Introduction over 30 Years Ago, the Field of Psychiatry Found Itself Struggling with an Imprecise Diagnostic System That Resulted in Unreli- Able Diagnostic Assignments across Clinical
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چکیده
OVER 30 YEARS AGO, THE FIELD OF PSYCHIATRY FOUND ITSELF STRUGGLING WITH AN IMPRECISE DIAGNOSTIC SYSTEM THAT RESULTED IN UNRELIABLE DIAGNOSTIC ASSIGNMENTS ACROSS CLINICAL AND RESEARCH SETTINGS. Largely this was due to the absence of explicit operational criteria in the diagnostic manuals published to aid psychiatric research and practice. As a result, diagnostic practice was a highly subjective and unreliable process that relied as much on psychiatric clinicians’ and researchers’ conceptions of the diagnoses they assigned as it did on the diagnostic manuals designed to guide their decisions. Fortunately, this problem was effectively addressed by the development of Research Diagnostic Criteria (RDC) , a set of operationally defined inclusion and exclusion criteria that standardized the definitions for a majority of the recognized psychiatric conditions. These RDC dramatically improved diagnostic reliability among clinicians and researchers and were quickly incorporated into psychiatry’s diagnostic manuals. The field of sleep medicine currently finds itself only slightly ahead of where the field of psychiatry was 30 years ago. For some time now, sleep specialists have had at their disposal diagnostic manuals that describe a range of sleep disorders and provide lists of diagnostic criteria for their ascertainment. However, sleep disorder diagnosis has been complicated by the existence of several distinctive nosologies that differ markedly and often produce rather discordant classification results. Moreover, many current criteria sets for sleep diagnoses are vague or lack sufficient specificity to assure reliable diagnoses across clinical and research settings. Recognizing this problem, work groups have convened to develop RDC-like definitions for selected sleep disorder diagnoses such as sleep apnea and restless legs syndrome. There is little doubt that such efforts will benefit the field greatly by standardizing clinical practice and research with such disorders. Nonetheless, for many sleep disorders, research and practice remains greatly hampered by a lack of universally accepted and precise diagnostic criteria. Nowhere is this problem more apparent than it is in the basic and clinical research pertaining to insomnia. Although there has been general agreement that insomnia per se is a symptom and not necessarily an independent sleep disorder, there has been great variability in how this “symptom” has been defined in the literature. For example, some liberal definitions 17) focus solely on the presence of nocturnal sleep disturbances (e.g., sleep initiation or maintenance difficulties, nonrestorative sleep), whereas other more conservative definitions require additional features such as associated daytime impairment 19), sleep dissatisfaction, or meeting all diagnostic criteria for a sleep disorder
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تاریخ انتشار 2004