Fellowes Sam
Department of Politics, Philosophy and Religion, Lancaster University, Lancaster, LA1 4YL, UK.
Department of Psychology, Lancaster University, Lancaster, LA1 4YF, UK.
Theor Med Bioeth. 2017 Aug;38(4):279-294. doi: 10.1007/s11017-017-9416-x.
Psychiatric researchers typically assume that the modelling of psychiatric symptoms is not influenced by psychiatric categories; symptoms are modelled and then grouped into a psychiatric category. I highlight this primarily through analysing research domain criteria (RDoC). RDoC's importance makes it worth scrutinizing, and this assessment also serves as a case study with relevance for other areas of psychiatry. RDoC takes inadequacies of existing psychiatric categories as holding back causal investigation. Consequently, RDoC aims to circumnavigate existing psychiatric categories by directly investigating the causal basis of symptoms. The unique methodological approach of RDoC exploits the supposed lack of influence of psychiatric categories on symptom modelling, taking psychiatric symptoms as the same regardless of which psychiatric category is employed or if no psychiatric category is employed. But this supposition is not always true. I will show how psychiatric categories can influence symptom modelling, whereby identical behaviours can be considered as different symptoms based on an individual's psychiatric diagnosis. If the modelling of symptoms is influenced by psychiatric categories, then psychiatric categories will still play a role, a situation which RDoC researchers explicitly aim to avoid. I discuss four ways RDoC could address this issue. This issue also has important implications for factor analysis, cluster analysis, modifying psychiatric categories, and symptom based approaches.
精神病学研究人员通常认为，精神症状的建模不受精神疾病分类的影响；先对症状进行建模，然后将其归入某个精神疾病类别。我主要通过分析研究领域标准（RDoC）来突出这一点。RDoC的重要性使其值得仔细审查，而这种评估也可作为一个与精神病学其他领域相关的案例研究。RDoC认为现有精神疾病分类的不足之处阻碍了因果关系研究。因此，RDoC旨在通过直接研究症状的因果基础来绕过现有的精神疾病分类。RDoC独特的方法论利用了精神疾病分类对症状建模缺乏影响这一假设，无论采用哪种精神疾病分类或是否不采用任何精神疾病分类，都将精神症状视为相同。但这种假设并不总是成立。我将展示精神疾病分类如何影响症状建模，即基于个体的精神疾病诊断，相同的行为可被视为不同的症状。如果症状建模受到精神疾病分类的影响，那么精神疾病分类仍将发挥作用，而这正是RDoC研究人员明确试图避免的情况。我讨论了RDoC可以解决这个问题的四种方法。这个问题对因素分析、聚类分析、修改精神疾病分类以及基于症状的方法也具有重要意义。
