Wexler B E
Connecticut Mental Health Center, New Haven 06508, USA.
J Neuropsychiatry Clin Neurosci. 1991 Winter;3(1):94-8. doi: 10.1176/jnp.3.1.94.
The current diagnostic system in psychiatry is symptom-based, as described in detail in DSM-III-R. In other branches of medicine the logic of diagnosis is based on knowledge of the normal function of the organ system affected by disease, and direct measures of pathophysiological process play an increasingly important role in clinical practice. New understanding of normal brain function has opened the way for psychiatry to begin to follow this path and develop a brain-based, rather than symptom-based, nosology. Different models of normal brain function, however, suggest quite different theoretical and research approaches. One way in which these models differ is the degree to which they link specific functions (and illnesses) to specific anatomic locations. In a previous paper I discussed the value of adopting a model of brain function that includes important roles for the processes that integrate multiple brain regions into ever-changing functional constellations. In this paper I have proposed the existence of a disease characterized by abnormality in the general physiological mechanism of task-specific regional brain activation. This is not an etiologic diagnosis and therefore presents nothing more than a symptom-based diagnosis about the cause of the disorder. However, I predict that this diagnosis will define a group of patients that is more homogeneous with respect to both clinical course and etiology than do the current symptom-based diagnoses to which these patients would otherwise be assigned. Furthermore, it may be possible to develop new treatments to address this physiological dysfunction.
当前精神病学的诊断系统是基于症状的，正如《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）中所详细描述的那样。在医学的其他分支中，诊断的逻辑基于对受疾病影响的器官系统正常功能的了解，并且病理生理过程的直接测量在临床实践中发挥着越来越重要的作用。对正常脑功能的新认识为精神病学开辟了道路，使其开始沿着这条路径发展一种基于大脑而非基于症状的疾病分类学。然而，不同的正常脑功能模型提出了截然不同的理论和研究方法。这些模型的不同之处之一在于它们将特定功能（和疾病）与特定解剖位置联系起来的程度。在之前的一篇论文中，我讨论了采用一种脑功能模型的价值，该模型认为将多个脑区整合到不断变化的功能组合中的过程具有重要作用。在本文中，我提出存在一种疾病，其特征是特定任务区域脑激活的一般生理机制异常。这不是一种病因诊断，因此只不过是一种基于症状的关于该障碍病因的诊断。然而，我预测这种诊断将定义出一组患者，与目前这些患者会被归类到的基于症状的诊断相比，这组患者在临床病程和病因方面更加同质。此外，有可能开发新的治疗方法来解决这种生理功能障碍。
