Artigas-Pallarès Josep, Paula Isabel
Universitat de Barcelona, España.
Universitat de Barcelona, España. E-mail:
Medicina (B Aires). 2020;80 Suppl 2:21-25.
Research on autism and mental disorders has been unsuccessful over the past few decades, as can be inferred from the poor results related to advances in other diseases. It is concerning that, after more than a half century of research based on the Diagnostic and Statistical Manual of Mental Disorders (DSM), no biological markers have been found to prove the validity of the DSM mental disorders. Criticisms to DSM have been focused mainly on the categorical conceptualization, false comorbidity and the polythetic nature of diagnostic criteria. The lack of validity of the DSM model requests for a change in research designs, in order to overcome the problems derived from a paradigm that has stopped to be productive. In the field of clinical practice, it is even more pressing a change of mindset in order to incorporate the heterogeneity of endophenotypes that overflows the classification of the DSM, to adopt a dimensional perspective of mental problems and to develop an alternative interpretation for comorbidity. Related to research are suggested designs based on Domain Research Criteria and a multifactorial analysis with very large samples (big data). For clinical practice it is suggested a dimensional approach based on the specificities of each person with autism.
在过去几十年里,自闭症和精神障碍的研究一直没有取得成功,从其他疾病进展所带来的糟糕结果中就可以推断出来。令人担忧的是,在基于《精神疾病诊断与统计手册》(DSM)进行了半个多世纪的研究之后,尚未发现任何生物学标志物来证明DSM精神障碍的有效性。对DSM的批评主要集中在分类概念化、虚假共病以及诊断标准的多标准性质上。DSM模型缺乏有效性,这就要求改变研究设计,以克服源自一个已不再有成效的范式所带来的问题。在临床实践领域,更迫切需要改变思维方式,以便纳入超出DSM分类的内表型异质性,采用精神问题的维度视角,并为共病发展出一种替代性解释。与研究相关的是,建议采用基于领域研究标准的设计以及对非常大的样本(大数据)进行多因素分析。对于临床实践,建议基于每个自闭症患者的特殊性采用维度方法。