DSM-5精神分裂症谱系的新变化:类别与维度之争

Changes of Schizophrenia Spectrum Disorder in DSM-5: Dispute between Categorical and Dimensional Approaches

美国精神病学协会(APA)于2013年5月发布了第五版的精神疾病诊断和统计手册(DSM-5),与第四版相比,呈现出较大的变化,尤其是对维度的思路的强调,引起了临床工作者和相关学者对精神疾病分类诊断中类别与维度的讨论。其中,精神分裂症谱系中维度取代亚型的新思路便是此次争论的一个焦点,维度论从信效度、临床实用性和科研价值角度批判传统亚型,并提出其在临床治疗和病理机制方面的优势。同时,总结了此次争论的其它观点,并就精神疾病诊断的分歧与发展进行讨论。

Released by the American Psychiatric Association （APA） in 2013, the Fifth Edition ot Diagnostic and Statistical Manual of Mental Disorders （DSM-5） has changed in a profound way compared to DSM-IV, especially concerning the adoption of dimensional approach. This new approach had triggered hot discussions among clinical psychiatrists and related researchers. As one of those areas where most discussions focused on, the Schizophrenia Spectrum Disorder had dropped the traditional subtypes so as to adopt this dimensional approach. Those who advocated dimensional approach criticized the traditional subtypes from the perspective of reliability, validity, clinical utility, and scientific literature, and publicity. Meanwhile, they proposed some advantages of dimensional diagnoses from the angle of clinical treatment and psychopathological mechanism. Besides, other opinions were introduced and the disparity between clinical psychiatrists and psychiatric researchers were further discussed on the development of diagnostic efficiency and precision.