Takiue Hiroyuki
Department of Psychiatry Tokyo Metropolitan Matsuzawa Hospital Setagaya-ku Tokyo Japan.
PCN Rep. 2025 Mar 31;4(2):e70090. doi: 10.1002/pcn5.70090. eCollection 2025 Jun.
The Diagnostic and Statistical Manual, Third Edition (DSM-III), the prototype of the modern DSMs, differed from previous traditions in American psychiatry in that it was etiologically agnostic. It also represented a re-importation of German psychiatry for the first time since Freud. An exception, however, was the hierarchical relationship between mood and psychosis, which was weighted in favor of mood in the United States. Specifically, mood-incongruent psychosis was considered a symptom that could also occur in affective (mood) disorders. This was a decision that also differed from the Ninth Revision of the International Statistical Classification of Disease, which was published 3 years before the DSM-III. It was not until the nineteenth century that a distinction was made between mood and psychosis. In Germany, the emphasis was on psychosis, whereas in the United States, under the strong influence of Adolf Meyer, the emphasis was on depression. Hallucinatory and delusional states, later summarized as Kurt Schneider's "first-rank symptoms" (FRS), were also incorporated into the framework for mood disorders. Subsequently, the United States entered the heyday of psychoanalysis, while German descriptive psychopathology was difficult to accept. When the DSM-III was drafted in the 1970s, the FRS were "cut out" from that descriptive psychopathology and introduced. However, since that time, the FRS, along with other mood-incongruent psychoses, have lost their specificity for schizophrenia and organic psychosis.
《诊断与统计手册》第三版（DSM - III）是现代DSM的原型，它与美国精神病学的先前传统不同，因为它在病因学上不做判断。它也是自弗洛伊德以来首次对德国精神病学的重新引入。然而，一个例外是情绪与精神病之间的等级关系，在美国这种关系更倾向于情绪。具体而言，情绪不一致性精神病被认为是一种也可能出现在情感（情绪）障碍中的症状。这一决定也与在DSM - III出版三年前发布的《国际疾病分类》第九版不同。直到19世纪，情绪和精神病才被区分开来。在德国，重点是精神病，而在美国，在阿道夫·迈耶的强烈影响下，重点是抑郁症。幻觉和妄想状态，后来被总结为库尔特·施耐德的“一级症状”（FRS），也被纳入了情绪障碍的框架。随后，美国进入了精神分析的全盛时期，而德国的描述性精神病理学却难以被接受。当20世纪70年代起草DSM - III时，FRS从那种描述性精神病理学中“分离”出来并被引入。然而，从那时起，FRS以及其他情绪不一致性精神病已经失去了它们对精神分裂症和器质性精神病的特异性。
