Wing J K
Medical Research Council Social Psychiatry Unit, Institute of Psychiatry, London, United Kingdom.
Schizophr Bull. 1988;14(4):669-73. doi: 10.1093/schbul/14.4.669.
Among the many technical issues dealt with in this symposium, two clinical problems are preeminent--how is schizophrenia defined and what is meant by outcome? Each problem is highly complex. Even given adequate designs, sampling, and analysis, the generalizability of the results depends on the extent to which the diagnostic and outcome criteria are independent of each other and reproducible. The authors amply demonstrate how far we are from achieving such comparability. Schizophrenia, at the moment, is diagnosable only on its manifestations, which can be influenced for better or worse by environmental conditions. Several standardized diagnostic systems are available but they recommend different sets of rules. It is premature, therefore, to speak of a "natural" long-term course. It is even doubtful whether further long-term studies (except perhaps of birth cohorts) should be attempted until more discriminating and reliable methods have been found. Short-term studies, however, focused on specific hypotheses, still hold out promise of yielding fruitful results.
在本次研讨会上讨论的众多技术问题中，有两个临床问题最为突出——精神分裂症是如何定义的，以及结局意味着什么？每个问题都极为复杂。即使有足够的设计、抽样和分析，结果的可推广性仍取决于诊断标准和结局标准彼此独立且可重复的程度。作者充分展示了我们距离实现这种可比性还有多远。目前，精神分裂症只能根据其表现进行诊断，而这些表现可能会受到环境条件的好坏影响。有几种标准化诊断系统可供使用，但它们推荐的规则各不相同。因此，现在谈论“自然”的长期病程还为时过早。甚至值得怀疑的是，在找到更具区分性和可靠性的方法之前，是否应该尝试进行进一步的长期研究（可能出生队列研究除外）。然而，专注于特定假设的短期研究仍有望产生丰硕成果。
