Department of Psychiatry, Vanderbilt University, Nashville, TN, USA.
Schizophr Res. 2013 Oct;150(1):11-4. doi: 10.1016/j.schres.2013.04.039. Epub 2013 May 23.
Schizophrenia spectrum disorders attract great interest among clinicians, researchers, and the lay public. While the diagnostic features of schizophrenia have remained unchanged for more than 100 years, the mechanism of illness has remained elusive. There is increasing evidence that the categorical diagnosis of schizophrenia and other psychotic disorders contributes to this lack of progress. The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) continues the categorical classification of psychiatric disorders since the research needed to establish a new nosology of equal or greater validity is lacking. However, even within a categorical system, the DSM-5 aims to capture the underlying dimensional structure of psychosis. The domains of psychopathology that define psychotic disorders are presented not simply as features of schizophrenia. The level, the number, and the duration of psychotic signs and symptoms are used to demarcate psychotic disorders from each other. Finally, the categorical assessment is complemented with a dimensional assessment of psychosis that allows for more specific and individualized assessment of patients. The structure of psychosis as outlined in the DSM-5 may serve as a stepping-stone towards a more valid classification system, as we await new data to redefine psychotic disorders.
精神分裂症谱系障碍在临床医生、研究人员和普通公众中引起了极大的兴趣。虽然精神分裂症的诊断特征 100 多年来没有改变，但疾病的机制仍然难以捉摸。越来越多的证据表明，精神分裂症和其他精神病性障碍的分类诊断导致了这一缺乏进展。《精神障碍诊断与统计手册》（DSM-5）第五版自缺乏建立新的分类学同等或更大有效性的研究以来，继续对精神障碍进行分类。然而，即使在分类系统内，DSM-5 也旨在捕捉精神病的潜在维度结构。定义精神病性障碍的精神病理学领域不仅仅是精神分裂症的特征。精神病性症状的严重程度、数量和持续时间用于区分不同的精神病性障碍。最后，对精神病进行分类评估，并辅以精神病的维度评估，以便更具体和个体化地评估患者。DSM-5 中概述的精神病结构可以作为更有效分类系统的垫脚石，因为我们正在等待新的数据来重新定义精神病性障碍。
