Lawrie Stephen M, O'Donovan Michael C, Saks Elyn, Burns Tom, Lieberman Jeffrey A
Department of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh, UK.
MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK.
Lancet Psychiatry. 2016 Apr;3(4):367-74. doi: 10.1016/S2215-0366(15)00577-5.
Psychosis has been recognised as an abnormal state in need of care throughout history and by diverse cultures. Present classifications of psychotic disorder remain based on the presence of specific psychotic symptoms, relative to affective and other symptoms, and their sequence and duration. Although extant diagnostic classifications have restricted validity, they have proven reliability and most clinicians and some patients find them useful. Moreover, these classifications have yet to be replaced by anything better. We propose that an expansion of the subgrouping approach inherent to classification will provide incremental improvement to present diagnostic constructs-as has worked in the rest of medicine. We also propose that subgroups could be created both within and across present diagnostic classifications, taking into consideration the potential value of continuous measures (eg, duration of psychotic symptoms and intelligence quotient). Health-care workers also need to work with service users and carers to develop and adapt approaches to diagnosis that are seen as helpful.
精神病在历史上以及不同文化中都被视为一种需要治疗的异常状态。目前对精神障碍的分类仍然基于特定精神病性症状的存在，相对于情感和其他症状而言，以及它们的顺序和持续时间。尽管现有的诊断分类有效性有限，但已证明具有可靠性，并且大多数临床医生和一些患者认为它们有用。此外，这些分类尚未被更好的分类所取代。我们建议，扩大分类中固有的亚组划分方法将逐步改进目前的诊断结构——就像在医学其他领域那样。我们还建议，可以在目前的诊断分类内部和之间创建亚组，同时考虑连续测量的潜在价值（例如，精神病性症状的持续时间和智商）。医护人员还需要与服务使用者和护理人员合作，开发和调整被认为有帮助的诊断方法。
