From the Department of Psychology and Neuroscience, the Department of Psychiatry and Behavioral Sciences, and the Center for Genomic and Computational Biology, Duke University, Durham, N.C.; and the Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London.
Am J Psychiatry. 2018 Sep 1;175(9):831-844. doi: 10.1176/appi.ajp.2018.17121383. Epub 2018 Apr 6.
In both child and adult psychiatry, empirical evidence has now accrued to suggest that a single dimension is able to measure a person's liability to mental disorder, comorbidity among disorders, persistence of disorders over time, and severity of symptoms. This single dimension of general psychopathology has been termed "p," because it conceptually parallels a dimension already familiar to behavioral scientists and clinicians: the "g" factor of general intelligence. As the g dimension reflects low to high mental ability, the p dimension represents low to high psychopathology severity, with thought disorder at the extreme. The dimension of p unites all disorders. It influences present/absent status on hundreds of psychiatric symptoms, which modern nosological systems typically aggregate into dozens of distinct diagnoses, which in turn aggregate into three overarching domains, namely, the externalizing, internalizing, and psychotic experience domains, which finally aggregate into one dimension of psychopathology from low to high: p. Studies show that the higher a person scores on p, the worse that person fares on measures of family history of psychiatric illness, brain function, childhood developmental history, and adult life impairment. A dimension of p may help account for ubiquitous nonspecificity in psychiatry: multiple disorders share the same risk factors and biomarkers and often respond to the same therapies. Here, the authors summarize the history of the unidimensional idea, review modern research into p, demystify statistical models, articulate some implications of p for prevention and clinical practice, and outline a transdiagnostic research agenda. [AJP AT 175: Remembering Our Past As We Envision Our Future October 1910: A Study of Association in Insanity Grace Helen Kent and A.J. Rosanoff: "No sharp distinction can be drawn between mental health and mental disease; a large collection of material shows a gradual and not an abrupt transition from the normal state to pathological states."(Am J Psychiatry 1910; 67(2):317-390 )].
在儿童和成人精神病学中，现在已经有了经验证据表明，一个单一的维度能够衡量一个人患上精神障碍的倾向、障碍之间的共病、障碍随时间的持续存在以及症状的严重程度。这个一般精神病理学的单一维度被称为“p”，因为它在概念上与行为科学家和临床医生已经熟悉的一个维度平行：一般智力的“g”因素。随着 g 维度反映出从低到高的心理能力，p 维度代表了从低到高的精神病理学严重程度，以思维障碍为极端。p 维度统一了所有障碍。它影响着数百种精神症状的现在/不存在状态，而现代分类系统通常将这些症状汇总成几十种不同的诊断，进而汇总成三个总体领域，即外部化、内化和精神病性经验领域，最终汇总成一个从低到高的精神病理学维度：p。研究表明，一个人在 p 上的得分越高，他们在精神病史、大脑功能、儿童发展历史和成年生活障碍方面的表现就越差。p 维度可能有助于解释精神病学中普遍存在的非特异性：多种障碍具有相同的风险因素和生物标志物，并且经常对相同的治疗方法有反应。在这里，作者总结了单一维度思想的历史，回顾了现代关于 p 的研究，揭开了统计模型的神秘面纱，阐明了 p 对预防和临床实践的一些影响，并概述了一个跨诊断研究议程。[《美国精神病学杂志》175 期：回顾过去，展望未来 1910 年 10 月：一项关于精神错乱的关联研究格雷斯·海伦·肯特和 A.J.罗萨诺夫：“精神健康和精神疾病之间没有明显的区别；大量材料表明，从正常状态到病理状态的转变是逐渐的，而不是突然的。”（《美国精神病学杂志》1910 年；67(2):317-390）]。
