Guelfi J D
Service de Psychiatrie, Hôpital Paul Brousse (Paris XI), Villejuif.
Encephale. 1995 Dec;21 Spec No 5:21-9.
The two main classifications of mood disorders currently used are the American system, DSM, the fourth edition of which came out in 1994, and the International Classification of Diseases, the tenth edition of which was published in 1993. These classifications are based on the following broad principles: simple description with no hypothetical aetio-pathogenic discussion, distinction between the various clinical forms in accordance with variety and intensity of symptoms, co-existence of other more or less serious somatic disorders, individual identification of bipolar forms, etc. The key changes made in the classification of mood disorders between the revised version of DSMIII published in 1987 and DSM-IV published in 1994 suggest that a greater degree of concordance in diagnosis between different practitioners may be expected in future. In addition, certain changes such as the therapeutic decision-trees will most likely have an impact on practice. In this way, further details are added to the clinical criteria of duration or description of the clinical features seen, thereby allowing a clearer distinction to be made between normality and the onset of the pathology in question. Regarding bipolar disorders, the general organisation of the classification and the terminology used have been extensively revised, with the distinction between types I and II becoming official. Furthermore, differentiation between certain aspects of depression emphasises the frequency of certain clinical particularities, either in the onset or during the course of these disorders. This is true of melancholic, catatonic and atypical features specifiers (i.e. with mood reactivity and interpersonal rejection sensitivity), post-partum onset specifier, seasonal pattern specifier and rapid-cycling specifier. Finally, a certain number of specifications are proposed allowing the postulation of notions of complete or partial cure between episodes in case of recurrence.
目前使用的情绪障碍的两种主要分类系统是美国的《精神疾病诊断与统计手册》(DSM),其第四版于1994年出版,以及《国际疾病分类》,其第十版于1993年发布。这些分类基于以下广泛原则:进行简单描述,不进行假设性病因 - 发病机制讨论;根据症状的多样性和强度区分各种临床形式;并存其他或多或少严重的躯体疾病;明确识别双相情感障碍形式等。1987年出版的DSM - III修订版与1994年出版的DSM - IV之间在情绪障碍分类方面所做的关键变化表明,未来不同从业者之间在诊断上有望达成更高程度的一致性。此外,某些变化,如治疗决策树,很可能会对实践产生影响。通过这种方式,临床标准中增加了病程持续时间的进一步细节或对所见临床特征的描述,从而能够更清晰地区分正常状态与相关病理状态的发作。关于双相情感障碍,分类的总体架构和所用术语已被广泛修订,I型和II型之间的区分已正式确定。此外,对抑郁症某些方面的区分强调了某些临床特殊性在这些疾病发作或病程中的出现频率。这适用于抑郁性、紧张性和非典型特征说明符(即具有情绪反应性和人际拒绝敏感性)、产后发作说明符、季节性模式说明符和快速循环说明符。最后,提出了一些说明符,允许在复发情况下假设发作之间完全或部分治愈的概念。