網頁

搜尋此網誌

2010年4月19日 星期一

DSM-V分類

將Wiki 的文章 .. 稍做修飾

 這裡將 disorder 翻譯為 異常  中國的翻譯 是 障礙 (哪個好哪個壞 留待後人評斷 )

DSM的發展史

以下根據DSM-IV和DSM-IV-TR之序言，
DSM之所以被發展出來，一開始是由於美國二戰後退伍軍人症候群在門診上的表現，為能提供更多客觀的詞彙給精神醫學研究，而將ICD-6改編為DSM-I。在DSM出版之前，精神醫學家之間的溝通並不統一，尤其是在不同的國家之間，因此建立特定判準是試圖使有關精神健康的研究和溝通更為容易。
不過，多軸系統的設立直到DSM-III才發展出來，以因應產生對於病患之更完整的圖像，而不僅僅是簡單的診斷。

DSM-I的出現時詞彙充滿「反應」(reaction)，且其理論根據是Adolf Meyer所主張的「精神異常是患者人格對於心理、社會、及生物因素的反應」。

而DSM-II則修飾精神異常的描述以及增加精神異常的診斷的區別力，然而「反應」的觀點仍保留著。

直到1980年DSM-III出版後試圖以客觀、中立的方式而擺脫各種病因學的理論與說法，而只著重於描述精神異常的症狀（以提高診斷者間信度）；但是，DSM的內容卻沒能反映出關於心理病理學（psychopathology）議題的所有意見、比如情緒困厄（emotional distress）及社會功能（social functioning）的狀態。而且關於那些診斷準則與分類，也沒有完全客觀的、生物可驗證性（verifiable）支持。

這類型的缺失一如Peterson在其著作「變態心理學」(Abnormal Psychology)中引述的Alloy(1989)觀點：精神異常的分類應該按照病源來分類，而不是將憂鬱症全部分放在一起而不管病源為何；Peterson又引用Vaillant(1984)的說明例子，把一堆不同原因的喉嚨痛症狀全湊在一起而不管是感冒還是喉嚨炎，不是很可笑嗎？

對此，DSM-IV以及TR版本都強調病因學的問題容易牽涉到詮釋理論、研究方法以及診斷類別的普遍性等錯綜問題。而這些診斷準則以及它們被臨床醫師應用的方式在某種程度上又會隨著文化差異影響，且必須週期性地被修改以反映當代的社會風俗（social landscape)。又「精神異常」的觀點常隨著時間而改變，例如在1973年的精神醫學表決之前，同性戀被列在DSM中，當作可診斷的精神異常，直到因應社會運動以及人們對於同性戀觀念逐漸改變才去汙名化從DSM中除去。

DSM-IV開始回顧過去的文獻資料，然而由於許多文獻不是過期的觀念、就是資料不足，故文獻回顧的作用並不大。而DSM-IV工作小組則又系統性地檢驗各理論以及其它實驗室數據，而若有大量數據顯示則診斷判準需變更，診斷準則的陳述又比DSM過去版本更為簡潔；然而若被認為是「應該刪除的異常」卻發現過去文獻具有相當高的診斷信度(reliability)則被列在DSM-IV準則之相關議題、或列入附錄中做為以後研究之參考(如女性經前症候群)。除此之外，在DSM-III-R版無法診斷或未註明之異常經由重新調查後，若是已被ICD-10納入者則優先考慮納入DSM-IV，次之則是有最新大量的研究數據顯示其一致性高者、最後才將DSM-III-R版本無法診斷的異常列入DSM-IV之「其它未註明之異常」以做為後續研究用。最後進行實地試用（field trial），分別在不同國家、社會文化背景進行調查，直到確認該診斷判準在不同時地背景具有一致性便正式納入DSM-IV正式版本。

DSM-IV-TR則修改一些診斷實用性遭質疑的異常：如急性壓力症候群(Acute Stress Disorder,簡稱ASD)及創傷後壓力症候群(Post-traumatic Stress Disorder，簡稱PTSD)，在DSM-IV僅在於ASD事發後三個月便可改診斷為PTSD，而在TR版則於ASD上又增加「三個月內必須出現解離性行為」以便跟PTSD「或重複出現解離性行為」區別開來。

DSM-V的實地研究（field study）及出版

DSM-V實地研究的總體目標是評估其可行性、臨床實用性、信度、以及診斷準則草案的效度和診斷特異性、以及回應所有對DSM-V交叉測試之建議。從訪問DSM-V網站收到訪客的反饋意見整理後，工作小組修改診斷準則草案，並隨著DSM-V研究小組檢討哪些診斷準則最需要進行實地調查。
DSM-V首先在美國和加拿大進行實地調查，而後對於該診斷類別進行再測信度及分析研究，最後再對DSM-V的新診斷症狀進行跨領域的信度測試。在實地調查中有三篇結果發表於「美國精神醫學雜誌」(American Journal of Psychiatry)，全部內容為23項新編診斷準則，其中有14項兒童及成人精神異常被發現具有相當高信度，尤其是過動症、創傷後壓力症候群及暴食症，在精神異常的「交叉症狀」測試中亦發現具有不錯的信度。然而有六項診斷信度較低，比如常見的憂鬱症和廣泛性焦慮症，對此負責小組主席 David Kupfer說他們專注於憂鬱症和焦慮症共存的診斷準則；而在美國及加拿大從2010年到2012年底進行再測信度後發現患者罹患憂鬱症及焦慮症在幾個星期內可以產生很大的波動，且兩個獨立的症狀再測信度很低，而有三個診斷信度低到DSM-V編輯小組決定大幅修改或不再列入診斷準則裡。另外，DSM-V雖然探討「網路成癮異常」(Internet addiction disorder)且有大量的研究文獻，然而卻未納入正式診斷裡。

 最後，DSM-V決定去除從DSM-III發展出來的五軸診斷只保留準則ABCDE，每一項診斷準則都經過各工作小組內部相當多的辯論，包含從方法學、觀念上的演變、診斷類別或向度、以及跨領域研究人員的溝通，以確保DSM-V的多元性及高特異性(Specify)。

DSM-V項目重編以及診斷準則的改變

DSM-V最著名的診斷方法為去除五軸診斷而只保留診斷準則ABCDE，而各異常之準則改變如亞斯伯格症不再設獨立診斷，而精神分裂症的各個亞型(妄想型、緊張型、混亂型、殘餘型)也都去除，而哀慟反應(bereavement)也可包含於憂鬱症裡面而不再相斥。而性別認同異常的準則則大幅修改，並且新增加了賭博性異常(gambling disorder)。

各重編之診斷項目如下︰

Neurodevelopmental disorders

神經發展異常(Neurodevelopmental disorders)

•    心智遲緩(Mental Retardation)改名為「智力失能」(intellectual disability )或「智力發展異常」((intellectual developmental disorder)。

•    語音異常(Phonological disorder)和口吃已經改名為「溝通異常」(communication disorders )，該異常包含「語言異常」、「說話語音異常」(speech sound disorder)、「兒童期開始的流暢異常」(childhood-onset fluency disorder)、以及社交溝通異常(Social communication disorder，其特點為社會語意以及非語意性的溝通損傷)。

•    自閉症光譜異常已經合併亞斯伯格異常、童年瓦解性異常、以及其它未註明之廣泛性發展異常。

新次分類--動作異常 包括 developmental coordination disorder發展協調異常, stereotypic movement disorder刻板動作異常, and the tic disorders抽動異常 including Tourette syndrome.妥瑞症後群

Schizophrenia spectrum and other psychotic disorders[edit]

  • All subtypes of schizophrenia were deleted (paranoid, disorganized, catatonic, undifferentiated, and residual).
  • A major mood episode is required for schizoaffective disorder (for a majority of the disorder's duration after criterion A is met).
  • Criteria for delusional disorder changed, and it is no longer separate from shared delusional disorder.
  • Catatonia in all contexts requires 3 of a total of 12 symptoms. Catatonia may be a specifier for depressive, bipolar, and psychotic disorders; part of another medical condition; or of another specified diagnosis.

精神分裂光譜 以及 其它 精神病性異常

•    刪除所有的精神分裂症亞型（妄想型，混亂型，緊張型，未分化型，殘餘型）。

•    「情感性分裂異常」至少需要情感性異常發作且需滿足主要的情感性異常的準則A之持續發作時間。

•    妄想症準則的改變，並且「共享型妄想症」不再和妄想症區別。妄想指的當不是來自於一般普通經驗時，而是不可信且固著的信念且無法改變，甚至有證據可以駁斥這想法為離奇的。

•    緊張型症狀(原緊張型亞型)在準則中需在12種症狀中滿足至少3項以上。

Bipolar and related disorders[edit]

  • New specifier "with mixed features" can be applied to bipolar I disorder, bipolar II disorder, bipolar disorder NED (not elsewhere defined, previously called "NOS", not otherwise specified) and MDD.
  • Allows other specified bipolar and related disorder for particular conditions.
  • Anxiety symptoms are a specifier ( called "anxious distress") added to bipolar disorder and to depressive disorders (but are not part of the bipolar diagnostic criteria).

雙極性以及相關之異常

•    註記「混合特徵」可適用於第一型及第二型雙極性異常、以及雙極性           異常NED型(過去稱NOS，其它未註明)及重鬱異常。

•    允許其它特異型雙極性及特殊情境之相關異常於雙極性異常。

•    註記焦慮性症狀添加於雙極性異常及憂鬱性異常，但並非雙極性異常           診斷準則的一部分。

Depressive disorders[edit]

憂鬱異常

•    「傷慟反應」在DSM-IV裡需排除憂鬱症的準則已在DSM-V裡移除該準則。

•    增加新的異常為「破裂性心情失調異常」( disruptive mood dysregulation disorder，DMDD)，於兒童18歲以前發作。

•    過去在DSM-IV/TR裡的附錄裡「經前症候群」正式成為一個異常診斷。

•    註記添加混合性症狀(mixed symptoms)以及同樣適用於焦慮症，且在醫師醫囑下仍有自殺傾向。
  • 詞彙 dysthymia 可被稱為 持續憂鬱異常 persistent depressive disorder.

Anxiety disorders[edit]

  • For the various forms of phobias and anxiety disorders, DSM-5 removes the requirement that the subject (formerly, over 18 years old) "must recognize that their fear and anxiety are excessive or unreasonable". Also, the duration of at least 6 months now applies to everyone (not only to children).[2]
  • Panic attack became a specifier for all DSM-5 disorders.[2]
  • Panic disorder and agoraphobia became two separate disorders.[2]
  • Specific types of phobias became specifiers but are otherwise unchanged.[2]
  • The generalized specifier for social anxiety disorder (formerly, social phobia) changed in favor of a performance only (i.e., public speaking or performance) specifier.[2]
  • Separation anxiety disorder and selective mutism are now classified as anxiety disorders (rather than disorders of early onset).

焦慮異常

•    對於畏懼症及焦慮症，DSM-V刪除DSM-IV過去要求的準則︰"18歲以           上，且必須認識到，他們的畏懼和焦慮是過分或不合理的。"

•    恐慌發作(Panic attack)在DSM-V中變成正式的異常而非現象。

•    恐慌症和懼曠症分開成為兩個獨立的診斷。

•    特定類型的畏懼症(Specific types of phobias)變成註記但其內容不變。

•    改變廣泛註記「社交焦慮異常」(社交畏懼症)以利於註記只有出現                 「表現型行為問題」(如公眾演講或表演)。

•    分離性焦慮以及選擇性緘默從「初發於早期之異常」                                          (disorders of early onset)移出並歸類於 焦慮性異常。


Obsessive-compulsive and related disorders

強迫症及相關異常

•    在該章節新增了四個異常︰剝皮(excoriation)異常、囤積症、物質/藥物引起之強迫性異常、其它醫學條件引起之強迫症及相關異常。

•    拔毛癖(Trichotillomania)從「其它未分類型衝動控制異常」移出而列入強迫症。

•    註記「身體畸形異常」和「囤積症」以說明良好的病識感、不好的病識感、以及缺乏病識感/妄想(如完整卻不真實的信念，強迫症所意識到的信念是「真實」的)。

•    增加「身體畸形異常」描述重複性的行為、或心理不斷感覺到身體外觀的缺陷之診斷準則。

•    在DSM-IV的焦慮性異常裡註記"伴隨強迫性症狀"之異常移出到該章節診斷裡。

•    其它特定的強迫症及相關異常可包含集中於身體之重複行為異常(如咬指甲、咬嘴唇、臉頰咀嚼、拔頭髮、撥皮)、強迫性的忌妒/醋意(jealousy)，或未註明的強迫性相關異常。


Trauma- and stressor-related disorders

  • Posttraumatic stress disorder (PTSD) is now included in a new section titled "Trauma- and Stressor-Related Disorders."[10]
  • The PTSD diagnostic clusters were reorganized and expanded from a total of three clusters to four based on the results of confirmatory factor analytic research conducted since the publication of DSM-IV.[11]
  • Separate criteria were added for children six years old or younger.[2]
  • For the diagnosis of acute stress disorder and PTSD, the stressor criteria (Criterion A1 in DSM-IV) was modified to some extent. The requirement for specific subjective emotional reactions (Criterion A2 in DSM-IV) was eliminated because it lacked empirical support for its utility and predictive validity.[11] Previously certain groups, such as military personnel involved in combat, law enforcement officers and other first responders, did not meet criterion A2 in DSM-IV because their training prepared them to not react emotionally to traumatic events.[12] [13] [14]
  • Two new disorders that were formerly subtypes were named: reactive attachment disorder and disinhibited social engagement disorder.[2]
  • Adjustment disorders were moved to this new section and reconceptualized as stress-response syndromes. DSM-IV subtypes for depressed mood, anxious symptoms, and disturbed conduct are unchanged.

創傷及壓力相關之異常++

•    創傷後壓力症候群現包含在「創傷及壓力相關異常」並且跟強迫性異常一樣從「焦慮性異常」獨立出來，除此之外，除了診斷準則B、C、D外，另外再添加行為上的症狀，如創傷後壓力異常試圖改變之準則；
The PTSD diagnostic clusters were reorganized and expanded from a total of three clusters to four based on the results of confirmatory factor analytic research conducted since the publication of DSM-IV.
對於6歲和以下孩童的診斷準則也獨立出來放在此項目。

而個體對於急性壓力症候群或創傷後壓力症候群的壓力源之主觀反應亦改變或取消。

•    這個項目分類主要是暴露於創傷或災難性事件，並強調和焦慮性異常、強迫性異常及解離性異常之間密切的關連。

•    過去有兩個亞型被納入此項目並且形成新的異常︰
「反應性依附異常」( reactive attachment disorder)及
「去抑制型社會參與異常」(disinhibited social engagement disorder)。

•    適應異常被移到該分類的 壓力-反應症候群 項目裡。

•    313.89 反應性依附異常(Reactive attachment disorder)︰指出生的嬰兒或是孩子於童年早期時雖然被認為能夠形成選擇性依附，然而並沒有從照顧者身上得到舒適、保護者或其他相關養育之依附，且當照顧者提供照顧時無法充分反應回饋 (註明︰至少持久至12個月以上)。註明當前的嚴重性(Specify current severity)。

•    313.89 去抑制性社會參與障礙(Disinhibited social engagement disorder)︰與相對的陌生孩子比較，該患者表現出過度不適當的行為模式於熟悉環境的和文化上，且已經嚴重違反社會邊界(註明︰至少持久至12個月以上)。

•    309.81 創傷後壓力異常(Posttraumatic stress disorder)︰在此異常中另外再分出6歲或更年輕的小孩子。註明是否︰
 伴隨解離性症狀
 1.自我消失感/去人格化(Depersonalization)
 2.去現實化(Derealization)
註明︰伴隨延遲性表達(完整準則為經歷創傷事件後，六個月內並未表現症狀)

•    308.3 急性壓力異常

•309    適應障礙
 註明是否︰
            309.0   伴隨憂鬱的心情
            309.24 伴隨焦慮
            309.28 伴隨混和焦慮和憂鬱情緒
            309.3  伴隨行為障礙
            309.4  伴隨混合情緒和行為障礙
 309.9  未註明
         •309.89 其它註明之創傷及壓力相關異常
•309.9   未註明之創傷及壓力相關異常


Dissociative disorders[edit]

解離異常

•    自我消失感異常 在DSM-V被改為「去人格化/去真實化異常」。

•    解離性迷遊症 被註解在解離性失憶症裡而不再獨立診斷。

•    新增 解離性身分異常 診斷準則為︰「附身/佔有形式的現象和功能性之神經症狀」且「轉換之身分可以觀察別人或自我陳述」；而準則B亦修飾為「該患者無法回憶每天的事件(不僅限於創傷)」。
•    這些異常的共同特徵為對患者的主觀經驗、情緒、記憶之正常整合性造成干擾或空隙導致患者的主觀經驗、情緒、記憶產生不連續性。

Somatic symptom and related disorders

軀體性症狀及相關異常 Somatic symptom and related disorders

  • 在DSM-V，該項目已刪除了身體化異常、慮病症、疼痛異常及未分化型軀體形式異常。
  • 患有慢性疼痛的患者在DSM-V可能被診斷為「軀體性症狀異常主要伴隨疼痛」、或「心理因素影響其它醫學性狀況」、或「伴隨適應性障礙」。
  • 軀體化異常somatization disorder和未分化的軀體形式異常合併成為軀體性症狀異常(somatic symptom disorder)。
  • 軀體性症狀在DSM-V被定義為「陽性症狀」，故儘量減少醫學性狀況無法解釋的異常，除了轉化症和假孕的狀況。而原來在DSM-IV裡「其它臨床關注的焦點」(DSM-V稱心理因素影響到其它醫療狀況)則被命名到新的精神異常。
  • 轉化症(在DSM-V稱為「功能性神經性症狀異常」)診斷準則已改變。

Feeding and eating disorders[edit]

  • Criteria for pica and rumination disorder were changed and can now refer to people of any age.[2]
  • Binge eating disorder graduated from DSM-IV's "Appendix B -- Criteria Sets and Axes Provided for Further Study" into a proper diagnosis.[16]
  • Requirements for bulimia nervosa and binge eating disorder were changed from "at least twice weekly for 6 months to at least once weekly over the last 3 months".
  • The criteria for anorexia nervosa were changed; there is no longer a requirement of amenorrhea.
  • "Feeding disorder of infancy or early childhood", a rarely used diagnosis in DSM-IV, was renamed toavoidant/restrictive food intake disorder, and criteria were expanded.

餵食或飲食異常

•    反芻異常及異食癖(pica，指喜歡吃非食物的物品如粉筆、黏土等)的診斷準則改變，且不限於任何年齡的人。

•    暴食症(binge eating disorder，指患者服用的食物大量超過該餐所需)從DSM-IV-TR的附錄B之「尚待進一步研究」獨立出來成為正式的診斷異常。

•    神經性暴食症(bulimia nervosa，指患者大量進食然後催吐)和暴飲暴食症(binge eating disorder)診斷需求改變為︰至少6個月內每週兩次以及至少最近3個月內每週都發生。

•    神經性厭食症(anorexia nervosa)準則改變，並且不再有月經失調(menstrual disorder)的要求準則。

•    過去於DSM-IV的「嬰兒及童年早期餵食異常」(Feeding disorder of infancy or early childhood)被重新命名為「迴避/限制攝取飲食異常」(avoidant/restrictive food intake disorder)，並且擴大其診斷準則。


Sleep–wake disorders[edit]

睡眠-覺醒異常

•    "關於其他精神異常之睡眠異常、且關於一般性醫學狀況之睡眠異常"被刪除。

•    原發性失眠異常(Primary insomnia )成為失眠異常(Insomnia disorder)，猝睡症(narcolepsy)則獨立於其他嗜睡症(hypersomnolence)。

•    新增三個與呼吸相關的睡眠異常：中樞性睡眠呼吸中止症(central sleep apnea)、低通氣阻塞性睡眠呼吸中止症(obstructive sleep apnea hypopnea)及與通氣不足相關的睡眠異常(sleep-related hypoventilation)。

•    晝夜節律睡眠 - 覺醒異常(Circadian rhythm sleep–wake disorders)擴增到包含下述的睡眠時相症候群：不規則 睡眠-覺醒型(irregular sleep–wake type)、非24小時睡眠 - 覺醒型(non-24-hour sleep–wake type)；睡眠時差問題(Jet lag)已刪除。

•    快速動眼睡眠行為異常(Rapid eye movement sleep behavior disorder)及腿不安寧症候群(restless legs syndrome)已從DSM-IV的「其它未註明之睡眠異常」裡移出而納入每一個睡眠異常準則裡。


Sexual dysfunctions[edit]

  • DSM-5 has sex-specific sexual dysfunctions.[2]
  • For females, sexual desire and arousal disorders are combined into female sexual interest/arousal disorder.[2]
  • Sexual dysfunctions (except substance-/medication-induced sexual dysfunction) now require a duration of approximately 6 months and more exact severity criteria.[2]
  • A new diagnosis is genito-pelvic pain/penetration disorder which combines vaginismus and dyspareunia from DSM-IV.[2]
  • Sexual aversion disorder was deleted.[2]
  • Subtypes for all disorders include only "lifelong versus acquired" and "generalized versus situational" (one subtype was deleted from DSM-IV).[2]
  • Two subtypes were deleted: "sexual dysfunction due to a general medical condition" and "due to psychological versus combined factors".[2]

性功能異常

 DSM-V新增與「性之特異性」(sex-specific)之性功能異常。

 女性之性慾(sexual desire)和性慾喚起異常(arousal disorders)合併為女性性趣/性慾喚起異常(female sexual interest/arousal disorder)。

 性功能異常（除物質/一般性醫學狀況引起之性功能障礙）現在要求持續時間約6個月及更確切的嚴重程度標準。

•    新增一種診斷：生殖系統-骨盆腔疼痛/插入異常(genito-pelvic pain/penetration disorder)，並與DSM-IV的「陰道痙攣和性交疼痛」(vaginismus and dyspareunia)相合併。

•    性厭惡異常(Sexual aversion disorder)已被刪除。

•    所有的性功能異常亞型 包含只有"終身或後天"(lifelong versus acquired)及"廣泛或情境型"(generalized versus situational)，另一種亞型刪除。

 刪除兩個亞型:「由一般性醫學狀況引起之性功能異常 」及「合併相對於源自心理因素」(due to psychological versus combined factors)。

Gender dysphoria[edit]

Further information: Gender dysphoria
  • DSM-IV gender identity disorder is similar to, but not the same as, gender dysphoria in DSM-5. Separate criteria for children, adolescents and adults that are appropriate for varying developmental states are added.
  • Subtypes of gender identity disorder based on sexual orientation were deleted.[2]
  • Among other wording changes, criterion A and criterion B (cross-gender identification, and aversion toward one’s gender) were combined.[2] Along with these changes comes the creation of a separate gender dysphoria in children as well as one for adults and adolescents. The grouping has been moved out of the sexual disorders category and into its own. The name change was made in part due to stigmatization of the term "disorder" and the relatively common use of "gender dysphoria" in the GID literature and among specialists in the area.[17] The creation of a specific diagnosis for children reflects the lesser ability of children to have insight into what they are experiencing and ability to express it in the event that they have insight.[18]

Disruptive, impulse-control, and conduct disorders[edit]

Some of these disorders were formerly part of the chapter on early diagnosis, oppositional defiant disorder; conduct disorder; and disruptive behavior disorder not otherwise specified became other specified and unspecified disruptive disorder, impulse-control disorder, and conduct disorders.[2] Intermittent explosive disorder, pyromania, and kleptomaniamoved to this chapter from the DSM-IV chapter "Impulse-Control Disorders Not Otherwise Specified".[2]
  • Antisocial personality disorder is listed here and in the chapter on personality disorders (but ADHD is listed under neurodevelopmental disorders).[2]
  • Symptoms for oppositional defiant disorder are of three types: angry/irritable mood, argumentative/defiant behavior, and vindictiveness. The conduct disorder exclusion is deleted. The criteria were also changed with a note on frequency requirements and a measure of severity.[2]
  • Criteria for conduct disorder are unchanged for the most part from DSM-IV.[2] A specifier was added for people with limited "prosocial emotion", showing callous and unemotional traits.[2]
  • People over the disorder's minimum age of 6 may be diagnosed with intermittent explosive disorder without outbursts of physical aggression.[2] Criteria were added for frequency and to specify "impulsive and/or anger based in nature, and must cause marked distress, cause impairment in occupational or interpersonal functioning, or be associated with negative financial or legal consequences".[2]

Substance-related and addictive disorders[edit]

  • Gambling disorder and tobacco use disorder are new.
  • Substance abuse and substance dependence have been combined into single substance use disorders specific to each substance of abuse within a new "addictions and related disorders" category.[19] "Recurrent legal problems" was deleted and "craving or a strong desire or urge to use a substance" was added to the criteria.[2] The threshold of the number of criteria that must be met was changed.[2] Severity from mild to severe is based on the number of criteria endorsed.[2] Criteria for cannabis and caffeine withdrawal were added.[2] New specifiers were added for early and sustained remission along with new specifiers for "in a controlled environment" and "on maintenance therapy".[2]

Neurocognitive disorders[edit]

Paraphilic disorders[edit]

  • New specifiers "in a controlled environment" and "in remission" were added to criteria for all paraphilic disorders.[2]
  • A distinction is made between paraphilic behaviors, or paraphilias, and paraphilic disorders.[21] All criteria sets were changed to add the word disorder to all of the paraphilias, for example, pedophilia is now pedophilic disorder.[2] There is no change in the basic diagnostic structure since DSM-III-R; however, people now must meet both qualitative (criterion A) and negative consequences (criterion B) criteria to be diagnosed with a paraphilic disorder. Otherwise they have a paraphilia (and no diagnosis).[2]

Personality disorders

  • Personality disorder previously belonged to a different axis than almost all other disorders, but is now in one axis with all mental and other medical diagnoses.[22] However, the same ten types of personality disorder are retained.




舊的 DSM 分類..

010 Disorders usually first diagnosed in infancy, childhood or adolescence. *Disorders such as ADHD and epilepsy have also been referred to as developmental disorders and developmental disabilities.

Examples

Mental retardation, ADHD


020 Delirium, dementia, and amnesia and other cognitive disorders

Examples

Alzheimer's disease


030 Mental disorders due to a general medical condition

Examples

AIDS-related psychosis


040 Substance-related disorders

Examples
Alcohol abuse


050 Schizophrenia and other psychotic disorders

Examples

Delusional disorder


060 Mood disorders

Examples

Major depressive disorder, Bipolar disorder


070 Anxiety disorders

General anxiety disorder


080 Somatoform disorders

Somatization disorder


090 Factitious disorders

Munchausen syndrome


100 Dissociative disorders

Dissociative identity disorder


110 Sexual and gender identity disorders

Dyspareunia, Gender identity disorder


120 Eating disorders

Anorexia nervosa, Bulimia nervosa


130 Sleep disorders

Insomnia


140 Impulse control disorders not elsewhere classified

Kleptomania


150 Adjustment disorders

Adjustment disorder


160 Personality disorders  (2nd Axis)

Narcissistic personality disorder


170 Other conditions that may be a focus of clinical attention

Tardive dyskinesia, Child abuse




CCMD-3目錄  ( 尚須要實徵研究加強 )


中國精神疾病分類與診斷標準，簡稱CCMD

現行的分類與診斷標準為《中國精神疾病分類與診斷標準第3版(CCMD-3)》，由衛生部科學研究基金資助，通過41家精神衛生機構負責對24種精神障礙的分類與診斷標準完成了前瞻性隨訪測試，於2001年完成，並編寫了《CCMD-3》和《CCMD-3相關精神障礙的治療和護理》[1]。

國際上通行的精神疾病診斷為美國《精神疾病診斷與統計手冊》（現行版本DSM-IV-TR）與世界衛生組織的《國際疾病與相關健康問題統計分類》（現行版本為ICD-10）。


• (0)器質性精神障礙

  o (00)阿爾茨海默(Alzheimer)病

  o (01)腦血管病所致精神障礙

  o (02)其他腦部疾病所致精神障礙

  o (03)軀體疾病所致精神障礙

  o (09)其他或待分類器質性精神障礙



• (1)精神活性物質或非成癮物質所致精神障礙

  o (10)精神活性物質所致精神障礙

  o (11)非成癮物質所致精神障礙

• (2)精神分裂症(分裂症)和其他精神病性障礙

  o (20)精神分裂症(分裂症)

  o (21)偏執性精神障礙

  o (22)急性短暫性精神病

  o (23)感應性精神病

  o (24)分裂情感性精神病

  o (29)其他或待分類的精神病性障礙

• (3)心境障礙(情感性精神障礙)

  o (30)躁狂發作

  o (31)雙相障礙

  o (32)抑鬱發作

  o (33)持續性心境障礙

  o (39)其他或待分類的心境障礙

• (4)癔症、應激相關障礙、神經症

  o (40)癔症

  o (41)應激相關障礙

  o (42)與文化相關的精神障礙

  o (43)神經症

• (5)心理因素相關生理障礙

  o (50)進食障礙

  o (51)非器質性睡眠障礙

  o (52)非器質性性功能障礙

• (6)人格障礙、習慣與衝動控制障礙、性心理

  o (60)人格障礙

  o (61)習慣與衝動控制障礙

  o (62)性心理障礙（性變態）

• (7)精神發育遲滯與童年和少年期心理發育障礙

  o (70)精神發育遲滯

  o (71)言語和語言發育障礙

  o (72)特定學校技能發育障礙

  o (73)特定運動技能發育障礙

  o (74)混合性特定發育障礙

  o (75)廣泛性發育障礙

• (8)童年和少年期的多動障礙、品行障礙、情緒障礙

  o (80)多動障礙

  o (81)品行障礙

  o (82)品行與情緒混合障礙

  o (83)特發於童年的情緒障礙

  o (84)兒童社會功能障礙

  o (85)抽動障礙

  o (86)其他童年和少年期行為障礙

  o (89)其他或待分類的童年和少年期精神障礙

• (9)其他精神障礙和心理衛生情況

  o (90)待分類的精神病性障礙

  o (91)待分類的非精神病性精神障礙

  o (92)其他心理衛生情況

  o (99)待分類的其他精神障礙
張貼者： 於
標籤： ,

沒有留言:

張貼留言

訂閱： 張貼留言 (Atom)