精神病的跨诊断维度:对精神疾病的分类学与研究的意义（英文）

The transdiagnostic dimension of psychosis: implications for psychiatric nosology and research

如果精神病是一种跨诊断的维度,精神病性症状的出现受动态变化的情境和情感因素左右,而后者又是可治疗的,那么目前精神科疾病的分类学和治疗研究的方法可能需要修改。迄今为此,无论在临床工作上还是在疾病概念上,占主导地位的方法是将精神病性症状置于精神分裂症的框架中。然而,终生患病率为1%的精神分裂症只代表了部分预后不佳的精神病谱系障碍,而后者发生更多,终生患病率为3.5%。因此,精神分裂症的研究结果可能反映了预后相关的机制,而非精神病和其他症状维度之间本质上的相关性。同样,常见的非精神病性精神障碍中高达30%的个体有阈下精神病性症状,他们会被归于精神病的跨诊断维度之下,这些精神症状还会影响临床严重程度和治疗有效性。上述发现也同样提示武断区分"精神病性"与"非精神病性"的做法妨碍了临床实践和研究。精神病学诊断手册可以借鉴跨诊断维度(包括精神病的跨诊断维度)的体系。引入跨诊断维度,则既能根据原则进行分类诊断(即疾病分组的特异性),又可结合个体特有的多维度综合评分(即个体特异性)。这样的益处在于促使人们思考在精神病理学中症状之间是如何动态地交互作用的,并思考社会环境是如何影响精神病理症状的。

Summary：If psychosis is a transdiagnostic dimension, the expression of which is governed by a dynamic set of contextual and emotional factors that are amenable to treatment, current approaches in psychiatric nosology and therapeutic research may need to be revised. The dominant approach to date is to clinically and conceptually situate psychotic symptoms in the construct of schizophrenia. However, schizophrenia, which has a lifetime prevalence of 1%, only represents the poor outcome fraction of a much broader spectrum of psychotic disorders which have a lifetime prevalence of 3.5%. Therefore, research findings in schizophrenia may reflect mechanisms of prognosis rather than fundamental associations with psychosis and other symptom domains per se. Similarly, the discovery that up to 30% of individuals with non-psychotic common mental disorders have subthreshold psychotic symptoms that situate them on the transdiagnostic dimension of psychosis - and which impact clinical severity and treatment response - indicates that the rigid separation between ＇psychotic＇ and ＇non-psychotic＇ hampers both clinical practice and research. Diagnostic manuals in psychiatry would benefit from a system of transdiagnostic dimensions, including a transdiagnostic dimension of psychosis. Introduction of transdiagnostic dimensions allows for a system combining a nomothetic （i.e., group-specific） categorical diagnosis with an idiographic （i.e., person-specific） combination of dimensional scores. The advantage of such a system is that it encourages consideration of how symptoms dynamically interact with each other in a network of psychopathology, and of how this network is impacted by the social world.