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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精神病理学症状的优先顺序和精神病学诊断中的临床特征


重要性精神病学主要处理由大脑功能介导但不直接归因于特定大脑异常的疾病。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。观察结果本叙述性综述评估了 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。定量推导的、维度的精神病理学分层分类法的临床效用值得怀疑。心理动力学诊断手册第 2 版遵循精神分析理论，侧重于人格。与 ICD-11 或 DSM-5 的替代模型中的人格评估不同，它基于五大特质（外向性、宜人性、开放性、责任心和神经质）的病态极端，它缺乏实证基础。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可用，分期会更容易。所有这些新方法的问题在于，它们将患者的体验抽象为更高层次的结构，可能会使个体症状变得如此模糊，以至于它们不再反映患者的实际问题。结论和相关性 ICD 和 DSM 诊断可以受到质疑，但精神病理学症状的现实，如幻觉、抑郁、焦虑、强迫症以及由此产生的痛苦，则不能。 因此，建议主要根据患者表现出的精神病理学症状以及由此产生的任何个人综合征来描述患者，这些症状嵌入到包括人格评估和分期在内的上下文临床特征框架中。DSM 和 ICD 是报销所必需的，但它们应该简化和合并。主要基于精神病理学症状的临床特征分析方法将是多维的和临床有用的，因为它将导致以问题为导向的治疗并支持跨诊断研究。它应该基于一种普遍使用的工具来评估精神病理学和结构化的临床特征。