Van Os J, Jones P, Sham P, Bebbington P, Murray R M
Department of Psychiatry and Neuropsychology, Maastricht University, The Netherlands.
Soc Psychiatry Psychiatr Epidemiol. 1998 Dec;33(12):596-605. doi: 10.1007/s001270050099.
Clinical practice, training and evaluation of treatment in the functional psychoses continues to be carried out mostly along the traditional line of separation by diagnostic entity. However, the combined evidence from research on risk factors for onset and for persistence of psychotic illness indicates quantitative, but not qualitative, differences between categories of schizophrenia and affective psychosis. "Developmental" factors, such as childhood dysfunction, increased cerebral ventricle size and familial morbid risk of schizophrenia operate preferentially, though not specifically, at that end of the psychopathological spectrum characterised by a preponderance of negative features. On the other hand, "social" factors, such as ethnic group, adverse life events and familial morbid risk of affective disorder have a larger impact at the end associated with predominance of affective features. Heterogeneity in the functional psychoses may thus be best conceived as two discrete effects operating at different ends of a continuous psychopathological spectrum. The use of highly reliable but arbitrary diagnostic categories may introduce serious bias in aetiological and treatment research. Evidence supporting the validity of a model of shared risk factors for continuous characteristics needs to be further elaborated and incorporated into our concepts of psychotic illness.
功能性精神病的临床实践、治疗培训及评估大多仍沿着按诊断实体进行区分的传统路线开展。然而，关于精神病发病及持续存在风险因素的研究综合证据表明，精神分裂症和情感性精神病类别之间存在数量上而非质量上的差异。“发育”因素，如童年功能障碍、脑室增大及精神分裂症的家族患病风险，虽非特异性地，但优先作用于以阴性症状为主的精神病理学谱系末端。另一方面，“社会”因素，如种族群体、不良生活事件及情感障碍的家族患病风险，在以情感症状为主的末端影响更大。因此，功能性精神病的异质性或许最好被理解为在连续的精神病理学谱系不同末端起作用的两种离散效应。使用高度可靠但随意的诊断类别可能在病因学和治疗研究中引入严重偏差。支持连续特征共享风险因素模型有效性的证据需要进一步阐述并纳入我们对精神病的概念中。
