ImportancePsychiatry mainly deals with conditions that are mediated by brain function but are not directly attributable to specific brain abnormalities. Given the lack of concrete biological markers, such as laboratory tests or imaging results, the development of diagnostic systems is difficult.ObservationsThis narrative review evaluated 9 diagnostic approaches. The validity of the DSM and the International Classification of Disorders (ICD) is limited. The Research Domain Criteria is a research framework, not a diagnostic system. The clinical utility of the quantitatively derived, dimensional Hierarchical Taxonomy of Psychopathology is questionable. The Psychodynamic Diagnostic Manual Version 2 follows psychoanalytic theory and focuses on personality. Unlike the personality assessments in ICD-11 or DSM-5’s alternative model, based on pathological extremes of the big 5 traits (extraversion, agreeableness, openness, conscientiousness, and neuroticism), it lacks foundation in empirical evidence. Network analytic approaches are intriguing, but their complexity makes them difficult to implement. Staging would be easier if individually predictive biological markers were available. The problem with all these new approaches is that they abstract patient experiences into higher-order constructs, potentially obscuring individual symptoms so much that they no longer reflect patients’ actual problems.Conclusions and RelevanceICD and DSM diagnoses can be questioned, but the reality of psychopathological symptoms, such as hallucinations, depression, anxiety, compulsions, and the suffering stemming from them, cannot. Therefore, it may be advisable to primarily describe patients according to the psychopathological symptoms they present, and any resulting personal syndromes, embedded in a framework of contextual clinical characterization including personality assessment and staging. The DSM and ICD are necessary for reimbursement, but they should be simplified and merged. A primarily psychopathological symptoms–based, clinical characterization approach would be multidimensional and clinically useful, because it would lead to problem-oriented treatment and support transdiagnostic research. It should be based on a universally used instrument to assess psychopathology and structured clinical characterization.

中文翻译：

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精神病学诊断中精神病理症状和临床特征的优先顺序


重要性精神病学主要研究由大脑功能介导的疾病，但并不直接归因于特定的大脑异常。由于缺乏具体的生物标志物，例如实验室测试或成像结果，诊断系统的开发很困难。观察这篇叙述性综述评估了 9 种诊断方法。 DSM 和国际疾病分类 (ICD) 的有效性是有限的。研究领域标准是一个研究框架，而不是一个诊断系统。定量得出的精神病理学维度层次分类法的临床效用值得怀疑。 《心理动力学诊断手册》第二版遵循精神分析理论，重点关注人格。与ICD-11或DSM-5替代模型中基于5大特征（外向性、宜人性、开放性、尽责性和神经质）的病态极端的人格评估不同，它缺乏经验证据的基础。网络分析方法很有趣，但其复杂性使其难以实施。如果有单独的预测生物标志物，分期会更容易。所有这些新方法的问题在于，它们将患者的经历抽象为更高阶的结构，可能会过多地掩盖个体症状，以致它们不再反映患者的实际问题。结论和相关性ICD和DSM的诊断可能会受到质疑，但精神病理学的现实幻觉、抑郁、焦虑、强迫症以及由此产生的痛苦等症状则不能。 因此，建议主要根据患者表现出的精神病理症状以及由此产生的个人综合症来描述患者，嵌入包括人格评估和分期在内的背景临床特征框架中。 DSM和ICD对于报销来说是必要的，但应该简化和合并。主要基于精神病理症状的临床表征方法将是多维的且在临床上有用，因为它将导致以问题为导向的治疗并支持跨诊断研究。它应该基于评估精神病理学和结构化临床特征的普遍使用的工具。