精神分裂症史上观念的变化

摘要(中文译文)

精神分裂症是医学与脑科学史上研究最为广泛但概念上最不稳定的疾病之一。自二十世纪之交被正式确立以来，该疾病被反复重新定义，反映了临床观察、诊断哲学以及脑功能神经科学模型的变迁。本综述旨在批判性地考察精神分裂症作为医学建构的历史演变，并分析诊断体系的转变如何塑造了对生物学与分子生物标志物的探索。本研究采用叙事性历史文献综述方法，整合了经典精神病学文献、诊断手册及当代神经科学研究。研究分析了精神分裂症概念化过程中的关键里程碑，并同步考察了生物学假说的发展，包括神经化学、电生理、神经影像、遗传学、免疫学、组学及数字化方法。重点在于识别各历史时期之间的概念连续性、断裂及方法学局限性。分析表明，精神分裂症的演变特征在于诊断标准化的不断增强与生物学异质性的日益显著并存。尽管相继提出的生物学模型为该疾病的特定方面提供了有价值的见解，但均未能产生单一、稳健的诊断生物标志物。相反，研究结果一致反映临床表型与生物学信号之间的部分重叠，且深受历史形成的诊断类别的影响。精神分裂症 definitive 诊断生物标志物的持续缺失不仅反映了技术局限性，也反映了该疾病作为异质性临床类别的历史建构。理解这一历史背景对于解读脑科学的当前研究发现至关重要。未来研究很可能受益于基于分层、维度及整合性的框架，这些框架超越类别诊断的同时保持临床相关性。

Abstract

: Schizophrenia is one of the most extensively studied yet conceptually unstable disorders in the history of medicine and brain sciences. Since its formalization at the turn of the twentieth century, the disorder has been repeatedly redefined, reflecting changes in clinical observation, diagnostic philosophy, and neuroscientific models of brain function. The objective of this review is to critically examine the historical evolution of schizophrenia as a medical construct and to analyze how shifts in diagnostic systems have shaped the search for biological and molecular biomarkers. : A narrative-historical review of the literature was conducted, integrating classical psychiatric texts, diagnostic manuals, and contemporary neuroscientific studies. Key milestones in the conceptualization of schizophrenia were analyzed alongside the development of biological hypotheses, including neurochemical, electrophysiological, neuroimaging, genetic, immunological, omics-based, and digital approaches. Emphasis was placed on identifying conceptual continuities, ruptures, and methodological limitations across historical periods. : The analysis reveals that the evolution of schizophrenia has been characterized by increasing diagnostic standardization accompanied by growing biological heterogeneity. While successive biological models have provided valuable insights into specific aspects of the disorder, none have yielded single, robust diagnostic biomarkers. Instead, findings consistently reflect partial overlaps between clinical phenotypes and biological signals, strongly influenced by historically derived diagnostic categories. : The persistent absence of definitive diagnostic biomarkers for schizophrenia reflects not only technical limitations but also the historical construction of the disorder as a heterogeneous clinical category. Understanding this historical context is essential for interpreting current findings in brain sciences. Future research is likely to benefit from stratification-based, dimensional, and integrative frameworks that move beyond categorical diagnosis while preserving clinical relevance.

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