yuyun 2010-6-8 00:34
DSM-5不只是給精神科醫師的工具而已
作者：Caroline Cassels
出處：WebMD醫學新聞
May 18, 2010 — 美國精神科醫學會（APA）的領導者出版了精神疾患診斷與統計手冊第五版（DSM-5），他們表示，這不只是給精神科醫師的工具，對所有醫療專業領域來說，都是一本重要的手冊。
DSM-5任務小組的主席和副主席David Kupfer醫師及Darrel Regier醫師表示，出版這本新手冊的主要目標在於讓它在臨床執業上更有用，包括初級照護。
他們在5月19日發表於美國醫學會期刊（JAMA）特別主題專輯的主編評論中寫到，雖然精神科醫師與其他精神健康照護專業人員對於將出版的手冊感到很有興趣，其他健康照護專業人員們也應該對DSM-5的發展感到興趣。舉例來說，對初級照護，大約有30%~50%病患有顯著的精神健康症狀，或是可確認的精神健康異常，如果未經治療，會有顯著的不良結果。
他們附帶表示，即使對外科專業，許多術前與術後發展都與顯著的精神健康議題有關。
新版的第一篇初稿預計在2013日5月發表，代表APA在審閱與改寫DSM過去10年來的努力，現在已經開放第一回合的公開檢閱及外部建議。
任務小組的13個工作團體，代表著精神疾病診斷的不同分類，將會繼續根據公開的回饋，以及最終臨床上與學術上許多次的研究後重新改寫這本手冊。
作者們表示，這篇JAMA上評論的主要目的在於突顯DSM-5改編過程中，醫師們的許多主要目標，包括促進精神科與其他醫學執業主流進一步的整合，針對一般醫學環境下診斷精神異常的挑戰，且強調不論臨床醫師的專科為何，關懷精神異常患者的重要性。
根據作者們表示，DSM-5將會進入下一階段的修訂以及發展，有許多關鍵議題需要提及：
* 決定如何改善精神疾患的臨床評估，以反應出臨床醫師們每天訪視病患的真實性。
* 決定如何更好地突顯精神科醫師與一般內科醫師的互動，包括一併發生的精神與一般內科症狀。
* 決定臨床醫師們是否可以從依賴病徵與症狀來分類精神疾患，到以根本的病理生理學新研究發展以及治療反應可以更佳地告知診斷類別。
* 決定DSM-5是否可以更彈性地及時與神經醫學與行為科學未來的進步結合，且
* 決定DSM-5是否可以與國際社會接軌，包括世界各地的初級照護醫師。
在受託擔任DSM-5任務小組的主席前，Kupfer醫師表示擔任禮來藥廠、Forest藥廠、輝瑞藥廠、Solvy/Wyeth藥廠以及Johnson Johnson藥廠的顧問團，且擔任Servire與Lundbeck藥廠的諮詢專家。Regier醫師，美國精神機構研究與教育執行主任，監督所有於美國精神醫學機構研究與教育部門，由聯邦與藥廠贊助的研究和研究訓練經費，但是表示未接受任何外在薪資、經費贊助、或是任何政府部門或藥廠的謝禮。
DSM-5 Not Just for Psychiatrists APA Says
By Caroline Cassels
Medscape Medical News
May 18, 2010 — Leaders of the American Psychiatric Association (APA) heading up the development of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) say the manual is important not only to psychiatry but all medical specialties.
David Kupfer, MD, and Darrel Regier, MD, MPH, chair and vice chair, respectively, of the DSM-5 task force, say one of the primary goals of developing the new manual is to make it more useful in all clinical practice, including primary care.
"Although psychiatrists and other mental health care professionals have a high level of interest in this forthcoming edition, other health care professionals should also be interested in the development of DSM-5. For instance in primary care settings, approximately 30% to 50% of patients have prominent mental health symptoms or identifiable mental health disorders, which have significant adverse consequences if left untreated," they write in an editorial in a special theme issue on mental health published May 19 in the Journal of the American Medical Association.
"Even in surgical specialties, many presurgical and postsurgical developments are associated with significant mental health issues," they add.
Scheduled for publication in May 2013, the first draft of the new edition, which represents a decade of work by the APA in reviewing and revising the DSM, has now been through the first round of public review and outside commentary.
From here members of the task force's 13 work groups, which represent different categories of psychiatric diagnoses, will continue to refine the manual based on public feedback and ultimately various rounds of field trials in clinical and academic settings.
One of the goals of the JAMA commentary, say the authors, is to highlight for physicians several major goals of the DSM-5 process, including facilitating further integration of psychiatry into mainstream medical practice, looking at the challenges of diagnosing mental disorders in general medical settings, and "emphasizing the importance of attending to patients with mental disorders regardless of the clinician's medical specialty."
According to the authors, as the DSM-5 moves into the next stages of revision and development, there are several key issues that need to be addressed:
Determining how clinical assessments of mental disorders can be improved to reflect the realities of the patients seen by clinicians on a daily basis;
Determining how to better address the interface between psychiatry and general medicine, including co-occurring psychiatric and general medical symptoms;
Determining whether clinicians can move away from relying on signs and symptoms to classify mental disorders and whether new research developments in underlying pathophysiology and treatment response can better inform diagnostic categories;
Determining whether DSM-5 can be made more flexible to incorporate future advances in neuroscience and behavioral science in a timely way; and
Determining whether DSM-5 can be aligned with the international community, including primary care physicians worldwide.
Before being appointed as chair of the DSM-5 Task Force, Dr. Kupfer reports having served on advisory boards for Eli Lilly Co, Forest Pharmaceuticals Inc, Pfizer Inc, Solvay/Wyeth Pharmaceuticals, and Johnson & Johnson and consulting for Servier and Lundbeck. Dr. Regier, executive director of the American Psychiatric Institute for Research and Education, oversees all federal and industry-sponsored research and research training grants in the American Psychiatric Institute for Research and Education but reports receipt of no external salary, funding, or honoraria from any government or industry sources.
JAMA. 2010;303:1974-1975.