Goldberg David
Institute of Psychiatry, King's College, London, UK,
Soc Psychiatry Psychiatr Epidemiol. 2015 Jan;50(1):1-5. doi: 10.1007/s00127-014-0924-y. Epub 2014 Jun 27.
The strengths and weaknesses of the 5th edition of the Diagnostic and Statistical Manual of the American Psychiatric Association are considered, and the likely form of the revised version of the International Classification of Disease, due to be released in the future is briefly considered.
It is argued that there are a number of problems in the checklist approach to diagnosis: there are no points of rarity between common disorders, and that many disorders are rough groupings containing highly heterogeneous syndromes. The tendency to reify these disorders and to view them as independent entities, and to stretch the concept of co-morbidity to cover individuals who satisfy more than one of the diagnostic checklists is seen as being misleading as it gives a false air of precision.
Two broadly similar solutions are proposed for an alternative approach to common mental disorders.
探讨了美国精神病学协会《精神疾病诊断与统计手册》第5版的优缺点,并简要考虑了未来即将发布的《国际疾病分类》修订版可能的形式。
有人认为,诊断的清单式方法存在一些问题:常见疾病之间没有罕见病例点,而且许多疾病只是粗略的分组,包含高度异质的综合征。将这些疾病具体化并视为独立实体的倾向,以及将共病概念扩展到满足多个诊断清单的个体的做法,被认为具有误导性,因为它给人一种虚假的精确感。
针对常见精神障碍的替代方法,提出了两种大致相似的解决方案。