ICube - CNRS UMR 7357, neurophysiology, FMTS, University of Strasbourg, France ; CEMNIS - Noninvasive Neuromodulation Center, University Hospital Strasbourg, France.
Department of Psychiatry and Psychotherapy, University of Würzburg, Würzburg, Germany.
Dialogues Clin Neurosci. 2020 Mar;22(1):37-49. doi: 10.31887/DCNS.2020.22.1/jfoucher.
While the ICD-DSM paradigm has been a major advance in clinical psychiatry, its usefulness for biological psychiatry is debated. By defining consensus-based disorders rather than empirically driven phenotypes, consensus classifications were not an implementation of the biomedical paradigm. In the field of endogenous psychoses, the Wernicke-Kleist-Leonhard (WKL) pathway has optimized the descriptions of 35 major phenotypes using common medical heuristics on lifelong diachronic observations. Regarding their construct validity, WKL phenotypes have good reliability and predictive and face validity. WKL phenotypes come with remarkable evidence for differential validity on age of onset, familiality, pregnancy complications, precipitating factors, and treatment response. Most impressive is the replicated separation of high- and low-familiality phenotypes. Created in the purest tradition of the biomedical paradigm, the WKL phenotypes deserve to be contrasted as credible alternatives with other approaches currently under discussion. .
虽然 ICD-DSM 范式在临床精神病学方面取得了重大进展，但它对生物精神病学的实用性仍存在争议。通过基于共识定义疾病，而不是基于经验驱动的表型，共识分类并不是生物医学范式的实施。在内源性精神病学领域，Wernicke-Kleist-Leonhard (WKL) 途径使用常见的医学启发式方法对终身历时观察中的 35 种主要表型进行了优化描述。关于其构念效度，WKL 表型具有良好的可靠性和预测性以及表面效度。WKL 表型在发病年龄、家族性、妊娠并发症、诱发因素和治疗反应方面具有显著的差异有效性证据。最令人印象深刻的是高家族性和低家族性表型的可重复分离。WKL 表型是在最纯粹的生物医学范式传统中创建的，它们应该与目前正在讨论的其他方法进行对比，作为可信的替代方案。
