Diagnostic Practice in a Psychiatric Unit

1974 ◽  
Vol 19 (3) ◽  
pp. 287-290 ◽  
Author(s):  
Stewart Meikle ◽  
Richard Gerritse ◽  
Keith Pearce
Keyword(s):  
Personality Disorders ◽  
Psychiatric Diagnosis ◽  
Classification Scheme ◽  
Reliability And Validity ◽  
Initial Diagnosis ◽  
Psychiatric Unit ◽  
Affective Psychoses ◽  
Diagnostic Practice ◽  
The Stability ◽  
Differential Degree

This study takes the view that although psychiatric diagnosis has frequently been criticized as being deficient in terms of both reliability and validity, as long as it remains in use as a classification scheme its limitation should continue to be investigated. In line with this approach the present investigation examined three questions: What are the frequencies of major diagnostic groupings on admission to hospital? Do these frequencies change by the time discharge arrives? Are there differences in the stability of initial diagnosis for the various diagnostic sub-groupings? It was found that the most frequently used admitting diagnoses in order were: affective psychoses, neuroses and schizophrenia. Both personality disorders and other psychoses were relatively rarely used. In general the same ranking also held on discharge. However some diagnoses applied on admission appeared much more stable than others. For example 80 percent of those patients initially diagnosed as schizophrenic remained so classified on discharge. In contrast the equivalent figure for diagnoses listed under ‘other conditions’ was 46 percent. Although practitioners often talk as though diagnosis is a meaningless ritual, in fact the present study suggests a differential degree to selection and consideration in their application of psychiatric categories.

Robert Kendell: his career and contribution to psychiatric diagnosis

2020 ◽  
pp. 096777202096131
Author(s):  
Geoffrey Lloyd
Keyword(s):  
Personality Disorders ◽  
Psychiatric Diagnosis ◽  
Categorical Approach ◽  
Affective Psychoses ◽  
Clear Cut ◽  
Definition Of

This paper reviews the career of Robert Kendell with emphasis on his contribution to diagnosis in psychiatry. His studies on the classification of depression showed that symptoms were distributed on a continuum and that division of depression into sub-types was not justified. Similarly he showed there was no clear-cut distinction between symptoms of schizophrenia and affective psychoses. He examined Scadding’s definition of disease as it applied to psychiatry and questioned whether some conditions such as neuroses and personality disorders would qualify as illnesses. He concluded that available evidence supported a dimensional rather than a categorical approach to diagnosis.

The Typology of Personality Disorders — Diagnostic Problems and Their Relevance for Suicidal Behavior

Crisis ◽  
1996 ◽  
Vol 17 (2) ◽  
pp. 55-58 ◽  
Author(s):  
Thomas Bronisch
Keyword(s):  
Personality Disorders ◽  
Suicidal Behavior ◽  
Reliability And Validity ◽  
International Classification Of Diseases ◽  
Classification Systems ◽  
Psychological Autopsy ◽  
Diagnostic And Statistical Manual ◽  
Classification Of Diseases ◽  
Methodological Problems

Personality disorders (PD) play an important role in clinical psychiatry. The typologies of personality disorders (PDs) found in different classification systems, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD), are quite congruent. There are many methodological problems with reliability and validity of the diagnosis of PD. However, having a typology seems to be very helpful. Recent psychological autopsy studies reported that about one third of suicide victims met the criteria for a PD. Antisocial PD, borderline PD, narcissistic PD, and depressive PD in particular were often clinically associated with suicidal behavior.

Borderline personality disorder: part 1 – assessment and diagnosis

2020 ◽  
Vol 26 (3) ◽  
pp. 159-172
Author(s):  
Jacqueline Garland ◽  
Stephen Miller
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Personality Disorders ◽  
Clinical Features ◽  
Borderline Personality ◽  
The Core ◽  
Diagnostic Practice ◽  
Assessment And Diagnosis

SUMMARYGeneral adult psychiatrists are largely responsible for the care of patients with personality disorders in community and in-patient settings, and this can be associated with diagnostic and management challenges. In the first of two articles focusing specifically on borderline personality disorder (BPD), we summarise the core clinical features of the disorder and discuss appropriate diagnostic practice.

Information Leading to Accurate Diagnosis in the Elderly

1975 ◽  
Vol 126 (5) ◽  
pp. 423-430 ◽  
Author(s):  
John M. Kellett ◽  
John R. M. Copeland ◽  
Michael J. Kelleher
Keyword(s):  
Physical Examination ◽  
Psychiatric Diagnosis ◽  
The Elderly ◽  
Accurate Diagnosis ◽  
Initial Diagnosis ◽  
Next Of Kin ◽  
Initial Interview ◽  
Category Information

SummaryPsychiatric diagnosis in the elderly has been examined in order to extract the information which leads to later modification of the diagnosis. Initial diagnoses of neuroses and toxic states were least stable, 14 out of 29 changing to a different category. Information from relatives and further interviews contributed most to the modification of the initial diagnosis, though affective and neurotic syndromes were particularly susceptible to change resulting from conceptual differences, and dementia to change consequent on physical examination.It is concluded that an adequate initial interview of a patient and his next of kin will achieve a diagnosiswhich iscorrectin itsmajor categoryon 95 per cent ofoccasions.

Leading cause of re-hospitalization in an Italian acute psychiatric unit: preliminary results

2011 ◽  
Vol 26 (S2) ◽  
pp. 512-512
Author(s):  
T. Attili ◽  
A.R. Atti ◽  
F. Moretti ◽  
E. Pedrini ◽  
M. Forlani ◽  
...  
Keyword(s):  
Personality Disorders ◽  
Social Stress ◽  
Psychiatric Rehabilitation ◽  
Northern Italy ◽  
Rehabilitation Service ◽  
Precipitating Factors ◽  
Psychiatric Unit ◽  
Family Conflicts ◽  
Icd 10 ◽  
Informatic System

ObjectivesTo describe the leading cause of re-hospitalization in an Acute Psychiatric Unit of a general hospital in Bologna, Northern Italy.MethodsAll repeated admissions (>3consecutive admissions in 18 months) were recorded thanks to the Hospital Informatic System. Case-history were reviewed to collect information, diagnoses were based on the ICD-10.ResultsIn the indexed period, 392 admissions were registered for 152 patients (mean age 44; 46,1% women). At least one precipitating cause was present in 64% of admissions. The most frequent were psycho-social stress such as family conflicts, parental separations, relational problems, job or economic difficulties (39%). The co-occurrence of 2+ of such factors was common (20%). Tricky situation within the psychiatric rehabilitation service (20%), low compliance to treatments (7%), alcohol/drugs abuse (7%), and low insight (3%) were the remaining associated factors. All the re-admissions of patients with poor insight or reduced compliance were due to the same cause. Poor adherence to therapies was more frequent in bipolar disorder compared with other diagnosis (17%vs7%, p<0.005). In patients affected by personality disorders the contemporary presence of 2 or more factors was needed in 40% of admissions. Patients with schizophrenia showed the most hetherogeneous pattern of precipitating factors.ConclusionsRegardless of diagnoses, in almost a half of the admissions a single psycho-social stress is sufficient to lead to re-hospitalization; in personality disorders the contemporary presence of 2+ stressors is needed to overcome the capacity compensation of the patient. Low insight is frequently associated to re-admissions. Tailored treatments might reduce the frequency of re-hospitalization.

The parental bonding as predictive factor for the development of adult psychiatric disorders

1997 ◽  
Vol 6 (2) ◽  
pp. 124-138 ◽  
Author(s):  
Ettore Favaretto ◽  
Stefano Torresani
Keyword(s):  
Anxiety Disorder ◽  
Personality Disorders ◽  
Drug Addiction ◽  
Psychiatric Diagnosis ◽  
Affective Disorders ◽  
Normal Subjects ◽  
Panic Attacks ◽  
Clinical Samples ◽  
Parental Style ◽  
And Control

SUMMARYObjective — To asses the capacity of the Parental Bonding Instrument (PBI) to discriminate between normal subjects and clinical samples and between with different psychiatric diagnosis. Design — The present paper analyzes the studies published between 1979 and 1995, which have used the PBI in normal subjects and clinical samples and have reported the respective means and standard deviations obtained on the two PBI dimensions: affection and control. Multiple comparisons were carried out between the mean scores of affection and control of: 1) samples with the same psychiatric diagnosis (intragroup comparison); 2) samples with different psychiatric diagnoses (intergroup comparison); 3) normal subjects and clinical samples. Results — Of the 46 studies with normal and clinical subjects, 23 studies were selected for the analysis, reporting means and standard deviations and specifying the diagnostic criteria. Samples with the same psychiatric diagnosis had similar affection and control scores. With the exception of bipolar affective disorders and avoidant personality disorders, the prevalent parental style was for all diagnostic groups the affectionless control style. Within the affectionless control style, the PBI discriminated between panic attacks, borderline personality and drug addiction but not between schizophrenia, unipolar depression and anxiety disorder. The PBI discriminated also between normal subjects samples and samples with anxiety disorder, schizophrenia, bipolar affective disorder, personality disorder and drug addiction respectively. Conclusion — The results confirm previous suggestions from single studies that the perceived parental style as measured by the PBI can be considered a good predictor for the presence of psychiatric disorders excluding panic attacks, avoidant personality disorders and unipolar affective disorders. Although the different diagnostic groups do not differ in their perceived parental style (affectionless control), significant differences between some diagnostic groups within this category suggest that the PBI might have some specificity as well.

Reliability, Validity, and the Mixed Blessings of Operationalism

2013 ◽  
Author(s):  
Nick Haslam
Keyword(s):  
Mental Disorders ◽  
Diagnostic Criteria ◽  
Psychiatric Diagnosis ◽  
Reliability And Validity ◽  
Diagnostic System ◽  
Theoretical Orientations ◽  
Diagnostic Reliability ◽  
Communicative Functions ◽  
First Languages ◽  
The Cost

The concepts of reliability and validity are fundamental for evaluating psychiatric diagnosis, including the "operationalist" approach pioneered in DSM-III. This chapter explores the complexity of these psychometric concepts and their interrelations. Although reliability constrains validity it does not guarantee it, and pursuing reliability in diagnosis can reduce validity. It is widely believed that the operationalist emphasis on diagnostic reliability has compromised the validity of recent psychiatric classifications. In particular, writers have argued that the drive for atheoretical diagnostic criteria has come at the cost of phenomenological richness and psychodynamic complexity. This chapter argues that although the operationalist turn may have impaired the validity of psychiatric diagnosis in some respects, these criticisms must be balanced by an appreciation of its benefits. In addition, it is suggested that some criticisms rest on a misunderstanding of the goals of operational descriptions. They should be evaluated primarily on pragmatic grounds as identification procedures and judged on their success in serving epistemic and communicative functions. Operational descriptions should not be viewed as comprehensive definitions of clinical phenomena or judged on their failure to encompass the richness and complexity of mental disorders. A diagnostic system is best understood as an intentionally delimited instrument for enabling clinical inference and communication. In essence, it is a simplified pidgin with which clinicians who speak different first languages (theoretical orientations) can conduct their shared business.

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