Department of Psychiatry, College of Medicine, Korea University Ansan Hospital, 516, Gojan-dong, 425-707, Ansan, Gyeonggi Province, Republic of Korea.
Department of Psychiatry, Inje University Haeundae Paik Hospital, 875, Haeun-daero, Haeundae-gu, 48108, Busan, Republic of Korea.
Adv Exp Med Biol. 2019;1192:17-25. doi: 10.1007/978-981-32-9721-0_2.
Because of the poor link between psychiatric diagnosis and neurobiological findings, it is difficult to classify mental disorders. The changes made to psychiatric diagnostic systems over the years can be understood in terms of "practical conservatism." The Diagnostic and Statistical Manual of Mental Disorders (DSM)-I and DSM-II were theoretically supported by the psychoanalytic and psychodynamic approach. Subsequently, psychiatric diagnoses of this kind were opposed by the anti-psychiatry movement, as well as by the findings of the Rosenhan experiment. Thus, the DSM-III revolution contained more empiricism, aligning psychiatry with biomedicine. Psychiatric diagnoses are classified and defined in terms of Kraepelinian dualism, using a categorical approach. The empirical trend was continued in the DSM-IV. To overcome the limitations of current psychiatric diagnostic systems and integrate fundamental genetic, neurobiological, behavioral, environmental, and experimental components into psychiatry, the Research Domain Criteria (RDoC) were established. To overcome the limitations of the categorical approach, psychiatrists have considered adopting a dimensional approach. However, their efforts were frustrated in the DSM-5 revision process. Thus, the DSM-5 is characterized by the rearrangement of psychiatric diagnoses, the partial adoption of a dimensional approach, the introduction of new diagnoses, and harmonization with the International Classification of Diseases.
由于精神疾病的诊断与神经生物学发现之间联系不佳,因此难以对精神障碍进行分类。多年来,精神疾病诊断系统所做的改变可以从“实际保守主义”的角度来理解。《精神障碍诊断与统计手册》(DSM)第一版和第二版在理论上受到精神分析和心理动力学方法的支持。随后,这种精神科诊断受到反精神病学运动以及罗森汉实验的结果的反对。因此,DSM-III 革命包含了更多的经验主义,使精神病学与生物医学保持一致。精神科诊断是根据克莱佩林的二元论进行分类和定义的,采用分类方法。DSM-IV 延续了这一经验趋势。为了克服当前精神疾病诊断系统的局限性,并将基础遗传、神经生物学、行为、环境和实验成分整合到精神病学中,建立了研究领域标准(RDoC)。为了克服分类方法的局限性,精神科医生曾考虑采用维度方法。然而,他们的努力在 DSM-5 修订过程中受挫。因此,DSM-5 的特点是对精神科诊断进行重新排列,部分采用维度方法,引入新的诊断,并与《国际疾病分类》相协调。