Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA.
Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI, USA; Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA.
Compr Psychiatry. 2017 Nov;79:80-88. doi: 10.1016/j.comppsych.2017.04.004. Epub 2017 Apr 18.
Although practice guidelines are based on disorders specified in diagnostic manuals, such as the DSM, practitioners appear to follow symptoms when making treatment decisions. Psychiatric medication is generally prescribed in a transdiagnostic manner, further highlighting how symptoms, not diagnoses, often guide clinical practice. A quantitative approach to nosology promises to provide better guidance as it describes psychopathology dimensionally and its organization reflects patterns of covariation among symptoms.
To investigate whether a quantitative classification of emotional disorders can account for naturalistic medication prescription patterns better than traditional diagnoses.
Symptom dimensions and DSM diagnoses of emotional disorders, as well as prescribed medications, were assessed using interviews in a psychiatric outpatient sample (N=318, mean age 42.5years old, 59% female, 81% Caucasian).
Each diagnosis was associated with prescription of multiple medication classes, and most medications were associated with multiple disorders. This was largely due to heterogeneity of clinical diagnoses, with narrow, homogenous dimensions underpinning diagnoses showing different medication profiles. Symptom dimensions predicted medication prescription better than DSM diagnoses, irrespective of whether this was examined broadly across all conditions, or focused on a specific disorder and medication indicated for it.
Psychiatric medication was prescribed in line with symptoms rather than DSM diagnoses. A quantitative approach to nosology may better reflect treatment planning and be a more effective guide to pharmacotherapy than traditional diagnoses. This adds to a diverse body of evidence about superiority of the quantitative system in practical applications and highlights its potential to improve psychiatric care.
尽管实践指南是基于诊断手册（如 DSM）中规定的障碍制定的，但医生在做出治疗决策时似乎更关注症状。精神科药物通常以跨诊断的方式开具，这进一步强调了症状而不是诊断通常指导临床实践。对分类学的定量方法有望提供更好的指导，因为它从维度上描述了精神病理学，其组织反映了症状之间的共变模式。
研究情绪障碍的定量分类是否比传统诊断更能解释自然发生的药物处方模式。
使用访谈对精神科门诊患者样本（N=318，平均年龄 42.5 岁，女性占 59%，白人占 81%）评估情绪障碍的症状维度和 DSM 诊断以及开处方的药物。
每个诊断都与多种药物类别相关，而大多数药物与多种疾病相关。这主要是由于临床诊断的异质性所致，具有狭窄、同质维度的诊断显示出不同的药物特征。症状维度比 DSM 诊断更能预测药物处方，无论这是在所有情况下进行广泛检查，还是专注于特定的疾病和为此开的药物。
精神科药物是根据症状而不是 DSM 诊断开的。对分类学的定量方法可能比传统诊断更能反映治疗计划，并且是更有效的药物治疗指导。这增加了关于定量系统在实际应用中具有优越性的大量证据，并强调了其改善精神保健的潜力。
