Derouesné Christian
Université Pierre et Marie Curie (Paris VI) ; EA 4556. Laboratoire Epsilon, Dynamique des capacités humaines et des conduites de santé, Université Paul Valéry, Montpellier 3, France.
Geriatr Psychol Neuropsychiatr Vieil. 2013 Dec;11(4):403-15. doi: 10.1684/pnv.2013.0436.
The DSM-5 introduces major modifications in the category of mental disorders due to brain lesions compared to the previous DSM versions, which are reviewed in this paper. The description of the category Major neurocognitive disorder, as a substitute for dementia, seems to fit better for patients and families, and more adapted to many neurodegenerative cognitive disorders for which memory impairment is not predominant. Similarly, the introduction of the category of Mild neurocognitive disorder appears to be an improvement although some difficulty still remains for distinguishing mild cognitive disorder from normal aging. The addition of new etiological categories such as fronto-temporal NCD or NCD with Lewy bodies should also to be considered as a significant improvement. Despite these advances, to circumscribe the mental disorders due to brain lesions to cognitive deficits and biological mechanisms remains highly questionable, and does not provide an adequate care for the patients and families if not complemented by a psychological and environmental approach.
与之前的DSM版本相比,《精神疾病诊断与统计手册》第5版(DSM-5)在脑损伤所致精神障碍类别上引入了重大修改,本文对此进行了综述。将主要神经认知障碍类别作为痴呆的替代,这似乎更适合患者和家庭,并且更适用于许多以记忆障碍不突出的神经退行性认知障碍。同样,轻度神经认知障碍类别的引入似乎是一种进步,尽管在区分轻度认知障碍与正常衰老方面仍存在一些困难。新增诸如额颞叶神经认知障碍或路易体神经认知障碍等病因类别也应被视为一项重大进步。尽管有这些进展,但将脑损伤所致精神障碍局限于认知缺陷和生物学机制仍存在很大疑问,如果没有心理和环境方面的方法作为补充,就无法为患者和家庭提供充分的照料。