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Blood tests to diagnose schizophrenia: self-imposed limits in psychiatry.
The Lancet Psychiatry ( IF 64.3 ) Pub Date : 2020-03-23 , DOI: 10.1016/s2215-0366(20)30058-4
Carsten Korth 1 , Heiner Fangerau 2
Affiliation  

The naturalisation of mental disorders—ie, their translation into measurable and preferably molecular variables—has not progressed despite breath-taking discoveries in the neurosciences. We ask whether self-inflicted limits exist among psychiatrists that would prevent them from supporting an imaginary perfect blood test with diagnostic specificity, sensitivity, and validity, which was able to replace clinical diagnosis completely. Although relevant for many mental disorders, we use the clinical disease category schizophrenia here as an example to discuss factors that oppose the naturalisation of clinical disease categories. We defend the provocative position that a complete substitution of the clinical diagnosis by a blood test is generally not desired among clinicians because various factors perpetuate the current diagnostic culture. These are (1) methodological problems, such as a falsely presumed homogeneity of biological causes under the umbrella of one clinical diagnosis that prevents efficient subset identification, (2) professional fears, such as loss of importance of interview-diagnostic expert skills, and (3) conceptual problems, such as a dualistic mindset. We posit that doubts regarding the possibility of a blood test for diagnosing schizophrenia can subtly result in a negative self-fulfilling prophecy, discouraging serious scientific efforts to develop one. We give historical examples of how some of these problems have been solved in other medical disciplines. We predict that only blood tests that improve diagnostic accuracy but do not displace the primacy of clinical diagnosis will be successful. In the future, novel professional expertise for orchestrating various biological variables together with clinical criteria will be needed.



中文翻译:

血液测试以诊断精神分裂症:精神病学的自我限制。

尽管神经科学有惊人的发现,但精神障碍的自然归化(即将其转化为可测量的分子变量,最好是分子变量)并未取得进展。我们询问精神科医生是否存在自我施加的限制,以防止他们支持具有诊断特异性,敏感性和有效性的假想的完美血液检查,从而能够完全取代临床诊断。尽管与许多精神障碍有关,但我们以此处的临床疾病类别精神分裂症为例,讨论与临床疾病类别自然化相反的因素。我们捍卫这一挑衅性立场,即临床医生通常不希望通过血液测试完全替代临床诊断,因为各种因素使当前的诊断文化得以延续。这些是(1)方法学问题,例如在一种临床诊断的保护下错误地推测出生物学原因的同质性,从而无法有效地进行子集识别;(2)专业上的恐惧,例如面试诊断专家技能的重要性下降,以及( 3)概念问题,例如二元思维。我们认为,对于通过血液测试来诊断精神分裂症的可能性的怀疑会巧妙地导致负面的自我实现的预言,从而阻碍了认真的科学努力来发展这种预言。我们提供了一些历史性的例子来说明在其他医学领域中如何解决这些问题。我们预测只有能够提高诊断准确性但不会取代临床诊断的首要条件的血液检查才会成功。在将来,

更新日期:2020-03-23
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