精神醫學的概念模式——精神疾病的演進模式

CONCEPTUAL MODEL OF PSYCHIATRY–EVOLUTIONARY MODEL & PSYCHIATRIC DISORDERS

精神醫學之臨床、研究與教學一直缺乏一個整合性高、彈性大、變數建構淸楚之概念模式。於檢討歷史上精神醫學的十二種概念模式之後，基於精神醫學遺傳學、生物學、心理、家庭、社會文化等方面研究所得之實證資料，依生物、心理、社會三個層面之種種發現分出精神疾病之潛在病因（遺傳因素，環境生物因素與慢性心理適應環境因素），中間變數（特質性生物學指標、人格特質、適應狀況）、觸發病因（急性心理適應因素、急性生物學因素、社會支持網絡），原始型態精神疾病，臨床所見精神疾病、臨床病程預後和影響病程發展之心理社會文化環境因素。所有變數建構時間依流程列出前後因果關係，建立了精神醫學之精神疾病演進摸式。依該模式可以建立一套整體性之精神醫學資料系統。該模式足資為臺灣精神醫學發展之理論取向，可以運用於研究、服務與教學。

Psychiatry has been lack of a comprehensive, flexible conceptual model of psychiatric disorder, with operationalized constructs. After examining twelve models of psychiatry critically, the empirical data including genetic, biological, psychological, familial, sociocultural aspects, relevent to psychiatry (or psychopathology) were collected and grouped by the constructs of predisposing factors (genetic, environmental biological and chronic psychosocial factors), intervening factor (biological trait marker, personality trait and social-adjustment functions) , precipitating factors (acute biological insult, acute psychosocial stress, social support system), original disease state, clinical disease state, prognostic state and psychosocial factors related to clinical course. By the time factor all these variables were connected into a coherent and meaning system with attempt to elicit the causal-effect relationship. This was called as the evolutionary model of psychiatry. This model was designed to be workable for theoretical development, clinical service, research and teaching purposes. A comprehensive psychiatric data system was constructed for this evolutionary model of psychiatry.