分。患者是作为门诊患者（研究 1；N=84）和从初级保健诊所招募的（研究 2；N=143）。
患者自我报告的情绪、焦虑和外化症状以及独立的临床适应功能评定。
临床医生的原型诊断与患者报告的精神病理学具有小到中等程度的相关性，其表现与 DSM-IV 诊断一样或更好。来自独立访谈者的原型诊断平均 r =.50，在预测适应功能方面与 DSM-IV 诊断相比具有实质性的增量有效性。
原型匹配是一种可行的精神病学诊断替代方法。与人格障碍研究一样，情绪和焦虑障碍原型在预测精神病理学和整体功能方面优于 DSM-IV 决策规则。原型匹配具有多种优势，包括在临床实践中易于使用、减少人为的共病、与诊断者自然发生的认知过程兼容，以及易于转化为分类和维度诊断。
