Module 3: Clinical Assessment, Diagnosis, and Treatment模块 3：临床评估、诊断与治疗

3rd edition as of July 2023
截至 2023 年 7 月的第三版

Module Overview 模块概述

Module 3 covers the issues of clinical assessment, diagnosis, and treatment. We will define assessment and then describe key issues such as reliability, validity, standardization, and specific methods that are used. In terms of clinical diagnosis, we will discuss the two main classification systems used around the world – the DSM-5-TR and ICD-11. Finally, we discuss the reasons why people may seek treatment and what to expect when doing so.
模块 3 涵盖了临床评估、诊断和治疗的问题。我们将定义评估，然后描述关键问题，如可靠性、有效性、标准化以及所使用的具体方法。在临床诊断方面，我们将讨论全球使用的两种主要分类系统——DSM-5-TR 和 ICD-11。最后，我们讨论人们寻求治疗的原因以及这样做时可以期待什么。

Module Outline 模块大纲

• 3.1. Clinical Assessment of Abnormal Behavior
  3.1. 临床异常行为评估
• 3.2. Diagnosing and Classifying Abnormal Behavior
  3.2. 诊断和分类异常行为
• 3.3. Treatment of Mental Disorders – An Overview
  3.3. 精神疾病治疗 - 概述

Module Learning Outcomes 模块学习成果

• Describe clinical assessment and methods used in it.
  描述临床评估及其使用的方法。
• Clarify how mental health professionals diagnose mental disorders in a standardized way.
  明确心理健康专业人士如何以标准化的方式诊断精神疾病。
• Discuss reasons to seek treatment and the importance of psychotherapy.
  讨论寻求治疗的原因和心理咨询的重要性。

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3.1. Clinical Assessment of Abnormal Behavior 3.1. 临床异常行为评估

Section Learning Objectives 章节学习目标

• Define clinical assessment.  定义临床评估。
• Clarify why clinical assessment is an ongoing process.
  明确为什么临床评估是一个持续的过程。
• Define and exemplify reliability.
  定义并举例说明可靠性。
• Define and exemplify validity.
  定义并举例说明有效性。
• Define standardization.  定义标准化。
• List and describe seven methods of assessment.
  列出并描述七种评估方法。

3.1.1. What is Clinical Assessment? 3.1.1. 临床评估是什么？

For a mental health professional to be able to effectively help treat a client and know that the treatment selected worked (or is working), they first must engage in the **clinical assessment **of the client, or collecting information and drawing conclusions through the use of observation, psychological tests, neurological tests, and interviews to determine the person’s problem and the presenting symptoms. This collection of information involves learning about the client’s skills, abilities, personality characteristics, cognitive and emotional functioning, the social context in terms of environmental stressors that are faced, and cultural factors particular to them such as their language or ethnicity. Clinical assessment is not just conducted at the beginning of the process of seeking help but throughout the process. Why is that?
心理健康专业人士要能够有效地帮助治疗客户并知道所选的治疗方法有效（或正在有效），他们首先必须进行客户的临床评估，即通过观察、心理测试、神经测试和访谈等方式收集信息并得出结论，以确定个人的问题和表现出的症状。这一信息收集过程包括了解客户的能力、技能、个性特征、认知和情感功能，以及他们在面对环境压力因素时的社会背景，以及他们特有的文化因素，如语言或种族。临床评估不仅在进行求助过程的开始时进行，而且在整个过程中都要进行。为什么是这样呢？

Consider this. First, we need to determine if a treatment is even needed. By having a clear accounting of the person’s symptoms and how they affect daily functioning, we can decide to what extent the individual is adversely affected. Assuming a treatment is needed, our second reason to engage in clinical assessment will be to determine what treatment will work best. As you will see later in this module, there are numerous approaches to treatment.  These include Behavior Therapy, Cognitive and Cognitive-Behavioral Therapy (CBT), Humanistic-Experiential Therapies, Psychodynamic Therapies, Couples and Family Therapy, and biological treatments (psychopharmacology). Of course, for any mental disorder, some of the aforementioned therapies will have greater efficacy than others. Even if several can work well, it does not mean a particular therapy will work well for that specific client. Assessment can help figure this out. Finally, we need to know if the treatment we employed worked. This will involve measuring before any treatment is used and then measuring the behavior while the treatment is in place. We will even want to measure after the treatment ends to make sure symptoms of the disorder do not return. Knowing what the person’s baselines are for different aspects of psychological functioning will help us to see when improvement occurs.
考虑这一点。首先，我们需要确定是否需要治疗。通过明确了解个人的症状及其对日常生活的影响，我们可以决定个人受到的不利影响程度。假设需要治疗，我们进行临床评估的第二个原因将是确定哪种治疗方法最有效。正如您将在本模块的后面看到的那样，治疗方法有很多。这包括行为疗法、认知和认知行为疗法（CBT）、人本-经验疗法、心理动力学疗法、夫妻和家庭疗法，以及生物治疗方法（精神药理学）。当然，对于任何精神疾病，上述某些治疗方法可能比其他治疗方法更有效。即使几种方法都可以很好地工作，并不意味着某种特定的治疗方法会适用于那位特定的客户。评估可以帮助弄清楚这一点。最后，我们需要知道我们采用的治疗是否有效。这涉及到在采用任何治疗之前进行测量，然后在治疗进行时测量行为。 我们甚至会在治疗结束后进行测量，以确保疾病的症状不会复发。了解该人在心理功能不同方面的基线情况将帮助我们判断何时出现改善。

In recap, obtaining the baselines happens in the beginning, implementing the treatment plan that is agreed upon happens more so in the middle, and then making sure the treatment produces the desired outcome occurs at the end. It should be clear from this discussion that clinical assessment is an ongoing process.
总结来说，确定基线发生在开始阶段，实施已达成共识的治疗计划主要发生在中间阶段，然后确保治疗产生预期结果发生在最后。从这次讨论中应该清楚，临床评估是一个持续的过程。

3.1.2. Key Concepts in Assessment 3.1.2. 评估中的关键概念

The assessment process involves three critical concepts – reliability, validity, and standardization. These three are important to science in general. First, we want the assessment to be reliable or consistent. Outside of clinical assessment, when our car has an issue and we take it to the mechanic, we want to make sure that what one mechanic says is wrong with our car is the same as what another says, or even two others. If not, the measurement tools they use to assess cars are flawed. The same is true of a patient who is suffering from a mental disorder. If one mental health professional says the person suffers from major depressive disorder and another says the issue is borderline personality disorder, then there is an issue with the assessment tool being used. Ensuring that two different raters are consistent in their assessment of patients is called interrater reliability. Another type of reliability occurs when a person takes a test one day, and then the same test on another day. We would expect the person’s answers to be consistent, which is called test-retest reliability. For example, let’s say the person takes the MMPI on Tuesday and then the same test on Friday. Unless something miraculous or tragic happened over the two days in between tests, the scores on the MMPI should be nearly identical to one another. What does identical mean? The score at test and the score at retest are correlated with one another. If the test is reliable, the correlation should be very high (remember, a correlation goes from -1.00 to +1.00, and positive means as one score goes up, so does the other, so the correlation for the two tests should be high on the positive side).
评估过程涉及三个关键概念——可靠性、有效性和标准化。这三个概念对科学总体来说都很重要。首先，我们希望评估是可靠的或一致的。在临床评估之外，当我们的车出现问题，我们把它送到修车行时，我们想确保一个修车工说的我们车的问题和另一个修车工说的是一样的，甚至两个修车工都一样。如果不是这样，他们用来评估汽车的工具就是有缺陷的。对于患有精神障碍的患者也是如此。如果一个心理健康专家说这个人患有重度抑郁症，而另一个说问题是边缘型人格障碍，那么评估工具就有问题。确保两位不同的评估者在评估患者时保持一致被称为评分者间可靠性。另一种可靠性发生在一个人一天内参加一次考试，然后在另一天参加同样的考试。我们预计这个人的答案将是一致的，这被称为重测信度。例如，假设这个人星期二参加了 MMPI 测试，然后在星期五参加了同样的测试。 除非在两次测试之间发生奇迹或悲剧，MMPI 的得分应该几乎相同。什么是相同？测试得分和复测得分相互关联。如果测试是可靠的，相关性应该非常高（记住，相关性从-1.00 到+1.00，正值意味着一个分数上升，另一个也上升，所以两个测试的相关性应该在正面上很高）。

In addition to reliability, we want to make sure the test measures what it says it measures. This is called validity. Let’s say a new test is developed to measure symptoms of depression. It is compared against an existing and proven test, such as the Beck Depression Inventory (BDI).  If the new test measures depression, then the scores on it should be highly comparable to the ones obtained by the BDI. This is called concurrent or descriptive validity. We might even ask if an assessment tool looks valid. If we answer yes, then it has *face *validity, though it should be noted that this is not based on any statistical or evidence-based method of assessing validity. An example would be a personality test that asks about how people behave in certain situations. Therefore, it seems to measure personality, or we have an overall feeling that it measures what we expect it to measure.
除了可靠性，我们还想确保测试测量了它所说的内容。这被称为效度。假设开发了一种新的测试来测量抑郁症的症状。它被与现有的、经过验证的测试进行比较，例如贝克抑郁量表（BDI）。如果新的测试测量了抑郁症，那么它的得分应该与 BDI 获得的得分高度可比。这被称为同时效度或描述效度。我们甚至可能会问一个评估工具是否看起来有效。如果我们回答是，那么它就具有表面效度，尽管应该指出的是，这并不是基于任何基于统计或证据的效度评估方法。一个例子是询问人们在某些情况下如何行为的个性测试。因此，它似乎在测量个性，或者我们有一种整体的感觉，它测量了我们期望它测量的内容。

Predictive validity is when a tool accurately predicts what will happen in the future. Let’s say we want to tell if a high school student will do well in college. We might create a national exam to test needed skills and call it something like the Scholastic Aptitude Test (SAT). We would have high school students take it by their senior year and then wait until they are in college for a few years and see how they are doing. If they did well on the SAT, we would expect that at that point, they should be doing well in college. If so, then the SAT accurately predicts college success. The same would be true of a test such as the Graduate Record Exam (GRE) and its ability to predict graduate school performance.
预测效度是指一个工具能够准确预测未来会发生什么。比如说，我们想知道一个高中生在大学里是否会表现良好。我们可能会创建一个全国性的考试来测试所需的技能，并称其为学术能力评估测试（SAT）。我们会在高中生高三那年让他们参加这个考试，然后等他们在大学里学习了几年后，看看他们的表现。如果他们在 SAT 考试中表现良好，我们就会期待他们在那个阶段，应该会在大学里表现良好。如果是这样，那么 SAT 就准确地预测了大学成功。同样的情况也适用于像研究生入学考试（GRE）这样的考试及其预测研究生院表现的能力。

Finally, we want to make sure that the experience one patient has when taking a test or being assessed is the same as another patient taking the test the same day or on a different day, and with either the same tester or another tester. This is accomplished with the use of clearly laid out rules, norms, and/or procedures, and is called standardization. Equally important is that mental health professionals interpret the results of the testing in the same way, or otherwise, it will be unclear what the meaning of a specific score is.
最后，我们想确保患者在参加测试或接受评估时的体验与其他患者在同一天或不同一天参加测试，以及与同一位或不同位测试者进行测试时的体验相同。这是通过使用明确规定的规则、规范和/或程序来实现的，这被称为标准化。同样重要的是，心理健康专业人员以相同的方式解释测试结果，否则，将不清楚特定分数的含义。

3.1.3. Methods of Assessment 3.1.3. 评估方法

So how do we assess patients in our care? We will discuss observation, psychological tests, neurological tests, the clinical interview, and a few others in this section.
那么我们如何评估我们照顾的病人呢？在本节中，我们将讨论观察、心理测试、神经测试、临床访谈以及其他一些内容。

**            3.1.3.1. Observation. **In Section 1.5.2.1 we talked about two types of observation – naturalistic, or observing the person or animal in their environment, and laboratory, or observing the organism in a more controlled or artificial setting where the experimenter can use sophisticated equipment and videotape the session to examine it later. One-way mirrors can also be used. A limitation of this method is that the process of recording a behavior causes the behavior to change, called **reactivity. **Have you ever noticed someone staring at you while you sat and ate your lunch? If you have, what did you do? Did you change your behavior? Did you become self-conscious? Likely yes, and this is an example of reactivity. Another issue is that the behavior made in one situation may not be made in other situations, such as your significant other only acting out at the football game and not at home. This form of validity is called **cross-sectional validity. **We also need our raters to observe and record behavior in the same way or to have high inter-rater reliability.
3.1.3.1. 观察。在第 1.5.2.1 节中，我们讨论了两种观察类型——自然主义观察，即观察人或动物在其环境中，和实验室观察，即在更受控或人工的环境中观察生物体，实验者可以使用复杂的设备并录像以供以后检查。也可以使用单面镜。这种方法的一个局限性是记录行为的过程会导致行为改变，称为反应性。你有没有注意到有人在你坐着吃午饭的时候盯着你看？如果你注意到了，你做了什么？你的行为有没有改变？你有没有变得自我意识？很可能是，这是一个反应性的例子。另一个问题是，在一种情况下做出的行为可能在其他情况下不会出现，比如你的伴侣只在足球比赛中表现，而不是在家里。这种形式的效度称为横断面效度。我们还需要我们的评分者以相同的方式观察和记录行为，或者具有高度的评分者间可靠性。

**            3.1.3.2. The clinical interview. **A clinical interview is a face-to-face encounter between a mental health professional and a patient in which the former observes the latter and gathers data about the person’s behavior, attitudes, current situation, personality, and life history. The interview may be unstructured in which open-ended questions are asked, structured in which a specific set of questions according to an interview schedule are asked, or semi-structured, in which there is a pre-set list of questions, but clinicians can follow up on specific issues that catch their attention. A mental status examination is used to organize the information collected during the interview and systematically evaluates the patient through a series of questions assessing appearance and behavior. The latter includes grooming and body posture, thought processes and content to include disorganized speech or thought and false beliefs, mood and affect such that whether the person feels hopeless or elated, intellectual functioning to include speech and memory, and awareness of surroundings to include where the person is and what the day and time are. The exam covers areas not normally part of the interview and allows the mental health professional to determine which areas need to be examined further. The limitation of the interview is that it lacks reliability, especially in the case of the unstructured interview.
3.1.3.2. 临床访谈。临床访谈是心理健康专业人士与患者面对面交流的过程，其中前者观察后者并收集有关该人行为、态度、当前情况、个性和生活经历的数据。访谈可能是非结构化的，其中提出开放式问题，结构化的，其中根据访谈日程提出一组特定问题，或半结构化的，其中有一个预设的问题列表，但临床医生可以跟进引起他们注意的具体问题。精神状态检查用于组织访谈期间收集的信息，并通过一系列评估外观和行为的问题系统地评估患者。后者包括仪容和身体姿势、思维过程和内容，包括混乱的言语或思维和错误信念、情绪和情感，即此人是否感到绝望或兴奋，智力功能包括言语和记忆，以及周围环境的意识，包括此人在哪里以及今天是星期几和几点。 考试涵盖了通常不包含在面试中的领域，并允许心理健康专业人士确定哪些领域需要进一步检查。面试的局限性在于它缺乏可靠性，尤其是在非结构化面试的情况下。

**            3.1.3.3. Psychological tests and inventories. Psychological tests** assess the client’s personality, social skills, cognitive abilities, emotions, behavioral responses, or interests. They can be administered either individually or to groups in paper or oral fashion. **Projective tests **consist of simple ambiguous stimuli that can elicit an unlimited number of responses. They include the Rorschach or inkblot test and the Thematic Apperception Test which asks the individual to write a complete story about each of 20 cards shown to them and give details about what led up to the scene depicted, what the characters are thinking, what they are doing, and what the outcome will be. From the response, the clinician gains perspective on the patient’s worries, needs, emotions, conflicts, and the individual always connects with one of the people on the card.  Another projective test is the *sentence completion test *and asks individuals to finish an incomplete sentence. Examples include ‘My mother…’ or ‘I hope…’
3.1.3.3. 心理测试和清单。心理测试评估客户的个性、社交技能、认知能力、情绪、行为反应或兴趣。它们可以以个体或群体形式，以书面或口头方式进行。投射测试包括简单的模糊刺激，可以引发无限数量的反应。它们包括罗夏测试或墨迹测试，以及主题统觉测试，要求个人针对展示给他们的 20 张卡片中的每一张写一个完整的故事，并详细说明导致场景发生的原因，人物的想法，他们在做什么，以及结果将如何。从回应中，临床医生可以了解患者的担忧、需求、情绪、冲突，并且个人总是与卡片上的人之一产生联系。另一种投射测试是句子完成测试，要求个人完成一个不完整的句子。例如，“我的母亲……”或“我希望……”。

Personality inventories ask clients to state whether each item in a long list of statements applies to them, and could ask about feelings, behaviors, or beliefs. Examples include the MMPI or Minnesota Multiphasic Personality Inventory and the NEO-PI-R, which is a concise measure of the five major domains of personality – Neuroticism, Extroversion, Openness, Agreeableness, and Conscientiousness. Six facets define each of the five domains, and the measure assesses emotional, interpersonal, experimental, attitudinal, and motivational styles (Costa & McCrae, 1992). These inventories have the advantage of being easy to administer by either a professional or the individual taking it, are standardized, objectively scored, and can be completed electronically or by hand. That said, personality cannot be directly assessed, and so you do not ever completely know the individual.
个性量表要求客户声明长列表中的每一项陈述是否适用于他们，并可能询问感受、行为或信念。例如，有 MMPI 或明尼苏达多项人格量表和 NEO-PI-R，它是对人格五大主要领域的简洁衡量——神经质、外向性、开放性、宜人性、责任心。六个方面定义了五个领域中的每一个，该量表评估情绪、人际、实验、态度和动机风格（Costa & McCrae，1992）。这些量表的优势在于既便于专业人士或个人进行管理，又是标准化的、客观计分的，可以通过电子方式或手工完成。尽管如此，人格不能直接评估，因此你永远无法完全了解个人。

**            3.1.3.4. Neurological tests. **Neurological tests are used to diagnose cognitive impairments caused by brain damage due to tumors, infections, or head injuries; or changes in brain activity. Positron Emission Tomography or PET is used to study the brain’s chemistry. It begins by injecting the patient with a radionuclide that collects in the brain and then having them lie on a scanning table while a ring-shaped machine is positioned over their head. Images are produced that yield information about the functioning of the brain. *Magnetic Resonance Imaging or MRI *provides 3D images of the brain or other body structures using magnetic fields and computers. It can detect brain and spinal cord tumors or nervous system disorders such as multiple sclerosis. Finally, *computed tomography or the CT scan *involves taking X-rays of the brain at different angles and is used to diagnose brain damage caused by head injuries or brain tumors.
3.1.3.4. 神经学检查。神经学检查用于诊断由肿瘤、感染或头部外伤引起的认知障碍；或脑活动变化。正电子发射断层扫描或 PET 用于研究大脑的化学成分。它首先通过向患者注射一种在脑部聚集的放射性同位素，然后让他们躺在扫描台上，同时将一个环形的机器定位在他们头顶上方。产生的图像可以提供关于大脑功能的信息。磁共振成像或 MRI 利用磁场和计算机提供大脑或其他身体结构的 3D 图像。它可以检测脑部和脊髓肿瘤或如多发性硬化症等神经系统疾病。最后，计算机断层扫描或 CT 扫描涉及从不同角度拍摄大脑的 X 光片，用于诊断由头部外伤或脑肿瘤引起的脑损伤。

**            3.1.3.5. Physical examination. **Many mental health professionals recommend the patient see their family physician for a physical examination, which is much like a check-up. Why is that? Some organic conditions, such as hyperthyroidism or hormonal irregularities, manifest behavioral symptoms that are like mental disorders. Ruling out such conditions can save costly therapy or surgery.
3.1.3.5.体格检查。许多心理健康专业人士建议患者去看家庭医生进行体格检查，这就像是一次体检。为什么？一些有机性疾病，如甲状腺功能亢进或激素失调，会表现出类似精神障碍的行为症状。排除这些疾病可以节省昂贵的治疗或手术费用。

**            3.1.3.6. Behavioral assessment. **Within the realm of behavior modification and applied behavior analysis, we talk about what is called behavioral assessment, which is the measurement of a target behavior. The target behavior is whatever behavior we want to change, and it can be in excess and needing to be reduced, or in a deficit state and needing to be increased. During the behavioral assessment we learn about the ABCs of behavior in which Antecedents are the environmental events or stimuli that trigger a behavior; **Behaviors **are what the person does, says, thinks/feels; and **Consequences **are the outcome of a behavior that either encourages it to be made again in the future or discourages its future occurrence. Though we might try to change another person’s behavior using behavior modification, we can also change our own behavior, which is called self-modification. The person does their own measuring and recording of the ABCs, which is called **self-monitoring. **In the context of psychopathology, behavior modification can be useful in treating phobias, reducing habit disorders, and ridding the person of maladaptive cognitions.
3.1.3.6. 行为评估。在行为改变和运用行为分析领域，我们谈论所谓的“行为评估”，即对目标行为的测量。目标行为是我们想要改变的行为，它可能是过度的，需要减少，也可能是缺乏的，需要增加。在行为评估过程中，我们了解行为的 ABC，其中前因是触发行为的环境事件或刺激；行为是个人所做、所说、所想/所感；后果是行为的结果，它要么鼓励未来再次发生，要么阻止未来的发生。尽管我们可能试图通过行为改变来改变他人的行为，但我们也可以改变自己的行为，这被称为自我改变。个人对自己的 ABC 进行测量和记录，这被称为自我监控。在心理病理学背景下，行为改变可以用于治疗恐惧症、减少习惯障碍和消除个人的不良认知。

**            3.1.3.7. Intelligence tests. **Intelligence testing determines the patient’s level of cognitive functioning and consists of a series of tasks asking the patient to use both verbal and nonverbal skills. An example is the Stanford-Binet Intelligence test, which assesses fluid reasoning, knowledge, quantitative reasoning, visual-spatial processing, and working memory. Intelligence tests have been criticized for not predicting future behaviors such as achievement and reflecting social or cultural factors/biases and not actual intelligence. Also, can we really assess intelligence through one dimension, or are there multiple dimensions?
3.1.3.7. 智力测试。智力测试用于确定患者的认知功能水平，包括一系列要求患者运用语言和非语言技能的任务。例如，斯坦福-比奈智力测试，它评估流体推理、知识、数量推理、视觉空间处理和工作记忆。智力测试因无法预测未来的行为（如成就）和反映社会或文化因素/偏见而非实际智力而受到批评。此外，我们是否真的可以通过一个维度来评估智力，或者是否存在多个维度？

Key Takeaways 关键要点

You should have learned the following in this section:
你应该在本节中学到了以下内容：

• Clinical assessment is the collecting of information and drawing conclusions through the use of observation, psychological tests, neurological tests, and interviews.
  临床评估是通过观察、心理测试、神经测试和访谈收集信息和得出结论的过程。
• Reliability refers to consistency in measurement and can take the form of interrater and test-retest reliability.
  可靠性指的是测量的稳定性，可以表现为评分者间和重测信度。
• Validity is when we ensure the test measures what it says it measures and takes the forms of concurrent or descriptive, face, and predictive validity.
  有效性是指我们确保测试测量了其所声称的内容，并采取并发或描述性、表面和预测效度的形式。
• Standardization is all the clearly laid out rules, norms, and/or procedures to ensure the experience each participant has is the same.
  标准化是一系列明确规定的规则、规范和/或程序，以确保每个参与者所经历的都是相同的。
• Patients are assessed through observation, psychological tests, neurological tests, and the clinical interview, all with their own strengths and limitations.
  患者通过观察、心理测试、神经学测试和临床访谈进行评估，每种方法都有其优势和局限性。

Section 3.1 Review Questions
第 3.1 节 复习问题

1. What does it mean that clinical assessment is an ongoing process?
   临床评估为何是一个持续的过程意味着什么？
2. Define and exemplify reliability, validity, and standardization.
   定义并举例说明可靠性、有效性和标准化。
3. For each assessment method, define it and then state its strengths and limitations.
   对于每种评估方法，先定义它，然后说明其优点和局限性。

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3.2. Diagnosing and Classifying Abnormal Behavior 3.2. 诊断和分类异常行为

Section Learning Objectives 章节学习目标

• Explain what it means to make a clinical diagnosis.
  解释临床诊断的含义。
• Define syndrome.  定义综合征。
• Clarify and exemplify what a classification system does.
  明确并举例说明分类系统的作用。
• Identify the two most used classification systems.
  识别最常用的两种分类系统。
• Outline the history of the DSM.
  概述 DSM 的历史。
• Identify and explain the elements of a diagnosis.
  识别并解释诊断的要素。
• Outline the major disorder categories of the DSM-5-TR.
  概述 DSM-5-TR 的主要失调类别。
• Describe the ICD-11.  描述 ICD-11。
• Clarify why the DSM-5-TR and ICD-11 need to be harmonized.
  阐明为什么 DSM-5-TR 和 ICD-11 需要协调一致。

3.2.1. Clinical Diagnosis and Classification Systems 3.2.1. 临床诊断和分类系统

Before starting any type of treatment, the client/patient must be clearly diagnosed with a mental disorder. **Clinical diagnosis **is the process of using assessment data to determine if the pattern of symptoms the person presents with is consistent with the diagnostic criteria for a specific mental disorder outlined in an established classification system such as the DSM-5-TR or ICD-11 (both will be described shortly). Any diagnosis should have clinical utility, meaning it aids the mental health professional in determining prognosis, the treatment plan, and possible outcomes of treatment (APA, 2022). Receiving a diagnosis does not necessarily mean the person requires treatment. This decision is made based upon how severe the symptoms are, level of distress caused by the symptoms, symptom salience such as expressing suicidal ideation, risks and benefits of treatment, disability, and other factors (APA, 2022). Likewise, a patient may not meet the full criteria for a diagnosis but demonstrate a clear need for treatment or care, nonetheless. As stated in the DSM, “The fact that some individuals do not show all symptoms indicative of a diagnosis should not be used to justify limiting their access to appropriate care” (APA, 2022).
在进行任何治疗之前，客户/患者必须被明确诊断为精神疾病。临床诊断是使用评估数据来确定该人呈现的症状模式是否符合在已建立的分类系统（如 DSM-5-TR 或 ICD-11）中概述的特定精神疾病的诊断标准的过程（两者将简要介绍）。任何诊断都应具有临床实用性，这意味着它有助于心理健康专业人士确定预后、治疗方案和治疗的可能结果（APA，2022）。获得诊断并不一定意味着该人需要治疗。这一决定是基于症状的严重程度、症状引起的痛苦程度、症状显著性（如表达自杀意念）、治疗的风险和收益、残疾以及其他因素（APA，2022）。同样，患者可能不符合诊断的全部标准，但仍然表现出明显的治疗或护理需求。 如 DSM 所述，“不能因为某些个体没有表现出所有表明诊断的症状，就用来证明限制他们获得适当护理的合理性”（APA，2022）。

Symptoms that cluster together regularly are called a syndrome. If they also follow the same, predictable course, we say that they are characteristic of a specific disorder.  Classification systems provide mental health professionals with an agreed-upon list of disorders falling into distinct categories for which there are clear descriptions and criteria for making a diagnosis. Distinct is the keyword here. People suffering from delusions, hallucinations, disorganized thinking (speech), grossly disorganized or abnormal motor behavior, and/or negative symptoms are different from people presenting with a primary clinical deficit in cognitive functioning that is not developmental but acquired (i.e., they have shown a decline in cognitive functioning over time). The former suffers from a schizophrenia spectrum disorder while the latter suffers from a neurocognitive disorder (NCD). The latter can be further distinguished from neurodevelopmental disorders which manifest early in development and involve developmental deficits that cause impairments in social, personal, academic, or occupational functioning (APA, 2022). These three disorder groups or categories can be clearly distinguished from one another. Classification systems also permit the gathering of statistics to determine incidence and prevalence rates and conform to the requirements of insurance companies for the payment of claims.
症状经常聚集在一起被称为综合征。如果它们也遵循相同的、可预测的病程，我们说它们是特定疾病的特征。分类系统为心理健康专业人士提供了一个达成共识的疾病列表，这些疾病分为不同的类别，每个类别都有明确的描述和诊断标准。在这里，“不同”是关键词。患有妄想、幻觉、思维（言语）紊乱、严重紊乱或异常的运动行为以及/或负面症状的人与表现出认知功能原发性临床缺陷（非发育性而是获得性，即他们认知功能随时间下降）的人不同。前者患有精神分裂症谱系障碍，而后者患有神经认知障碍（NCD）。后者可以进一步与神经发育障碍区分开来，后者在发育早期表现出来，涉及发育缺陷，导致社会、个人、学术或职业功能受损（APA，2022）。 这三组或类别的不规则可以清楚地相互区分。分类系统还允许收集统计数据以确定发病率和患病率，并符合保险公司支付索赔的要求。

The most widely used classification system in the United States is the *Diagnostic and Statistical Manual of Mental Disorders *(DSM) which is a “medical classification of disorders and as such serves as a historically determined cognitive schema imposed on clinical and scientific information to increase its comprehensibility and utility. The classification of disorders (the way in which disorders are grouped) provides a high-level organization for the manual” (APA, 2022, pg. 11). The DSM is currently in its 5th edition Text-Revision (DSM-5-TR) and is produced by the American Psychiatric Association (APA, 2022). Alternatively, the World Health Organization (WHO) publishes the *International Statistical Classification of Diseases and Related Health Problems (ICD) *currently in its 11th edition. We will begin by discussing the DSM and then move to the ICD.
美国最广泛使用的分类系统是《精神疾病诊断与统计手册》（DSM），它是一种“疾病分类”，作为一种历史上确定的认知模式，它被应用于临床和科学信息，以提高其可理解性和实用性。疾病的分类（疾病分组的方式）为手册提供了一个高级组织结构（APA，2022，第 11 页）。DSM 目前处于第 5 版文本修订（DSM-5-TR）阶段，由美国精神病学协会（APA，2022）出版。另一方面，世界卫生组织（WHO）出版《国际疾病分类及有关健康问题的统计分类》（ICD），目前处于第 11 版。我们将首先讨论 DSM，然后转向 ICD。

3.2.2. The DSM Classification System 3.2.2. 精神疾病诊断与统计手册分类系统

**            3.2.2.1.** A brief history of the DSM. The DSM-5 was published in 2013 and took the place of the DSM IV-TR (TR means Text Revision; published in 2000). In March 2022, a Text-Revision was published for the DSM-5, making it the DSM-5-TR.
3.2.2.1. DSM 的简要历史。DSM-5 于 2013 年出版，取代了 DSM IV-TR（TR 表示文本修订；2000 年出版）。2022 年 3 月，为 DSM-5 发布了一次文本修订，使其成为 DSM-5-TR。

The history of the DSM goes back to 1952 when the American Psychiatric Association published the first edition of the DSM which was “…the first official manual of mental disorders to contain a glossary of descriptions of the diagnostic categories” (APA, 2022, p. 5). The DSM evolved through four major editions after World War II into a diagnostic classification system to be used by psychiatrists and physicians, but also other mental health professionals. The Herculean task of revising the DSM began in 1999 when the APA embarked upon an evaluation of the strengths and weaknesses of the DSM in coordination with the World Health Organization (WHO) Division of Mental Health, the World Psychiatric Association, and the National Institute of Mental Health (NIMH). This collaboration resulted in the publication of a monograph in 2002 called A Research Agenda for DSM-V. From 2003 to 2008, the APA, WHO, NIMH, the National Institute on Drug Abuse (NIDA), and the National Institute on Alcoholism and Alcohol Abuse (NIAAA) convened 13 international DSM-5 research planning conferences “to review the world literature in specific diagnostic areas to prepare for revisions in developing both DSM-5 and the International Classification of Disease, 11th Revision (ICD-11)” (APA, 2022, pg. 6).
DSM 的历史可以追溯到 1952 年，当时美国精神病学协会出版了第一版 DSM，这是“第一本包含诊断类别描述词汇表的精神疾病官方手册”（APA，2022，第 5 页）。二战后，DSM 经历了四次主要版本更新，发展成为供精神科医生和内科医生以及其他心理健康专业人士使用的诊断分类系统。1999 年，APA 开始修订 DSM，与世界卫生组织（WHO）精神卫生司、世界精神病学协会和国家精神卫生研究所（NIMH）合作评估 DSM 的优缺点。这次合作在 2002 年出版了一本名为《DSM-V 研究议程》的专著。 从 2003 年到 2008 年，美国精神病学协会（APA）、世界卫生组织（WHO）、美国国立精神卫生研究所（NIMH）、国家药物滥用研究所（NIDA）和国家酒精滥用与酒精中毒研究所（NIAAA）召开了 13 次国际 DSM-5 研究规划会议，“以审查特定诊断领域的世界文献，为修订 DSM-5 和国际疾病分类第 11 版（ICD-11）做准备”（APA，2022，第 6 页）。

After the naming of a DSM-5 Task Force Chair and Vice-Chair in 2006, task force members were selected and approved by 2007, and workgroup members were approved in 2008. An intensive 6-year process of “conducting literature reviews and secondary analyses, publishing research reports in scientific journals, developing draft diagnostic criteria, posting preliminary drafts on the DSM-5 website for public comment, presenting preliminary findings at professional meetings, performing field trials, and revisiting criteria and text” was undertaken (APA, 2022, pg. 7). The process involved physicians, psychologists, social workers, epidemiologists, neuroscientists, nurses, counselors, and statisticians, all who aided in the development and testing of DSM-5 while individuals with mental disorders, families of those with a mental disorder, consumer groups, lawyers, and advocacy groups provided feedback on the mental disorders contained in the book. Additionally, disorders with low clinical utility and weak validity were considered for deletion while “Conditions for Future Study” were placed in Section 3 and “contingent on the amount of empirical evidence generated on the proposed diagnosis, diagnostic reliability or validity, presence of clear clinical need, and potential benefit in advancing research” (APA, 2022, pg. 7).
2006 年任命 DSM-5 任务小组组长和副组长后，小组成员于 2007 年选出并获得批准，工作组成员于 2008 年获得批准。进行了一项为期 6 年的密集过程，“进行文献综述和二次分析，在科学期刊上发表研究报告，制定诊断标准草案，在 DSM-5 网站上发布初步草案供公众评论，在专业会议上展示初步发现，进行现场试验，并重新审视标准和文本”（APA，2022，第 7 页）。该过程涉及医生、心理学家、社会工作者、流行病学家、神经科学家、护士、顾问和统计学家，他们帮助开发和测试 DSM-5，而患有精神疾病的人、精神疾病患者的家属、消费者团体、律师和倡导团体则对书中的精神疾病提供反馈。 此外，考虑删除临床实用性和效度较低的疾病，而“未来研究条件”被置于第 3 节，“取决于对所提议的诊断、诊断可靠性或效度、明确的临床需求以及推进研究的潜在益处所生成的经验证据的数量”（APA，2022，第 7 页）。

**            3.2.2.2. The DSM-5 text revision process. **In the spring 2019, APA started work on the Text-Revision for the DSM-5. This involved more than 200 experts who were asked to conduct literature reviews of the past 10 years and to review the text to identify any material that was out-of-date. Experts were divided into 20 disorder review groups, each with its own section editor. Four cross-cutting review groups to include Culture, Sex and Gender, Suicide, and Forensic, reviewed each chapter and focused on material involving their specific expertise. The text was also reviewed by an Ethnoracial Equity and Inclusion work group whose task was to “ensure appropriate attention to risk factors such as racism and discrimination and the use of nonstigmatizing language” (APA, 2022, pg. 11).
3.2.2.2. DSM-5 文本修订过程。2019 年春季，APA 开始对 DSM-5 进行文本修订。这涉及 200 多位专家，他们被要求对过去 10 年的文献进行综述，并审查文本以确定任何过时的内容。专家被分为 20 个疾病审查组，每个组都有自己的编辑。四个跨学科审查组包括文化、性别和性别、自杀和法医，审查了每一章，并专注于涉及他们特定专业知识的材料。文本还由一个民族种族平等和包容工作组进行审查，其任务是“确保对风险因素如种族主义和歧视以及非污名化语言的适当关注”（APA，2022，第 11 页）。

As such, the DSM-5-TR “is committed to the use of language that challenges the view that races are discrete and natural entities” (APA, 2022, pg. 18). Some of changes include:
因此，DSM-5-TR“致力于使用挑战种族是离散和自然实体的观点的语言”（APA，2022，第 18 页）。其中一些变化包括：

• Use of racialized instead of racial to indicate the socially constructed nature of race
  种族化而非种族的使用，以表明种族的社会建构性质
• *Ethnoracial *is used to denote U.S. Census categories such as Hispanic, African American, or White
  民族种族用于表示美国人口普查类别，如西班牙裔、非裔美国人或白人
• *Latinx *is used in place of *Latino or Latina *to promote gender-inclusive terminology
  拉丁裔被用来代替拉美裔或拉丁裔女性，以推广性别包容的术语
• The term *Caucasian *is omitted since it is “based on obsolete and erroneous views about the geographic origin of a prototypical pan-European ethnicity” (pg. 18)
  高加索人这一术语被省略，因为它“基于关于典型泛欧洲族群的地理起源的过时和错误观点”（第 18 页）
• To avoid perpetuating social hierarchies, the terms *minority *and non-White are avoided since they describe social groups in relation to a racialized “majority”
  为了避免延续社会等级制度，避免使用“少数族裔”和“非白人”等术语，因为这些术语描述的是与种族化的“多数”相关的社会群体
• The terms *cultural contexts and cultural backgrounds *are preferred to culture which is only used to refer to a “heterogeneity of cultural views and practices within societies” (pg. 18)
  文化语境和文化背景这两个术语比“文化”一词更受欢迎，后者仅用于指代“社会内部的文化观点和实践的异质性”（第 18 页）
• The inclusion of data on specific ethnoracial groups only when “existing research documented reliable estimates based on representative samples.” This led to limited inclusion of data on Native Americans since data from nonrepresentative samples may be misleading.
  仅在“现有研究基于代表性样本提供了可靠的估计”时才包含特定族群的数据。这导致了关于美洲原住民的数据包含有限，因为来自非代表性样本的数据可能具有误导性。
• The use of *gender differences *or “women and men” or “boys and girls” since much of the information on the expressions of mental disorders in women and men is based on self-identified gender.
  性别差异或“男性和女性”或“男孩和女孩”的使用，因为关于男性和女性心理疾病表现的信息大多基于自我认同的性别。
• Inclusion of a new section for each diagnosis providing information about suicidal thoughts or behavior associated with that diagnosis.
  新增每个诊断的独立章节，提供与该诊断相关的自杀想法或行为信息。

**            3.2.2.3. Elements of a diagnosis. **The DSM-5-TR states that the following make up the key elements of a diagnosis (APA, 2022):
3.2.2.3. 诊断要素。DSM-5-TR 指出，以下内容构成了诊断的关键要素（APA，2022 年）：

• Diagnostic Criteria and Descriptors – Diagnostic criteria are the guidelines for making a diagnosis and should be informed by clinical judgment. When the full criteria are met, mental health professionals can add severity and course specifiers to indicate the patient’s current presentation. If the full criteria are not met, designators such as “other specified” or “unspecified” can be used. If applicable, an indication of severity (mild, moderate, severe, or extreme), descriptive features, and course (type of remission – partial or full – or recurrent) can be provided with the diagnosis. The final diagnosis is based on the clinical interview, text descriptions, criteria, and clinical judgment.
  诊断标准和描述 – 诊断标准是进行诊断的指南，应受临床判断的指导。当满足全部标准时，心理健康专业人员可以添加严重程度和病程说明，以表明患者的当前表现。如果未满足全部标准，可以使用“其他指定”或“未指定”等标识符。如果适用，可以在诊断中提供严重程度（轻度、中度、重度或极重度）、描述性特征和病程（缓解类型 – 部分或完全 – 或复发）。最终诊断基于临床访谈、文字描述、标准和临床判断。
• Subtypes and Specifiers – Subtypes denote “mutually exclusive and jointly exhaustive phenomenological subgroupings within a diagnosis” (APA, 2022, pg. 22). For example, non-rapid eye movement (NREM) sleep arousal disorders can have either a sleepwalking or sleep terror type. Enuresis is nocturnal-only, diurnal-only, or both. *Specifiers *are not mutually exclusive or jointly exhaustive and so more than one specifier can be given. For instance, binge eating disorder has remission and severity specifiers. Somatic symptom disorder has a specifier for severity, if with predominant pain, and/or if persistent. Again, the fundamental distinction between subtypes and specifiers is that there can be only one subtype but multiple specifiers. As the DSM-5-TR says, “Specifiers and subtypes provide an opportunity to define a more homogeneous subgrouping of individuals with the disorder who share certain features… and to convey information that is relevant to the management of the individual’s disorder” (pg. 22).
  亚型和指定者 - 亚型表示“在诊断中相互排斥且相互穷尽的病态现象亚组”（APA，2022，第 22 页）。例如，非快速眼动（NREM）睡眠觉醒障碍可以是梦游或睡眠恐怖类型。遗尿症仅发生在夜间、仅发生在白天或两者都有。指定者不是相互排斥或相互穷尽的，因此可以给出多个指定者。例如，暴食症有缓解和严重程度指定者。躯体症状障碍有严重程度指定者，如果以疼痛为主，以及/或者如果持续。再次强调，亚型和指定者之间的基本区别是只能有一个亚型，但可以有多个指定者。正如 DSM-5-TR 所说，“指定者和亚型提供了定义具有某些特征的同质亚组个体的机会……以及传达与个体疾病管理相关的信息”（第 22 页）。
• Principle Diagnosis – A principal diagnosis is used when more than one diagnosis is given for an individual. It is the reason for the admission in an inpatient setting or the basis for a visit resulting in ambulatory care medical services in outpatient settings. The principal diagnosis is generally the focus of attention or treatment.
  主要诊断 - 当对个人给出多个诊断时，使用主要诊断。它是住院设置中入院的原因或门诊设置中导致门诊医疗服务访问的基础。主要诊断通常是关注的焦点或治疗的基础。
• Provisional Diagnosis – If not enough information is available for a mental health professional to make a definitive diagnosis, but there is a strong presumption that the full criteria will be met with additional information or time, then the provisional specifier can be used.            **
  暂定诊断 - 如果没有足够的信息供心理健康专业人士做出明确诊断，但根据额外信息或时间，有强烈的预感将满足所有标准，则可以使用暂定限定词。

**            3.2.2.4. DSM-5 disorder categories. **The DSM-5 includes the following categories of disorders:
3.2.2.4. DSM-5 疾病分类。DSM-5 包括以下疾病类别：

Table 3.1. DSM-5 Classification System of Mental Disorders
表 3.1. 精神疾病 DSM-5 分类系统

3.2.3. The ICD-11 3.2.3. 国际疾病分类第 11 版

In 1893, the International Statistical Institute adopted the International List of Causes of Death which was the first international classification edition. The World Health Organization was entrusted with the development of the ICD in 1948 and published the 6th version (ICD-6). The ICD-11 went into effect January 1, 2022, though it was adopted in May 2019. The WHO states:
1893 年，国际统计学会采用了《国际死亡原因列表》，这是第一版国际分类版。世界卫生组织于 1948 年被委托开发 ICD，并发布了第 6 版（ICD-6）。ICD-11 于 2022 年 1 月 1 日起生效，尽管它在 2019 年 5 月已被采用。世界卫生组织表示：

ICD serves a broad range of uses globally and provides critical knowledge on the extent, causes and consequences of human disease and death worldwide via data that is reported and coded with the ICD. Clinical terms coded with ICD are the main basis for health recording and statistics on disease in primary, secondary and tertiary care, as well as on cause of death certificates. These data and statistics support payment systems, service planning, administration of quality and safety, and health services research. Diagnostic guidance linked to categories of ICD also standardizes data collection and enables large scale research.
ICD 在全球范围内具有广泛的应用，通过报告和编码 ICD 的数据，提供了关于人类疾病和死亡范围、原因和后果的宝贵知识。ICD 编码的临床术语是初级、二级和三级保健以及死亡证明中疾病记录和统计的主要依据。这些数据和统计支持支付系统、服务规划、质量和安全管理和医疗服务研究。与 ICD 类别相关的诊断指南也标准化了数据收集，并促进了大规模研究。

As a classification system, it “allows the systematic recording, analysis, interpretation and comparison of mortality and morbidity data collected in different countries or regions and at different times.” As well, it “ensures semantic interoperability and reusability of recorded data for the different use cases beyond mere health statistics, including decision support, resource allocation, reimbursement, guidelines and more.”
作为一个分类系统，它“允许系统地记录、分析、解释和比较在不同国家或地区以及不同时间收集的死亡率和发病率数据。”此外，它“确保了记录数据的语义互操作性和可重用性，这些数据不仅限于卫生统计，还包括决策支持、资源分配、报销、指南等更多用途。”

Source: http://www.who.int/classifications/icd/en/
来源：http://www.who.int/classifications/icd/en/

The ICD lists many types of diseases and disorders to include Chapter 06: Mental, Behavioral, or Neurodevelopmental Disorders. The list of mental disorders is broken down as follows:
国际疾病分类（ICD）列出了许多疾病和紊乱，包括第 06 章：精神、行为或神经发育障碍。精神障碍的分类如下：

• Neurodevelopmental disorders  神经发育障碍
• Schizophrenia or other primary psychotic disorders
  精神分裂症或其他原发性精神病性障碍
• Catatonia  紧张症
• Mood disorders  情绪障碍
• Anxiety or fear-related disorders
  焦虑或恐惧相关障碍
• Obsessive-compulsive or related disorders
  强迫症或相关障碍
• Disorders specifically associated with stress
  与压力特别相关的疾病
• Dissociative disorders  分离性障碍
• Feeding or eating disorders
  喂养或进食障碍
• Elimination disorders  排泄障碍
• Disorders of bodily distress or bodily experience
  身体不适或身体体验的紊乱
• Disorders due to substance use or addictive behaviours
  物质使用或成瘾行为引起的疾病
• Impulse control disorders  冲动控制障碍
• Disruptive behaviour or dissocial disorders
  破坏性行为或反社会性障碍
• Personality disorders and related traits
  人格障碍及相关特征
• Paraphilic disorders  性欲倒错障碍
• Factitious disorders  做作性障碍
• Neurocognitive disorders  神经认知障碍
• Mental or behavioural disorders associated with pregnancy, childbirth or the puerperium
  妊娠、分娩或产褥期相关的精神或行为障碍

It should be noted that Sleep-Wake Disorders are listed in Chapter 07.
应注意的是，睡眠觉醒障碍列在第七章。

To access Chapter 06 of the ICD-11, please visit the following:
请访问以下链接以访问 ICD-11 的第 06 章：

https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f334423054

3.2.4. Harmonization of DSM-5-TR and ICD-11 3.2.4. DSM-5-TR 与 ICD-11 的协调

According to the DSM-5-TR, there is an effort to harmonize the two classification systems: 1) for a more accurate collection of national health statistics and design of clinical trials aimed at developing new treatments, 2) to increase the ability to replicate scientific findings across national boundaries, and 3) to rectify the issue of DSM-IV and ICD-10 diagnoses not agreeing (APA, 2022, pg. 13). Complete harmonization of the DSM-5 diagnostic criteria with the ICD-11 disorder definitions has not occurred due to differences in timing. The DSM-5 developmental effort was several years ahead of the ICD-11 revision process. Despite this, some improvement in harmonization did occur as many ICD-11 working group members had participated in the development of the DSM-5 diagnostic criteria and all ICD-11 work groups were given instructions to review the DSM-5 criteria sets and make them as similar as possible (unless there was a legitimate reason not to). This has led to the ICD and DSM being closer than at any time since DSM-II and ICD-8 (APA, 2022).
根据 DSM-5-TR，有努力使两个分类系统协调一致：1）为了更准确地收集国家卫生统计数据和设计旨在开发新疗法的临床试验，2）为了提高跨国家边界复制科学发现的能力，3）为了纠正 DSM-IV 和 ICD-10 诊断不一致的问题（APA，2022，第 13 页）。由于时间上的差异，DSM-5 诊断标准与 ICD-11 疾病定义的完全协调尚未发生。尽管如此，协调性确实有所改善，因为许多 ICD-11 工作组成员参与了 DSM-5 诊断标准的制定，所有 ICD-11 工作组都接到指示，要审查 DSM-5 标准集，并尽可能使它们相似（除非有合法理由不这样做）。这导致 ICD 和 DSM 比 DSM-II 和 ICD-8 以来的任何时候都更接近（APA，2022）。

Key Takeaways 关键要点

You should have learned the following in this section:
你应该在本节中学到了以下内容：

• Clinical diagnosis is the process of using assessment data to determine if the pattern of symptoms the person presents with is consistent with the diagnostic criteria for a specific mental disorder outlined in an established classification system such as the DSM-5-TR or ICD-11.
  临床诊断是使用评估数据来确定患者所呈现的症状模式是否与在已建立的分类系统（如 DSM-5-TR 或 ICD-11）中概述的特定精神障碍的诊断标准一致的过程。
• Classification systems provide mental health professionals with an agreed-upon list of disorders falling into distinct categories for which there are clear descriptions and criteria for making a diagnosis.
  分类系统为心理健康专业人士提供了一个公认的疾病列表，这些疾病被划分为不同的类别，每个类别都有明确的描述和诊断标准。
• Elements of a diagnosis in the DSM include the diagnostic criteria and descriptors, subtypes and specifiers, the principle diagnosis, and a provisional diagnosis.
  诊断标准手册（DSM）中的诊断要素包括诊断标准和描述、亚型和特定描述、主要诊断和临时诊断。

Section 3.2 Review Questions
第 3.2 节复习题

1. What is clinical diagnosis?
   什么是临床诊断？
2. What is a classification system and what are the two main ones used today?
   什么是分类系统？今天使用的主要有两个是什么？
3. Outline the diagnostic categories used in the DSM-5-TR.
   概述 DSM-5-TR 中使用的诊断类别。

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3.3. Treatment of Mental Disorders – An Overview 3.3. 精神疾病治疗概述

Section Learning Objectives 章节学习目标

• Clarify reasons why an individual may need to seek treatment.
  明确个人可能需要寻求治疗的原因。
• Critique myths about psychotherapy.
  批判心理治疗中的神话。

3.3.1. Seeking Treatment 3.3.1. 寻求治疗

**            3.3.1.1. Who seeks treatment?** Would you describe the people who seek treatment as being on the brink, crazy, or desperate? Or can the ordinary Joe in need of advice seek out mental health counseling? The answer is that anyone can. David Sack, M.D. (2013) writes in the article 5 Signs Its Time to Seek Therapy, published in Psychology Today, that “most people can benefit from therapy at least some point in their lives,” and though the signs you need to seek help are obvious at times, we often try “to sustain [our] busy life until it sets in that life has become unmanageable.” So, when should we seek help? First, if we feel sad, angry, or not like ourselves. We might be withdrawing from friends and families or sleeping more or less than we usually do. Second, if we are abusing drugs, alcohol, food, or sex to deal with life’s problems. In this case, our coping skills may need some work. Third, in instances when we have lost a loved one or something else important to us, whether due to death or divorce, the grief may be too much to process. Fourth, a traumatic event may have occurred, such as abuse, a crime, an accident, chronic illness, or rape. Finally, if you have stopped doing the things you enjoy the most. Sack (2013) says, “If you decide that therapy is worth a try, it doesn’t mean you’re in for a lifetime of head shrinking.” A 2001 study in the Journal of Counseling Psychology found that most people feel better within seven to 10 visits. In another study, published in 2006 in the Journal of Consulting and Clinical Psychology, 88% of therapy-goers reported improvements after just one session.”
3.3.1.1. 谁寻求治疗？你会把寻求治疗的人描述为处于边缘、疯狂还是绝望吗？或者，需要建议的普通乔也能寻求心理健康咨询吗？答案是任何人都可以。大卫·萨克博士（2013）在《心理学今天》杂志上发表的文章《5 个迹象表明是时候寻求治疗了》中写道：“大多数人至少在生命中的某个阶段都能从治疗中受益，”尽管有时需要寻求帮助的迹象很明显，我们往往试图“维持我们忙碌的生活，直到生活变得无法管理。”那么，我们应该何时寻求帮助呢？首先，如果我们感到悲伤、愤怒或不像自己。我们可能会从朋友和家人中退缩，或者睡得更多或更少。其次，如果我们滥用药物、酒精、食物或性来处理生活中的问题。在这种情况下，我们的应对技巧可能需要一些改进。第三，在我们失去亲人或对我们来说重要的事情时，无论是由于死亡还是离婚，悲伤可能过于难以处理。第四，可能发生了创伤性事件，例如虐待、犯罪、事故、慢性疾病或强奸。 最后，如果你已经停止了你最喜欢的事情。Sack（2013）说：“如果你决定尝试治疗，并不意味着你将过上终身缩头缩脑的生活。”2001 年，《咨询心理学杂志》的一项研究发现，大多数人经过 7 到 10 次访问后感觉更好。在另一项研究中，该研究于 2006 年发表在《咨询与临床心理学杂志》上，88%的接受治疗者表示在仅一次会话后就有所改善。”

**            3.3.1.2. When friends, family, and self-healing are not enough. **If you are experiencing any of the aforementioned issues, you should seek help. Instead of facing the potential stigma of talking to a mental health professional, many people think that talking through their problems with friends or family is just as good. Though you will ultimately need these people to see you through your recovery, they do not have the training and years of experience that a psychologist or similar professional has. “Psychologists can recognize behavior or thought patterns objectively, more so than those closest to you who may have stopped noticing — or maybe never noticed. A psychologist might offer remarks or observations similar to those in your existing relationships, but their help may be more effective due to their timing, focus, or your trust in their neutral stance” (http://www.apa.org/helpcenter/psychotherapy-myths.aspx). You also should not wait to recover on your own. It is not a failure to admit you need help, and there could be a biological issue that makes it almost impossible to heal yourself.
3.3.1.2. 当朋友、家人和自我疗愈都不够时。如果你正在经历上述任何问题，你应该寻求帮助。与其面对与心理健康专业人士交谈可能带来的潜在耻辱，许多人认为与朋友或家人谈论他们的问题同样有效。尽管你最终需要这些人帮助你度过康复期，但他们没有心理学家或类似专业人士所拥有的培训和多年经验。“心理学家可以客观地识别行为或思维模式，比那些最接近你的人更能注意到——或者可能从未注意到。心理学家可能会提出与你现有关系相似的评论或观察，但他们的帮助可能更有效，因为他们的时机、专注或你对他们中立立场的信任”（http://www.apa.org/helpcenter/psychotherapy-myths.aspx）。你也无需等待自己恢复。承认你需要帮助并不是失败，而且可能存在一种生物学问题，几乎不可能自我疗愈。

**            3.3.1.3. What exactly is psychotherapy?** According to the APA, in psychotherapy “psychologists apply scientifically validated procedures to help people develop healthier, more effective habits.” Several different approaches can be utilized to include behavior, cognitive and cognitive-behavior, humanistic-experiential, psychodynamic, couples and family, and biological treatments.
3.3.1.3. 心理治疗究竟是什么？根据美国心理学会（APA）的定义，在心理治疗中，“心理学家运用经过科学验证的程序来帮助人们培养更健康、更有效的习惯。”可以采用多种不同的方法，包括行为、认知和认知行为、人本-经验、心理动力学、夫妻和家庭以及生物治疗方法。

**            3.3.1.4. The client-therapist relationship. **What is the ideal client-therapist relationship? APA says, “Psychotherapy is a collaborative treatment based on the relationship between an individual and a psychologist. Grounded in dialogue, it provides a supportive environment that allows you to talk openly with someone who’s objective, neutral and nonjudgmental. You and your psychologist will work together to identify and change the thought and behavior patterns that are keeping you from feeling your best.” It’s not just about solving the problem you saw the therapist for, but also about learning new skills to help you cope better in the future when faced with the same or similar environmental stressors.
3.3.1.4. 客户-治疗师关系。理想的客户-治疗师关系是什么？APA 表示：“心理治疗是一种基于个体与心理学家之间关系的协作治疗。基于对话，它提供了一个支持性的环境，让您可以与一个客观、中立且无偏见的人公开交谈。您和您的心理学家将共同努力，识别和改变那些让您无法感到最佳状态的思想和行为模式。” 这不仅关乎解决您寻求治疗师帮助的问题，还关乎学习新技能，以帮助您在未来面对相同或类似的环境压力时更好地应对。

So how do you find a psychotherapist? Several strategies may prove fruitful. You could ask family and friends, your primary care physician (PCP), look online, consult an area community mental health center, your local university’s psychology department, state psychological association, or use APA’s Psychologist Locator Service (https://locator.apa.org/?_ga=2.160567293.1305482682.1516057794-1001575750.1501611950). Once you find a list of psychologists or other practitioners, choose the right one for you by determining if you plan on attending alone or with family, what you wish to get out of your time with a psychotherapist, how much your insurance company pays for and if you have to pay out of pocket how much you can afford, when you can attend sessions, and how far you are willing to travel to see the mental health professional. Once you have done this, make your first appointment.
那么你如何找到一个心理治疗师呢？几种策略可能会证明是有成效的。你可以询问家人和朋友，你的初级保健医生（PCP），在网上搜索，咨询当地社区心理健康中心，你所在地区的大学心理学系，州级心理学会，或者使用 APA 的心理学家定位服务（https://locator.apa.org/?_ga=2.160567293.1305482682.1516057794-1001575750.1501611950）。一旦你找到了心理学家或其他从业者的名单，通过确定你是否打算独自或与家人一起参加，你希望从心理治疗师那里得到什么，你的保险公司支付多少，如果你需要自付多少，你能负担多少，你何时可以参加课程，以及你愿意为看心理健康专家走多远，来选择适合你的那一个。完成这些后，预约你的第一次咨询。

But what should you bring? APA suggests, “to make the most of your time, make a list of the points you want to cover in your first session and what you want to work on in psychotherapy. Be prepared to share information about what’s bringing you to the psychologist. Even a vague idea of what you want to accomplish can help you and your psychologist proceed efficiently and effectively.” Additionally, they suggest taking report cards, a list of medications, information on the reasons for a referral, a notebook, a calendar to schedule future visits if needed, and a form of payment. What you take depends on the reason for the visit.
但是你应该带些什么呢？APA 建议，“为了最大限度地利用你的时间，列出你希望在第一次会话中涵盖的要点以及你希望在心理治疗中解决的问题。准备好分享让你去看心理医生的原因。即使是对你想要达成的目标有一个模糊的想法，也能帮助你和你心理医生高效有效地进行。”此外，他们还建议携带成绩单、药物清单、转诊原因的信息、笔记本、如果需要预约未来访问的日历以及一种支付方式。你带什么取决于访问的原因。

In terms of what you should expect, you and your therapist will work to develop a full history which could take several visits. From this, a treatment plan will be developed. “This collaborative goal-setting is important, because both of you need to be invested in achieving your goals. Your psychologist may write down the goals and read them back to you, so you’re both clear about what you’ll be working on. Some psychologists even create a treatment contract that lays out the purpose of treatment, its expected duration and goals, with both the individual’s and psychologist’s responsibilities outlined.”
关于您应该期待的内容，您和您的治疗师将共同努力，制定一个可能需要多次访问的完整病史。据此，将制定一个治疗方案。“这种协作目标设定很重要，因为你们双方都需要投入精力去实现目标。您的心理学家可能会写下目标并读给您听，以确保你们双方都清楚将要做什么。一些心理学家甚至制定了一份治疗合同，其中概述了治疗的目的、预期的持续时间和目标，以及个人和心理学家的责任。”

After the initial visit, the mental health professional may conduct tests to further understand your condition but will continue talking through the issue. He/she may even suggest involving others, especially in cases of relationship issues. Resilience is a skill that will be taught so that you can better handle future situations.
在初次访问之后，心理健康专业人士可能会进行测试以进一步了解您的状况，但会继续讨论这个问题。他/她甚至可能建议让其他人参与，尤其是在关系问题的情况下。韧性是一种将被教授的技能，以便您能更好地应对未来的情况。

**            3.3.1.5. Does it work?** APA writes, “Reviews of these studies show that about 75 percent of people who enter psychotherapy show some benefit. Other reviews have found that the average person who engages in psychotherapy is better off by the end of treatment than 80 percent of those who don’t receive treatment at all.” Treatment works due to finding evidence-based treatment that is specific for the person’s problem; the expertise of the therapist; and the characteristics, values, culture, preferences, and personality of the client.
3.3.1.5. 它有效吗？APA 写道：“这些研究的综述表明，大约 75%接受心理治疗的人有所获益。其他综述发现，接受心理治疗的人平均来说，在治疗结束时比 80%未接受任何治疗的人状况更好。”治疗之所以有效，是因为找到了针对个人问题的基于证据的治疗方法；治疗师的专业知识；以及客户的特点、价值观、文化、偏好和个性。

**            3.3.1.6. How do you know you are finished?** “How long psychotherapy takes depends on several factors: the type of problem or disorder, the patient’s characteristics and history, the patient’s goals, what’s going on in the patient’s life outside psychotherapy and how fast the patient is able to make progress.” It is important to note that psychotherapy is not a lifelong commitment, and it is a joint decision of client and therapist as to when it ends. Once over, expect to have a periodic check-up with your therapist. This might be weeks or even months after your last session. If you need to see him/her sooner, schedule an appointment. APA calls this a “mental health tune up” or a “booster session.”
3.3.1.6. 你怎么知道你已经完成了？ “心理治疗需要多长时间取决于几个因素：问题的类型或障碍，患者的特征和历史，患者的目标，患者生活中除心理治疗外发生的事情以及患者能够进步的速度。” 需要注意的是，心理治疗不是终身的承诺，何时结束是客户和治疗师共同的决定。一旦结束，预期将定期与治疗师进行复查。这可能是在你上次会话后的几周甚至几个月。如果你需要更早地见到他/她，请预约。APA 称这为“心理健康调整”或“加强会话”。

For more on psychotherapy, please see the very interesting APA article on this matter:
关于心理治疗，请参阅 APA 关于此问题的非常有趣的文章：

http://www.apa.org/helpcenter/understanding-psychotherapy.aspx

Key Takeaways 关键要点

You should have learned the following in this section:
你应该在本节中学到了以下内容：

• Anyone can seek treatment and we all can benefit from it at some point in our lives.
  任何人都可以寻求治疗，我们每个人在生命中的某个时刻都能从中受益。
• Psychotherapy is when psychologists apply scientifically validated procedures to help a person feel better and develop healthy habits.
  心理治疗是指心理学家应用经过科学验证的程序来帮助一个人感觉更好并养成健康习惯。

Section 3.3 Review Questions
第 3.3 节复习题

1. When should you seek help?
   您应该在何时寻求帮助？
2. Why should you seek professional help over the advice dispensed by family and friends?
   为什么你应该寻求专业帮助而不是家人朋友的建议？
3. How do you find a therapist and what should you bring to your appointment?
   您如何找到治疗师以及您应该带什么去预约？
4. Does psychotherapy work?  心理治疗有效吗？

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Module Recap 模块总结

That’s it. With the conclusion of Module 3, you now have the necessary foundation to understand each of the groups of disorders we discuss beginning in Module 4 and through Module 14.
这是结束。随着模块 3 的结束，你现在拥有了理解从模块 4 开始到模块 14 中我们讨论的每一组疾病的必要基础。

In Module 3 we reviewed clinical assessment, diagnosis, and treatment. In terms of assessment, we covered key concepts such as reliability, validity, and standardization; and discussed methods of assessment such as observation, the clinical interview, psychological tests, personality inventories, neurological tests, the physical examination, behavioral assessment, and intelligence tests. In terms of diagnosis, we discussed the classification systems of the DSM-5-TR and ICD-11. For treatment, we discussed the reasons why someone may seek treatment, self-treatment, psychotherapy, the client-centered relationship, and how well psychotherapy works.
在模块 3 中，我们回顾了临床评估、诊断和治疗。在评估方面，我们涵盖了关键概念，如可靠性、有效性和标准化；并讨论了评估方法，如观察、临床访谈、心理测试、人格量表、神经测试、体格检查、行为评估和智力测试。在诊断方面，我们讨论了 DSM-5-TR 和 ICD-11 的分类系统。在治疗方面，我们讨论了为什么有人可能寻求治疗、自我治疗、心理治疗、以客户为中心的关系以及心理治疗的效果。

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3rd edition  第三版

Source: https://opentext.wsu.edu/abnormal-psych/chapter/module-3-clinical-assessment-diagnosis-and-treatment/