Preskorn S H, Fast G A
Department of Psychiatry, University of Kansas School of Medicine-Wichita.
J Clin Psychiatry. 1993 Jan;54 Suppl:24-32.
Both primary care physicians and psychiatrists report frequent difficulty in distinguishing between major depression and generalized anxiety disorder. This fact has suggested the need for a new diagnostic category of mixed anxiety and depression. The solution, however, does not address the fundamental issues and creates additional problems. While there are multiple factors contributing to the difficulty in distinguishing between these categories, two are of paramount importance. First, pivotal cross-sectional criteria for the two disorders as enumerated in DSM-III-R are virtually identical. Second, the crux of the distinction between these two disorders involves factors other than the immediate cross-sectional presentation in the office such as the longitudinal course of the patient's complaints. Obtaining such a history takes time and training. For a variety of reasons (e.g., time allocated for patient evaluation, physician training), such a longitudinal history may not be elicited in a primary care office. To respond to these problems by establishing a mixed diagnostic category does not address the primary problems, may encourage cursory evaluations of patients, and will likely hinder research.
初级保健医生和精神科医生都表示，在区分重度抑郁症和广泛性焦虑症时常常遇到困难。这一事实表明需要一个新的混合性焦虑和抑郁诊断类别。然而，这种解决办法并未触及根本问题，反而引发了更多问题。虽然有多种因素导致难以区分这两种类别，但其中两个因素至关重要。首先，《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）中列举的这两种疾病的关键横断面标准几乎相同。其次，这两种疾病之间区别的关键涉及到办公室即时横断面表现之外的因素，比如患者症状的纵向病程。获取这样的病史需要时间和培训。由于各种原因（例如，分配给患者评估的时间、医生培训），在初级保健办公室可能无法获取这样的纵向病史。通过设立一个混合诊断类别来应对这些问题，既没有解决主要问题，可能会促使对患者进行草率评估，而且很可能会阻碍研究。
