Mental Health Center Amager, Denmark.
Mental Health Center Amager, Denmark; Center for Subjectivity Research, Department of Communication, University of Copenhagen, Denmark; Mental Health Center Glostrup, Denmark.
Psychiatry Res. 2020 Sep;291:113302. doi: 10.1016/j.psychres.2020.113302. Epub 2020 Jul 13.
In everyday clinical work, psychiatrists encounter patients who present with symptoms spanning several diagnostic categories, e.g., showing signs of a psychosis, depression, and anxiety. This raises the critical question of which symptoms hold precedence over other and, by extension, which diagnosis is the right diagnosis. ICD-10 and DSM-5 do not provide unambiguous answers to this question and therefore psychiatry remains exposed to diagnostic disagreement with consequences for treatment and research. We explored symptom distribution in a sample of 98 first-admission psychiatric patients. We extracted and categorized singular symptoms into symptom domains: anxiety, mania, delusions, hallucinations, first-rank symptoms, and negative symptoms. Most symptoms were seen in most disorders. We found symptoms of depression and anxiety in almost all patients. Thus, just counting symptoms do not seem to be a valid way to make diagnoses. We elaborately discuss these issues in the context of the differential-diagnosis between schizophrenia and depression. Finally, we suggest that a combination of a criteria- and Gestalt-based approach to diagnosing mental disorders may contribute to counteract some of the current differential-diagnostic confusion.
在日常临床工作中，精神科医生会遇到同时出现多种诊断类别的症状的患者，例如表现出精神病、抑郁和焦虑的迹象。这就提出了一个关键问题，即哪些症状优先于其他症状，以及哪个诊断是正确的诊断。ICD-10 和 DSM-5 并没有对此问题给出明确的答案，因此精神病学仍然容易出现诊断分歧，这对治疗和研究都有影响。我们研究了 98 名首次入院的精神科患者样本中的症状分布。我们将单一症状提取并分类为症状域：焦虑、躁狂、妄想、幻觉、一级症状和阴性症状。大多数症状出现在大多数疾病中。我们发现几乎所有患者都有抑郁和焦虑的症状。因此，仅仅计数症状似乎不是一种有效的诊断方法。我们在精神分裂症和抑郁症的鉴别诊断背景下详细讨论了这些问题。最后，我们建议将基于标准和基于整体的方法相结合来诊断精神障碍，可能有助于对抗当前一些鉴别诊断的混乱。
