克雷佩林与精神病人的时代形象

精神疾病分类学不仅构建了对于这种疾病的评价,也决定了病人的名誉及其在法律关系中的责任。通过这些直接或间接的作用,精神疾病分类学塑造了一个时代的精神病人的形象。概述了克雷佩林的理论体系和分类思想,分析了贯穿其间的哲学讨论及其产生的社会影响,在此基础上说明起始阶段的精神疾病分类学如何塑造了那样一种精神病人的时代形象。     

Factors associated with Borderline pathology in school-age children

The Diagnostic Interview for Borderlines as revised (DIB-R) for use with children and chart review was completed using the records of 54 children, ages 6 to 12 years, who had been admitted to a public psychiatric hospital. Based on the results of the DIB-R, the children were grouped as borderline and nonborderline. The two groups were then compared with regard to 52 independent variables which have historically been associated with the borderline diagnosis. Stepwise logistic regression was used to identify the cluster of diagnostic and independent variables which best discriminated the borderline subjects. Self-destructive behavior, irritable affect, anhedonia, and an externalizing disorder diagnosis at the time of admission accounted for 95.4% of the borderline children. These findings are in contrast to previous studies which have found an assortment of neuropsychological and/or neurological deficits and stressed the importance of a tendency toward psychotic regression on psychological testing as discriminative variables. The authors underscore the idea that borderline pathology may represent a spectrum of disorders and the need for a more specific psychiatric nosology in describing and diagnosing these children.     

Attention Deficit Hyperactivity Disorder in Adults: Implications for Theories of Diagnosis

The diagnosis of attention deficit hyperactivity disorder (ADHD) in adults has been a source of controversy, with some prominent researchers questioning its very existence and others suggesting it is an urgent clinical problem. This article reviews five domains of data addressing the validity of adult ADHD: clinical correlates, family history, treatment response, laboratory studies, and long-term outcome. It then shows how the debate over adult ADHD reflects a clash of theoretical paradigms and concludes by suggesting ways in which psychological science can collect the data needed to clarify the validity of adult ADHD.     

Symptom Properties as a Function of ADHD Type: An Argument for Continued Study of Sluggish Cognitive Tempo

Inconsistent alertness and orientation (sluggishness, drowsiness, daydreaming) were reported to accompany Attention Deficit Disorder (ADD) without Hyperactivity in DSM-III. Such Sluggish Cognitive Tempo items were tested in the DSM-IV Field Trial for ADHD, but were discarded from the Inattention symptom list because of poor negative predictive power. Using 692 children referred to a pediatric subspecialty clinic for ADHD, Sluggish Tempo items were re-evaluated. When Hyperactivity–Impulsivity was absent (i.e., using only cases of Inattentive Type plus clinic controls), Sluggish Tempo items showed substantially improved utility as symptoms of Inattention. Factor analyses distinguished a Sluggish Tempo factor from an Inattention factor. When DSM-IV ADHD types were compared, Inattentive Type was uniquely elevated on Sluggish Tempo. These findings suggest that (a) Sluggish Tempo items are adequate symptoms for Inattentive Type, or (b) Sluggish Tempo may distinguish two subtypes of Inattentive Type. Either conclusion is incompatible with ADHD nosology in DSM-IV.     

Two Poems

No abstract available for this article.     

Nosology and Causal Necessity; The Relation BetweenDefining a Disease and Discovering its Necessary Cause

The problem of disease definition is related to theproblem of proving that a certain agent is thenecessary cause of a certain disease. Natural kindterms like rheumatoid arthritis and AIDS refer toessences which are discoverable rather thanpredeterminate. No statement about such diseases isa priori necessarily true. Because theories onnecessary causes involve natural kind semantics,Koch's postulates cannot be used to falsify or verifysuch theories. Instead of proving that agent A is thenecessary cause of disease D, we include A in atheoretical definition of D, take this to representthe real meaning of D, and discard thepretheoretical definition. This is illustrated byKoch's own attempt to prove he had discovered thenecessary cause of tuberculosis. Methodologicalarguments about disease causation require a clear viewof our use of diagnostic terms. Medical lexicographersshould do more to provide such a view.     

Toward a Cognitive-Behavioral Classification System for Mental Disorders

As is true for its predecessors, the recently published DSM-5 uses arbitrary criteria and cutoffs to define categories of mental disorders that are of questionable validity and that provide no guidance for treatment. Recently, the NIMH introduced an alternative classification system, the Research Domain Criteria (RDoC). Both the DSM-5 and the RDoC initiative make the strong assumption that psychological problems are expressions of specific latent disease entities. In contrast, the complex causal network approach conceptualizes psychological problems as mutually interacting, often reciprocally reinforcing, elements of a complex causal network. The cognitive behavioral model offers a classification framework that is compatible with the complex causal network approach and provides a treatment-relevant alternative to the latent disease model that is the basis for the DSM-5 and the RDoC initiative.     

Assessment and Diagnostic Issues in Rational Emotive Behavior Therapy: Introduction to the Special Issue

This article introduces a special issue of the Journal of Rational-Emotive & Cognitive-Behavior Therapy on assessment and diagnostic issues in REBT. Contributions to the special issue include reviews of (a) the psychometric properties of irrational beliefs measures and (b) the potential utility for REBT research and practice of behavioral measures of distress tolerance; (c) a primary study of the diagnostic and functional significance of high trait anger, with implications for classification and REBT treatment of anger disorders; and (d) a closing commentary by John Malouff on themes raised in the earlier papers.     

DSM-IV criteria for borderline personality disorder: A critical evaluation

The present article critically examines the diagnostic criteria for borderline personality disorder (BPD) recently proposed by the DSM-IV Axis II work group (Gunderson, J. G., et al., Journal of Personality Disorders, 5, 340–352, 1991). It is concluded that some of the revisions are trivial and there is insufficient justification for others. The revisions are likely to increase the overlap between BPD and other disorders and represent an attempt to retain a categorical classification in the face of evidence that a dimensional model is more appropriate. Evidence suggests that many borderline traits are manifestations of extreme neuroticism.