The release of the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5）2013年5月，美国精神病学协会刺激了有关精神病诊断的许多讨论。有关该主题的辩论文章已发表在BMC医学in an article collection on当前的精神病学争议并在上一个博客。本文收集的最新成员侧重于DSM-5对临床实践中精神疾病的诊断和治疗的影响和未来方向。

在interview和BMC医学,大卫·库普弗（David Kupfer）, chair of the DSM-5 task force, discusses the future directions of DSM-5 in light of the研究领域标准(RDoC) and11th Revision of the International Classification of Diseases（ICD-11）。他还指出，DSM-5将有助于改善全球心理健康分类的沟通，他最近在国际会议上的主题演讲中进行了讨论DSM-5 and the Future of Psychiatric Diagnosis: Where is the roadmap taking us?held at theInstitute of Psychiatry at King’s College London。

您可以在此播客中听David Kupfer的采访：

从我们的第一个中也出版了更广泛的精神科医生的观点Forum article, where several of ourEditorial Board members和their colleagues provide their personal opinions on how the DSM-5 might affect their specific areas of medicine. These areas include autism, trauma-and stressor-related disorders, obsessive-compulsive and related disorders, mood disorders (including major depression and bipolar disorders) and schizophrenia spectrum disorders which we summarize below.

Charles Nemeroff和Daniel Weinberger discuss that even though there are no current biomarkers for psychiatric disorders there is an overall improvement for mental health classification in DSM-5 compared with the older revision DSM-IV. This includes disorders such as autism – but asMichael Rutter指出的是，消除自闭症谱系障碍（ASD）的子分类（例如，DSM-5中的阿斯伯格综合症）可能会影响对服务的可访问性，尤其是在功能较高的自闭症的个人中。可以理解的是，这是一个分歧意见的问题。最近在皇家精神科学院国际大会2013年,大卫·斯库斯（David Skuse）mentioned that when criteria were validated for ASD diagnosis there was largely improvement in DSM-5 compared with DSM-IV. Continuing on the topic of neurodevelopmental disorders, attention deficit hyperactivity disorder (ADHD) is now classified in DSM-5 under this group of conditions rather than as a disruptive disorder. In aninterview和BMC医学，埃里克·泰勒（Eric Taylor）解释说，尽管他欢迎DSM-5在ADHD诊断方面的变化，但他觉得他们错过了迈向连续方法的机会，即在严重性，分期和损害方面描述个人的特征。

You can listen to Eric Taylor’s interview in this podcast:

Another change in the DSM-5 is the introduction of a new chapter termed trauma-and stressor-related disorders (TRSD).哈里特·麦克米伦（Harriet MacMillan）comments that over-diagnosis of these disorders in childhood will be minimized with the need for history of exposure, specific trauma symptoms and association with significant distress or impairment. Furthermore, posttraumatic stress disorder (PTSD) has been restructured in DSM-5, andRichard Bryant和西蒙·韦斯利（Simon Wessely）认为对该疾病的新定义增加了异质性，并引起了人们对在研究环境中使用这种诊断的严重关注。此外，还包括了关于强迫症和相关疾病（OCRD）的全新章节，并且已经包括Dan Stein(who served as Chair of the DSM-5 Sub-work Group on OCRDs) suggests that these changes will help clinicians to diagnose patients with OCRDs.

关于抑郁症，有两个具体的变化：排除丧亲和引入新的“disruptive mood dysregulation disorder (DMDD)”用于儿童。Carmine Parianteemphasizes that the introduction of this new disorder will prevent the diagnoses of bipolar disorder in children, which is accompanied with the premature use of medication in such young individuals. He further highlights that removal of the bereavement exclusion for diagnosis of major depression will allow individuals who have been clinically depressed for less than two months following the loss of a loved one to have a diagnosis of the disorder. Florian Seemüller, however, argues that broadening of diagnostic boundaries for the risk for recurrent depression in people who experience severe grief will label them unnecessarily as having the illness and to receive needless treatment.

DSM-5放弃了精神病的高风险状态，并就精神分裂症谱系疾病进行了几次修正。解决的关键问题Paul Lysaker表明DSM-5似乎不太可能改变临床实践，因为它专注于定义精神分裂症谱系障碍的个体成分，而不是了解有关组件如何与更好的治疗相关的核心精神病理学过程。在第七届全国治疗精神分裂症会议专注于药物遗传学，早期干预措施和社会心理干预措施以及如何精神分裂症委员会report aims to provide practical steps to improve the quality of care of psychotic patients.

但是，鉴于当前的精神医学挑战，克拉斯·沃德纳尔（Klaas Wardenaar）和Peter de Jongeargue that evidence-based diagnostic methods should be developed by using multimode analysis and modeling to assess heterogeneity across persons and symptoms over time, to accurately identify optimal homogeneous subgroups.

We hope that potential developments on the integration of different classification systems including RDoC and ICD-11, along with the DSM-5, will ultimately improve the diagnosis, management, treatment and care of psychiatric patients.