Goldstein Ferber Sari, Shoval Gal, Weller Aron, Zalsman Gil
Department of Psychology and Brain Sciences, University of Delaware, Newark, DE 19716, United States.
Psychology and Gonda Brain Research Center, Bar Ilan University, Ramat Gan 5317000, Israel.
World J Psychiatry. 2023 Jul 19;13(7):402-408. doi: 10.5498/wjp.v13.i7.402.
A condition of exposure to multiple stressors resulting in a mixed clinical picture spanning conventional categories without meeting any of them in full, encompasses a risk for a list of comorbidities preventing appropriate prevention and treatment. New transformative transdiagnostic approaches suggest changes spanning conventional categories. They base their systems of classification on biomarkers as well as on brain structural and functional dysregulation as associated with behavioral and emotional symptoms. These new approaches received critiques for not being specific enough and for suggesting a few biomarkers for psychopathology as a whole. Therefore, they put the value of differential diagnosis at risk of avoiding appropriate derived prevention and treatment. Multiplicity of stressors has been considered mostly during and following catastrophes, without considering the resulting mixed clinical picture and life event concomitant stressors. We herewith suggest a new category within the conventional classification systems: The Complex Stress Reaction Syndrome, for a condition of multiplicity of stressors, which showed a mixed clinical picture for daily life in the post coronavirus disease 2019 era, in the general population. We argue that this condition may be relevant to daily, regular life, across the lifespan, and beyond conditions of catastrophes. We further argue that this condition may worsen without professional care and it may develop into a severe mental health disorder, more costly to health systems and the suffering individuals. Means for derived prevention and treatment are discussed.
暴露于多种应激源导致出现跨越传统类别且未完全符合其中任何一类的混合临床症状的情况,包含一系列共病风险,从而妨碍进行适当的预防和治疗。新的变革性跨诊断方法表明传统类别正在发生变化。它们的分类系统基于生物标志物以及与行为和情绪症状相关的脑结构和功能失调。这些新方法因不够具体以及仅为整个精神病理学提出少数生物标志物而受到批评。因此,它们使鉴别诊断的价值面临无法进行适当的衍生预防和治疗的风险。应激源的多样性大多在灾难期间及之后得到考虑,而未考虑由此产生的混合临床症状以及生活事件伴随的应激源。我们在此建议在传统分类系统中新增一个类别:复杂应激反应综合征,用于描述应激源多样性的情况,在2019冠状病毒病后的时代,普通人群的日常生活中呈现出混合临床症状。我们认为这种情况可能与整个生命周期的日常、正常生活相关,且不限于灾难情况。我们进一步认为,如果没有专业护理,这种情况可能会恶化,并可能发展成严重的心理健康障碍,给卫生系统和受苦个体带来更高成本。文中还讨论了衍生预防和治疗的方法。