van Praag H M
Department of Psychiatry, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York.
Psychiatr Dev. 1989 Winter;7(4):375-94.
Before the advent of antidepressants, no generally accepted and operationalized classification of depression existed. In the late fifties and sixties we developed a multi-axial and operationalized depression taxonomy in order to be able to study systematically the clinical and biochemical action of antidepressants and biological characteristics of depressives responsive to antidepressants. The keypoints of that system and the data on which it was based are discussed, after which it is compared with the depression classification proposed by the DSM III and DSM III-R. Though it is recognized that a system based on consensus opinion can never be overall acceptable to everyone, the conclusion is reached that the DSM depression classification is outright unsatisfactory and contributes to diagnostic confusion rather than to reduce it. It is recommended that an immediate moratorium should be laid on expert-opinion-based alterations in the classification of depressions and that future changes will be based only on research specifically designed to resolve issues pertinent to that classification. In organizing, conducting and funding such a collaborative, goal-directed effort, the National Institute of Mental Health could play a seminal role.
在抗抑郁药出现之前，不存在被普遍接受且可操作的抑郁症分类。在五十年代末和六十年代，我们制定了一种多轴且可操作的抑郁症分类法，以便能够系统地研究抗抑郁药的临床和生化作用以及对抗抑郁药有反应的抑郁症患者的生物学特征。文中讨论了该系统的要点及其所基于的数据，之后将其与《精神疾病诊断与统计手册》第三版（DSM III）和《精神疾病诊断与统计手册》第三版修订本（DSM III-R）提出的抑郁症分类进行了比较。尽管人们认识到基于共识意见的系统永远不可能让所有人完全接受，但得出的结论是，DSM抑郁症分类完全不能令人满意，它加剧了诊断混乱而非减少了混乱。建议立即暂停基于专家意见对抑郁症分类进行的更改，并且未来的更改应仅基于专门为解决与该分类相关的问题而设计的研究。在组织、开展和资助这样一项协作性的、目标明确的工作中，美国国立精神卫生研究所可以发挥关键作用。
