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精神病学只是神经学吗?还是只是变态心理学?百年之后似曾相识。

Is psychiatry only neurology? Or only abnormal psychology? Déjà vu after 100 years.

作者信息

de Leon Jose

机构信息

University of Kentucky Mental Health Research Center at Eastern State Hospital,Lexington,KY,and Psychiatry and Neurosciences Research Group (CTS-549),Institute of Neurosciences,University of Granada,Granada,Spain,and Biomedical Research Centre in Mental Health Net (CIBERSAM),Santiago Apóstol Hospital,University of the Basque Country,Vitoria,Spain.

出版信息

Acta Neuropsychiatr. 2015 Apr;27(2):69-81. doi: 10.1017/neu.2014.34.

Abstract

Forgetting history, which frequently repeats itself, is a mistake. In General Psychopathology, Jaspers criticised early 20th century psychiatrists, including those who thought psychiatry was only neurology (Wernicke) or only abnormal psychology (Freud), or who did not see the limitations of the medical model in psychiatry (Kraepelin). Jaspers proposed that some psychiatric disorders follow the medical model (Group I), while others are variations of normality (Group III), or comprise schizophrenia and severe mood disorders (Group II). In the early 21st century, the players' names have changed but the game remains the same. The US NIMH is reprising both Wernicke's brain mythology and Kraepelin's marketing promises. The neo-Kraepelinian revolution started at Washington University, became pre-eminent through the DSM-III developed by Spitzer, but reached a dead end with the DSM-5. McHugh, who described four perspectives in psychiatry, is the leading contemporary representative of the Jaspersian diagnostic approach. Other neo-Jaspersians are: Berrios, Wiggins and Schwartz, Ghaemi, Stanghellini, Parnas and Sass. Can psychiatry learn from its mistakes? The current psychiatric language, organised at its three levels, symptoms, syndromes, and disorders, was developed in the 19th century but is obsolete for the 21st century. Scientific advances in Jaspers' Group III disorders require collaborating with researchers in the social and psychological sciences. Jaspers' Group II disorders, redefined by the author as schizophrenia, catatonic syndromes, and severe mood disorders, are the core of psychiatry. Scientific advancement in them is not easy because we are not sure how to delineate between and within them correctly.

摘要

忘记历史(而历史常常重演)是一个错误。在《普通精神病理学》中,雅斯贝尔斯批评了20世纪早期的精神病学家,包括那些认为精神病学只是神经学(韦尼克)或只是变态心理学(弗洛伊德)的人,或者那些没有看到精神病学中医学模式局限性的人(克雷佩林)。雅斯贝尔斯提出,一些精神障碍遵循医学模式(第一组),而另一些是正常状态的变体(第三组),或者包括精神分裂症和严重情绪障碍(第二组)。在21世纪初,参与者的名字变了,但游戏依旧。美国国立精神卫生研究所(NIMH)正在重演韦尼克的大脑神话和克雷佩林的营销承诺。新克雷佩林主义革命始于华盛顿大学,通过斯皮策开发的《精神疾病诊断与统计手册》第三版(DSM - III)变得卓越,但在《精神疾病诊断与统计手册》第五版(DSM - 5)时走到了死胡同。描述了精神病学四种观点的麦克休,是当代雅斯贝尔斯诊断方法的主要代表人物。其他新雅斯贝尔斯主义者有:贝里奥斯、威金斯和施瓦茨、加米、斯坦盖利尼、帕尔纳斯和萨斯。精神病学能从其错误中吸取教训吗?当前的精神病学语言,按症状、综合征和障碍这三个层次组织起来,是在19世纪发展起来的,但对于21世纪来说已经过时。雅斯贝尔斯第三组障碍的科学进展需要与社会科学和心理科学的研究人员合作。雅斯贝尔斯第二组障碍,被作者重新定义为精神分裂症、紧张症综合征和严重情绪障碍,是精神病学的核心。它们的科学进展并不容易,因为我们不确定如何在它们之间以及它们内部正确地进行界定。

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