Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Drs Flaherty and Katz contributed equally to this article.
J Clin Psychiatry. 2022 Jul 6;83(4):21ct14543. doi: 10.4088/JCP.21ct14543.
Classic psychiatry patients are rare; real-world patients tend to have overlapping features of multiple disorders. Striving for diagnostic certainty, and treatments aimed at tentative diagnoses, often fail these patients. In such cases, tolerating diagnostic ambiguity and "treating the symptoms" can sometimes be transformative. An important symptom, often undertreated in a diagnosis-based approach, is rumination. We present a case study of a woman who, after 20 years of treatment failure, achieved significant symptom relief when her primary complaint-"labored thinking"-was targeted specifically. However, because no seriously ill person has only 1 symptom, 6 clinicians from different subdisciplines will discuss the patient's other issues, ones that an overfocus on rumination might leave out.
经典精神疾病患者较为少见；而实际患者往往具有多种障碍的重叠特征。为了追求明确的诊断和针对暂定诊断的治疗，这些患者往往得不到有效治疗。在这种情况下，容忍诊断上的不确定性并“治疗症状”有时可能会产生变革性的效果。一个重要的症状，在基于诊断的方法中往往治疗不足，就是反刍。我们提出了一个案例研究，一名女性患者在 20 年的治疗失败后，当她的主要抱怨——“思维费力”——得到了特别关注时，她的症状得到了显著缓解。然而，由于没有任何重病患者只有 1 个症状，因此来自不同亚专科的 6 位临床医生将讨论患者的其他问题，这些问题可能会因为过度关注反刍而被遗漏。
