| 金卫东.DSM-5中的混合特征：存在的问题及解决方法[J].四川精神卫生杂志,2021,34(5):393-397.Jin Weidong,Mixed features in DSM-5： problems and solutions[J].SICHUAN MENTAL HEALTH,2021,34(5):393-397 |
| DSM-5中的混合特征：存在的问题及解决方法 |
| Mixed features in DSM-5： problems and solutions |
| 投稿时间：2021-05-12 |
| DOI：10.11886/scjsws20210512002 |
| 中文关键词: DSM-5 双相障碍 抑郁发作 混合特征 精神病理学 |
| 英文关键词:DSM-5 Bipolar disorder Major depressive disorder Mixed feature Psychopathology |
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| 中文摘要: |
| 本文对《精神障碍诊断与统计手册（第5版）》（DSM-5）中双相障碍和抑郁障碍的混合特征诊断标准提出异议，并试提出可能的解决方法。目前，DSM-5中双相障碍的混合特征在临床使用过程中存在某些问题，特别是作为伴随特征的诊断标准，给临床带来一定的困扰。DSM-5虽然摒弃了过去抑郁和躁狂同时存在、同时符合抑郁发作和躁狂发作的严格诊断思路的标准设置，而改为存在3个或以上相反症状的诊断标准。但是两种截然相反的症状或症状群同时存在所导致的状态或特征的诊断困难的问题依然没有得到有效解决。在实际临床工作中，伴混合特征时，躁狂背景下的抑郁症状已经不典型，抑郁背景下的躁狂症状有时也失去典型躁狂的本色。因此，本文主要针对混合特征的精神病理学特点，结合临床以及部分研究观点进行分析，提出某些可能有建设性意义的设想，以期为混合特征的临床问题解决提供参考。 |
| 英文摘要: |
| This study contests the mixed states in diagnostic criteria for bipolar disorder and major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5）， and attempts to propose possible solutions. At present， the DSM-5 defined “mixed feature specifier” in bipolar disorder faces a number of problems in clinical use， particularly with regard to the classification of incidental features， which poses some clinical difficulties. DSM-5 abandons the previous standard setting which conform to the strict diagnostic thinking that both depression and mania exist together， and primarily captures three or more non-overlapping symptoms of the opposite pole in clinical diagnosis， but the difficulty in diagnosing the states or features resulting from the coexistence of two diametrically opposed symptoms or symptom clusters has still not been effectively addressed. In practice， clinical features of depressive episodes across participants with maniac disorder and manic episodes in depressive disorder within bipolar disorder pedigrees become atypical. Therefore， this paper focuses on the psychopathological features of the mixed profile and conducts analysis in the context of clinical practice and selected research perspectives， so as to propose some potentially constructive ideas to inform the solution of the clinical problems of the mixed states. |
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