1 Children's Hospital of Eastern Ontario-Research Institute and the University of Ottawa, Ottawa, Ontario, Canada.
Can J Psychiatry. 2018 Sep;63(9):597-601. doi: 10.1177/0706743718772515. Epub 2018 Apr 19.
The term dual diagnosis can refer to the co-occurrence of an intellectual disability and a mental disorder. While such a term may have some advocacy rationale aimed at facilitating improved mental health care for those with intellectual disabilities, it is proposed that the construct has flawed underpinnings, and its application may problematize mental health service delivery. A core concern is the promotion of categorical diagnostic models, whereas dimensional models may more accurately reflect underlying continuums for both cognitive and mental health challenges. A categorical diagnostic approach may also contribute to questionable dichotomization of mental health difficulties in persons with intellectual disabilities into "problem or challenging behaviours" versus "mental disorders." Organizing services based on beliefs that such distinctions and categorical classifications are accurate may contribute to unnecessary and inappropriate fractionation of interventions and create additional service barriers for a vulnerable population. It is proposed that the term dual diagnosis be abandoned and replaced by systematic use of a dimensional approach to help facilitate assessment, intervention evaluation, and equitable service access.
“双重诊断”一词可指智力障碍和精神障碍同时存在。虽然这个术语可能有一些倡导的理由，旨在为智力障碍者提供更好的精神保健，但有人认为这个概念基础有缺陷，其应用可能会使精神卫生服务的提供复杂化。一个核心问题是促进分类诊断模式，而维度模型可能更准确地反映认知和精神健康挑战的潜在连续体。分类诊断方法也可能导致对智力障碍者的精神健康问题进行可疑的二分法，将其分为“问题或挑战行为”与“精神障碍”。基于这样的信念来组织服务，即这种区分和分类是准确的，可能会导致干预措施的不必要和不适当的分割，并为弱势群体制造更多的服务障碍。建议放弃“双重诊断”一词，代之以系统地使用维度方法，以帮助促进评估、干预评估和公平的服务获取。
