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广泛性焦虑障碍作为一种诊断类别之历史。

The history of generalized anxiety disorder as a diagnostic category.

作者信息

Crocq Marc-Antoine

机构信息

Medical Center, Rouffach, France.

出版信息

Dialogues Clin Neurosci. 2017 Jun;19(2):107-116. doi: 10.31887/DCNS.2017.19.2/macrocq.

Abstract

From the 19th century into the 20th century, the terms used to diagnose generalized anxiety included "pantophobia" and "anxiety neurosis." Such terms designated paroxysmal manifestations (panic attacks) as well as interparoxysmal phenomenology (the apprehensive mental state). Also, generalized anxiety was considered one of numerous symptoms of neurasthenia, a vaguely defined illness. Generalized anxiety disorder (GAD) appeared as a diagnostic category in the third edition of the () in 1980, when anxiety neurosis was split into GAD and panic disorder. The distinct responses these two disorders had to imipramine therapy was one reason to distinguish between the two. Since the revised (), worry about a number of life circumstances has been gradually emphasized as the distinctive symptom of GAD. Thus, a cognitive aspect of anxiety has become the core criterion of GAD. The validity of GAD as an independent category has been questioned from up to preparation of . Areas of concern have included the difficulty to establish clear boundaries between GAD and (i) personality dimensions, (ii) other anxiety-spectrum disorders, and (iii) nonbipolar depression. The National Institute of Mental Health has recently proposed the Research Domain Criteria (RDoC), a framework destined to facilitate biological research into the etiology of mental symptoms. Within the RDoC framework, generalized anxiety might be studied as a dimension denominated "anxious apprehension" that would typically fit into the research domain called "negative valence systems" and the more specific construct termed "potential threat."

摘要

从19世纪到20世纪,用于诊断广泛性焦虑的术语包括“泛恐惧症”和“焦虑神经症”。这些术语既指阵发性表现(惊恐发作),也指发作间期的现象学(焦虑的精神状态)。此外,广泛性焦虑被认为是神经衰弱这一界定模糊的疾病的众多症状之一。广泛性焦虑障碍(GAD)在1980年《精神疾病诊断与统计手册》第三版中作为一个诊断类别出现,当时焦虑神经症被分为广泛性焦虑障碍和惊恐障碍。这两种障碍对丙咪嗪治疗的不同反应是区分二者的一个原因。自《精神疾病诊断与统计手册》修订版以来,对多种生活状况的担忧逐渐被强调为广泛性焦虑障碍的独特症状。因此,焦虑的认知方面已成为广泛性焦虑障碍的核心标准。从《精神疾病诊断与统计手册》第三版到第五版编制期间,广泛性焦虑障碍作为一个独立类别的有效性一直受到质疑。关注的领域包括难以在广泛性焦虑障碍与(i)人格维度、(ii)其他焦虑谱系障碍以及(iii)非双相抑郁之间划定明确界限。美国国立精神卫生研究所最近提出了研究领域标准(RDoC),这是一个旨在促进对精神症状病因进行生物学研究的框架。在RDoC框架内,广泛性焦虑可能被作为一个名为“焦虑性担忧”的维度来研究,该维度通常属于名为“负性效价系统”的研究领域以及更具体的名为“潜在威胁”的结构。

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