Maes Michael Hj, Stoyanov Drozdstoy
Department of Psychiatry, Chulalongkorn University, Bangkok 10330, Thailand.
Department of Psychiatry, Medical University Plovdiv, Plovdiv 4000, Bulgaria.
World J Psychiatry. 2022 May 19;12(5):651-667. doi: 10.5498/wjp.v12.i5.651.
The current understanding of major depressive disorder (MDD) and bipolar disorder (BD) is plagued by a cacophony of controversies as evidenced by competing schools to understand MDD/BD. The DSM/ICD taxonomies have cemented their status as the gold standard for diagnosing MDD/BD. The aim of this review is to discuss the false dogmas that reign in current MDD/BD research with respect to the new, data-driven, machine learning method to model psychiatric illness, namely nomothetic network psychiatry (NNP). This review discusses many false dogmas including: MDD/BD are mind-brain disorders that are best conceptualized using a bio-psycho-social model or mind-brain interactions; mood disorders due to medical disease are attributable to psychosocial stress or chemical imbalances; DSM/ICD are the gold standards to make the MDD/BD diagnosis; severity of illness should be measured using rating scales; clinical remission should be defined using threshold values on rating scale scores; existing diagnostic BD boundaries are too restrictive; and mood disorder spectra are the rule. In contrast, our NNP models show that MDD/BD are not mind-brain or psycho-social but systemic medical disorders; the DSM/ICD taxonomies are counterproductive; a shared core, namely the reoccurrence of illness (ROI), underpins the intertwined recurrence of depressive and manic episodes and suicidal behaviors; mood disorders should be ROI-defined; ROI mediates the effects of nitro-oxidative stress pathways and early lifetime trauma on the phenome of mood disorders; severity of illness and treatment response should be delineated using the NNP-derived causome, pathway, ROI and integrated phenome scores; and MDD and BD are the same illness.
目前对重度抑郁症（MDD）和双相情感障碍（BD）的理解充斥着各种争议，不同学派试图理解MDD/BD的竞争就证明了这一点。《精神疾病诊断与统计手册》（DSM）/《国际疾病分类》（ICD）分类法巩固了其作为诊断MDD/BD的金标准的地位。本综述的目的是讨论当前MDD/BD研究中盛行的错误教条，这些教条涉及用于对精神疾病进行建模的新的、数据驱动的机器学习方法，即实证网络精神病学（NNP）。本综述讨论了许多错误教条，包括：MDD/BD是心脑疾病，最好使用生物 - 心理 - 社会模型或心脑相互作用来进行概念化；由医学疾病引起的情绪障碍可归因于心理社会压力或化学失衡；DSM/ICD是进行MDD/BD诊断的金标准；疾病严重程度应使用评定量表来衡量；临床缓解应使用评定量表分数的阈值来定义；现有的BD诊断界限过于严格；以及情绪障碍谱系是常态。相比之下，我们的NNP模型表明，MDD/BD不是心脑或心理 - 社会疾病，而是全身性医学疾病；DSM/ICD分类法适得其反；一个共同的核心，即疾病复发（ROI），支撑着抑郁发作、躁狂发作和自杀行为的交织复发；情绪障碍应以ROI来定义；ROI介导了硝基氧化应激途径和早期生活创伤对情绪障碍表型的影响；疾病严重程度和治疗反应应使用NNP衍生的病因、途径、ROI和综合表型分数来描述；并且MDD和BD是同一种疾病。
