迈向 DSM-6:关于重新引入一级症状作为精神分裂症核心标准和重新定义幻觉的专家调查结果》(Towards the DSM-6: Results of a Survey of Experts on Reintroduction of First-Rank Symptoms as Core Criteria of Schizophrenia)。

IF 5.3 1区 医学 Q1 PSYCHIATRY Schizophrenia Bulletin Pub Date : 2024-08-27 DOI:10.1093/schbul/sbae061
Steffen Moritz, Lisa Borgmann, Andreas Heinz, Thomas Fuchs, Jürgen Gallinat
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引用次数: 0

摘要

背景:精神障碍的诊断标准是不断变化的。精神分裂症的情况尤其如此,在目前的 DSM-5 中,精神分裂症的诊断标准与克拉佩林(Kraepelin)曾命名为 "前驱痴呆"、布勒勒(Bleuler)称之为 "精神分裂症 "的诊断标准几乎没有任何相似之处。本研究报告了就精神分裂症的两个核心主题对专家进行调查的结果:(a) 《精神分裂症分类》(DSM)的后续版本是否应再次赋予施耐德一级症状(FRS,如思维广播)在《精神分裂症分类》(DSM)-IV 中的突出地位;(b) 《精神分裂症分类》(DSM)-5 中目前对幻觉的定义相当狭窄,要求幻觉生动、清晰,并具有正常知觉的全部力量和影响,是否应扩大幻觉的定义,以纳入个人能够从正常知觉中区分出来但仍认为是真实的、由外部产生的知觉样现象。假设:调查的目的是了解专家的观点,没有明确的假设:研究设计:通过各种渠道招募精神分裂症方面的国际专家,并邀请他们参与简短的在线调查。最终样本由 136 位专家组成,其中 53 位专家的身份已得到核实,并拥有至少 6 年的临床和/或研究经验:投票赞成(49.3%)恢复 FRS 在早期版本 DSM 中的重要地位的专家略多于投票反对(34.6%)的专家。大约五分之四的专家同意扩大《疾病分类》中幻觉的定义。根据研究结果,除了在现象学上与真实感知无法区分的内部症状外,持有者确信是从其他来源插入的(即非自身产生的)感觉侵入也应纳入定义中:尽管绝大多数专家建议修改幻觉的定义,但专家们对 FRS 的意见却不尽相同。我们希望这篇文章能激励今后针对这些症状的诊断相关性进行研究,并鼓励人们讨论核心精神病症状的定义以及即将出版的《精神医学疾病诊断标准》的诊断标准。
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Towards the DSM-6: Results of a Survey of Experts on the Reintroduction of First-Rank Symptoms as Core Criteria of Schizophrenia and on Redefining Hallucinations.

Background: Diagnostic criteria for mental disorders are subject to change. This is particularly true for schizophrenia, whose diagnostic criteria in the current DSM-5 bear little resemblance to what Kraepelin once named "dementia praecox" and Bleuler termed "the schizophrenias." The present study reports results from a survey of experts on two core topics of schizophrenia: (a) whether subsequent editions of the DSM should once again give the Schneiderian first-rank symptoms (FRS; eg, thought broadcasting) the prominent role they had in the DSM-IV and (b) whether the currently quite narrow definition of hallucinations in the DSM-5 requiring them to be vivid and clear and have the full force and impact of normal perceptions should be broadened to incorporate perceptual-like phenomena that the individual can differentiate from proper perceptions but still perceives as real and externally generated.

Hypothesis: The aim of the survey was to learn about experts' opinions with no clear hypotheses.

Study design: International experts on schizophrenia were recruited via various sources and invited to participate in a short online survey. The final sample comprised 136 experts with a subgroup of 53 experts with verified identity and at least 6 years of clinical and/or research experience.

Study results: Slightly more experts voted in favor (49.3%) of returning FRS to the prominent role they had in earlier versions of the DSM than against (34.6%). Approximately four out of five experts agreed that the definition of hallucinations in the DSM should be expanded. According to the results, alongside internal symptoms that are phenomenologically indistinguishable from true perceptions, sensory intrusions that the holder is convinced were inserted from another source (ie, not self-generated) should be included in the definition.

Conclusions: While a large majority of experts recommend a change in the definition of hallucinations, the experts' opinions on FRS are more mixed. We hope that this article will stimulate future studies targeting the diagnostic relevance of these symptoms and encourage discussion about the definition of core psychotic symptoms and the diagnostic criteria for the upcoming edition of the DSM.

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来源期刊
Schizophrenia Bulletin
Schizophrenia Bulletin 医学-精神病学
CiteScore
11.40
自引率
6.10%
发文量
163
审稿时长
4-8 weeks
期刊介绍: Schizophrenia Bulletin seeks to review recent developments and empirically based hypotheses regarding the etiology and treatment of schizophrenia. We view the field as broad and deep, and will publish new knowledge ranging from the molecular basis to social and cultural factors. We will give new emphasis to translational reports which simultaneously highlight basic neurobiological mechanisms and clinical manifestations. Some of the Bulletin content is invited as special features or manuscripts organized as a theme by special guest editors. Most pages of the Bulletin are devoted to unsolicited manuscripts of high quality that report original data or where we can provide a special venue for a major study or workshop report. Supplement issues are sometimes provided for manuscripts reporting from a recent conference.
期刊最新文献
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