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是时候唤醒睡美人了吗?自 1980 年以来,欧洲精神病学一直处于沉睡状态。

Is it time to awaken Sleeping Beauty? European psychiatry has been sleeping since 1980.

机构信息

University of Kentucky Mental Health Research Center, Eastern State Hospital, Lexington, KY, Estados Unidos; Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, España.

出版信息

Rev Psiquiatr Salud Ment. 2014 Oct-Dec;7(4):186-94. doi: 10.1016/j.rpsm.2013.12.004. Epub 2014 Jan 31.

DOI:10.1016/j.rpsm.2013.12.004
PMID:24486358
Abstract

The Diagnostic and Statistical Manual of Mental Disorders (DSM-III), published in 1980, has led to a dead end, the DSM-V. Following the allegory of Sleeping Beauty, the DSM-III put European psychiatry to sleep; it now must wake up to create a 21st century psychiatric language for descriptive psychopathology and psychiatric nosology. Four topics are reviewed. First, the review of descriptive psychopathology focuses on: a) Chaslin's and Jaspers's books, and b) Schneider's transmittal of Jaspers's ideas and involvement with Kraepelin in incorporating neuroscience into psychiatric nosology. Second, US psychiatry's historic steps include: a) the pseudoscience of psychoanalysis, b) the low level of pre-DSM-III diagnostic expertise, c) the neo-Kraepelinian revolution which led to DSM-III, d) the failure to improve diagnostic skills, and e) the reprise of Kraepelin's marketing ("neuroscience will save psychiatry"). Third, the DSM-III devastated European psychiatry by destroying: a) the national textbooks which increased consistency but eliminated creative European thinking; and b) the Arbeitsgemenschaft fur Methodic und Dokumentation in der Psychiatrie, the most reasonable attempt to reach diagnostic agreement: start with symptoms/signs (first level) rather than disorders (second level). Fourth, Berrios elaborated upon Jaspers, who described psychiatry as a hybrid science and heterogeneous. Berrios affirmed that psychiatric symptoms/signs are hybrid. Some symptoms are in the "semantic space" and cannot be "explained" by neuroscience.

摘要

《精神障碍诊断与统计手册》(DSM-III)于 1980 年出版,导致了 DSM-V 的出现。就像《睡美人》的寓言一样,DSM-III 让欧洲精神病学陷入了沉睡;现在它必须醒来,为描述性精神病理学和精神疾病分类学创造一种 21 世纪的精神科语言。本文回顾了四个主题。首先,描述性精神病理学的回顾重点关注:a)Chaslin 和 Jaspers 的著作,以及 b)Schneider 对 Jaspers 思想的传递以及与 Kraepelin 合作将神经科学纳入精神疾病分类学。其次,美国精神病学的历史步骤包括:a)精神分析的伪科学,b)DSM-III 前诊断专业知识水平低,c)导致 DSM-III 的新 Kraepelin 革命,d)未能提高诊断技能,以及 e)Kraepelin 营销策略的再现(“神经科学将拯救精神病学”)。第三,DSM-III 通过摧毁:a)增加一致性但消除了创造性的欧洲思维的国家教科书;以及 b)Arbeitsgemenschaft fur Methodic und Dokumentation in der Psychiatrie,这是达成诊断共识的最合理尝试:从症状/体征(一级)而不是疾病(二级)开始。第四,Berrios 对 Jaspers 进行了阐述,Jaspers 将精神病学描述为一种混合科学和异质科学。Berrios 肯定了精神科症状/体征是混合的。有些症状处于“语义空间”,无法用神经科学“解释”。

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