Pies Ronald W
Dr. Pies is Professor of Psychiatry at SUNY Upstate Medical University Syracuse, New York, and Clinical Professor of Psychiatry at Tufts University School of Medicine in Boston.
Innov Clin Neurosci. 2014 Jul;11(7-8):19-22.
The removal of the bereavement exclusion in the diagnosis of major depression was perhaps the most controversial change from DSM-IV to DSM-5. Critics have argued that removal of the bereavement exclusion will "medicalize" ordinary grief and encourage over-prescription of antidepressants. Supporters of the DSM-5's decision argue that there is no clinical or scientific basis for "excluding" patients from a diagnosis of major depression simply because the condition occurs shortly after the death of a loved one (bereavement). Though bereavement-related grief and major depression share some features, they are distinct and distinguishable conditions. Bereavement does not "immunize" the patient against a major depressive episode, and is in fact a common precipitant of clinical depression. Recognizing major depression in the context of recent bereavement takes careful clinical judgment, and by no means implies that antidepressant treatment is warranted. But given the serious risks of unrecognized major depression-including suicide- eliminating the bereavement exclusion from DSM-5 was, on balance, a reasonable decision.
在重度抑郁症诊断中取消丧亲排除标准可能是《精神疾病诊断与统计手册》（DSM）从第四版到第五版最具争议的变化。批评者认为，取消丧亲排除标准会将普通悲伤“医学化”，并助长抗抑郁药的过度处方。支持DSM - 5这一决定的人认为，仅仅因为某种情况发生在亲人去世（丧亲）后不久，就将患者“排除”在重度抑郁症诊断之外，这没有临床或科学依据。虽然与丧亲相关的悲伤和重度抑郁症有一些共同特征，但它们是不同且可区分的状况。丧亲并不能使患者“免疫”于重度抑郁发作，实际上它是临床抑郁症的常见诱因。在近期丧亲的背景下识别重度抑郁症需要谨慎的临床判断，这绝不意味着就有必要进行抗抑郁治疗。但是，鉴于未被识别的重度抑郁症存在严重风险，包括自杀，总体而言，从DSM - 5中取消丧亲排除标准是一个合理的决定。
