Seifert Roland, Schirmer Bastian, Seifert Johanna
Institute of Pharmacology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Naunyn Schmiedebergs Arch Pharmacol. 2025 Feb;398(2):1099-1110. doi: 10.1007/s00210-024-03413-z. Epub 2024 Sep 4.
The precise diagnosis of mental disorders constitutes a formidable problem. Mental disorders are currently diagnosed based on clinical symptoms, which are often subjective. Various drug classes, traditionally referred to as "antidepressants," "antipsychotics" and "mood stabilizers" are then used empirically to treat affected patients. The previous decade has witnessed an increasing extension of the use of drug classes beyond their traditional indications (e.g., "antidepressants" in the treatment of anxiety disorders). Therefore, we would like to initiate a discussion in the pharmacological and psychiatric research communities on an alternative classification of mental disorders: Instead of using the traditional categorical classification of mental disorders physicians should rather diagnose symptoms (e.g., anhedonia) without bias to a traditional categorization (e.g., depression). The appropriate most effective drugs are then selected based on these symptoms. Depending on the responsiveness of the patient towards a given drug X, the disease should be classified, e.g., as drug X-responsive disease. This approach will also help us elucidate the still poorly understood molecular mechanisms underlying mental disorders, i.e., drugs can also be viewed and used as molecular diagnostic tools. In several fields of medicine, drugs are already used as molecular diagnostic tools. Thus, there is already precedence for the concept proposed here for mental disorders.
精神障碍的精确诊断是一个棘手的问题。目前精神障碍是根据临床症状来诊断的，而这些症状往往具有主观性。然后，各类传统上被称为“抗抑郁药”“抗精神病药”和“心境稳定剂”的药物会被经验性地用于治疗患病患者。在过去十年中，各类药物的使用范围不断超出其传统适应证（例如，“抗抑郁药”用于治疗焦虑症）。因此，我们希望在药理学和精神病学研究领域发起一场关于精神障碍另一种分类方式的讨论：医生不应采用传统的精神障碍分类方式，而应无偏见地诊断症状（例如，快感缺失），而不局限于传统分类（例如，抑郁症）。然后根据这些症状选择最合适、最有效的药物。根据患者对特定药物X的反应，疾病应被分类，例如，作为对药物X有反应的疾病。这种方法也将有助于我们阐明精神障碍背后仍未被充分理解的分子机制，也就是说，药物也可以被视为并用作分子诊断工具。在医学的几个领域，药物已经被用作分子诊断工具。因此，这里提出的精神障碍概念已经有先例可循。
