Making a good mental health diagnosis: Science, art and ethics

Background There are limitations to psychiatric classification, which affects the utility of diagnosis in general practice. Objective The aim of this article is to explore the principles of science, art and ethics to create clinically useful psychiatric diagnoses in general practice. Discussion Psychiatric classification systems provide useful constructs for clinical practice and research. Evidence-based treatments are based on the classification of mental illnesses. However, while classification is necessary, it is not sufficient to provide a full understanding of ‘what is going on’. A good psychiatric diagnosis will also include a formulation, which provides an understanding of the psychosocial factors that provide a context for illness. Experiences such as trauma and marginalisation will change the illness experience but also provide other forms of evidence that shape therapy. Diagnoses also carry ethical implications, including stigma and changes in self‑concept. The science, art and ethics of diagnosis need to be integrated to provide a complete assessment.

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From measurement to classificatory practice: improving psychiatric classification independently of the opposition between symptom-based and causal approaches

European Journal for Philosophy of Science ◽

10.1007/s13194-021-00424-y ◽

2021 ◽

Vol 11 (4) ◽

Author(s):

Alessandra Basso

Keyword(s):

Mental Disorders ◽

Classification Systems ◽

Psychiatric Classification ◽

Way Of Thinking

AbstractThe article advances a new way of thinking about classifications in general and the classification of mental disorders in particular. By applying insights from measurement practice to the context of classification, I defend a notion of epistemic accuracy that allows one to evaluate and improve classifications by comparing different classifying methods to each other. Progress in classification arises from the mutual development of classification systems and classifying methods. Based on this notion of accuracy, the article illustrates with an example how psychiatric classifications can be improved via circumscribed comparisons of different perspectives on mental disorders, without relying on complete models of their complex aetiology. When applying this strategy, the traditional opposition between symptom-based and causal approaches is of little consequence for making progress in the epistemic accuracy of psychiatric classification.

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Social and ethical implications of psychiatric classification for low- and middle-income countries

South African Journal of Psychiatry ◽

10.4102/sajpsychiatry.v20i3.589 ◽

2014 ◽

Vol 20 (3) ◽

pp. 6

Author(s):

Jonathan K Burns

Keyword(s):

Global Mental Health ◽

Classification Systems ◽

Societal Implications ◽

Ethical Challenges ◽

Psychiatric Classification ◽

Middle Income ◽

Middle Income Countries ◽

Ethical Implications ◽

Essentially Normal ◽

Low And Middle Income

With the publication of the Diagnostic and Statistical Manual, 5th edition, and the ongoing revision of the International Classification of Diseases, currently 10th edition, it is timely to consider the wider societal implications of evolving psychiatric classification, especially within low- and middle-income countries (LMICs). The author reviewed developments in psychiatric classification, especially the move from categorical to dimensional approaches based on biobehavioural phenotypes. While research supports this move, there are several important associated ethical challenges. Dimensional classification runs the risk of ‘medicalising’ a range of normality; the broadening of some definitions and the introduction of new disorders means more people are likely to attract psychiatric diagnoses. Many LMICs do not have the political, social, legal and economic systems to protect individuals in society from the excesses of medicalisation, thus potentially rendering more citizens vulnerable to forms of stigma, exploitation and abuse, conducted in the name of medicine and psychiatry. Excessive medicalisation within such contexts is also likely to worsen existing disparities in healthcare and widen the treatment gap, as inappropriate diagnosis and treatment of mildly ill or essentially normal people has an impact on health budgets and resources, leading to relative neglect of those with genuine, severe psychiatric disorders. In an era of evolving psychiatric classification, those concerned for, and involved in, global mental health should be critically self-reflective of all aspects of the modern psychiatric paradigm, especially changes in classification systems, and should alert the global profession to the sociopolitical, economic and cultural implications of changing nosology for LMIC regions of the world.

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Vagueness in Psychiatry

10.1093/med/9780198722373.001.0001 ◽

2016 ◽

Keyword(s):

Mental Disorders ◽

Mentally Ill ◽

Classification Systems ◽

Psychiatric Classification ◽

Therapeutic Practice ◽

Legal Implications ◽

Health And Disease ◽

Pros And Cons ◽

Recurrent Theme

Blurred boundaries between the normal and the pathological are a recurrent theme in almost every publication concerned with the classification of mental disorders. However, systematic approaches that take into account the philosophical discussions about vagueness are rare. This is the first volume to systematically draw various lines of philosophical and psychiatric inquiry together–including the debates about categorial versus dimensional approaches in current psychiatric classification systems, the principles of psychiatric classification, the problem of prodromal phases and subthreshold disorders, and the problem of overdiagnosis in psychiatry–and to explore the connections of these debates to philosophical discussions about vagueness. The book consists of an introduction (Part I) followed by three parts. Part II encompasses historical and recent philosophical positions regarding the nature of demarcation problems in nosology. Here the authors discuss the pros and cons of gradualist approaches to health and disease and the relevance of philosophical discussions of vagueness to these debates. Part III narrows the focus to psychiatric nosology. The authors approach the vagueness of psychiatric classification by drawing on contentious medical categories, such as PTSD or schizophrenia, and on the dilemmas of day-to-day diagnostic and therapeutic practice. Against this background, the chapters critically evaluate how current revisions of the ICD classifications and DSM manuals conceptualize mental disorders and how they are applied in various contexts. Part IV is concerned with social, moral, and legal implications that arise when being mentally ill is a matter of degree. Not surprisingly, the law is ill-equipped to deal with these challenges due to its binary logic. Still, the authors show that there are more and less reasonable ways of dealing with blurred boundaries and of arriving at warranted decisions in hard cases.

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Classification

Shorter Oxford Textbook of Psychiatry ◽

10.1093/med/9780198747437.003.0002 ◽

2017 ◽

pp. 21-34

Author(s):

Paul Harrison ◽

Philip Cowen ◽

Tom Burns ◽

Mina Fazel

Keyword(s):

International Classification Of Diseases ◽

Classification Systems ◽

World Health ◽

Psychiatric Classification ◽

Dsm 5 ◽

Classification Of Diseases ◽

Icd 10 ◽

History Of ◽

Key Issues

‘Classification’ introduces concepts of mental illness before briefly reviewing the reasons for, and criticisms of, psychiatric classification. Key issues of reliability, validity, and stigma associated with classification are covered. After an overview of the history of classifications, the organizing principles of the two current major classification systems used in psychiatry (ICD-10 and DSM-5) are then outlined: the World Health Organization’s International Classification of Diseases (‘ICD-10’), and the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (‘DSM-5’). Additional schemes, used in particular countries, are also briefly mentioned. Finally, the chapter summarizes how psychiatric classification may develop in the future, with particular reference to ICD-11, which is due in 2018 or 2019.

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Classification of Post-Fire Responses of Woody Plants to include Pyrophobic Communities

Fire ◽

10.3390/fire3020015 ◽

2020 ◽

Vol 3 (2) ◽

pp. 15 ◽

Cited By ~ 1

Author(s):

Lynda D. Prior ◽

David M. J. S. Bowman

Keyword(s):

Woody Plants ◽

Seed Banks ◽

Classification Systems ◽

Woody Vegetation ◽

General Category ◽

Conifer Species ◽

Soil Seed Banks ◽

Obligate Seeder ◽

In Fire

Developing standardised classification of post-fire responses is essential for globally consistent comparisons of woody vegetation communities. Existing classification systems are based on responses of species growing in fire-prone environments. To accommodate species that occur in rarely burnt environments, we have suggested some important points of clarification to earlier schemes categorizing post-fire responses. We have illustrated this approach using several Australasian conifer species as examples of pyrophobic species. In particular, we suggest using the term “obligate seeder” for the general category of plants that rely on seed to reproduce, and qualifying this to “post-fire obligate seeder” for the narrower category of species with populations that recover from canopy fire only by seeding; the species are typically fire-cued, with large aerial or soil seed banks that germinate profusely following a fire, and grow and reproduce rapidly in order to renew the seed bank before the next fire.

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Interobserver agreement of the Paris and simplified classifications of superficial colonic lesions: a Western study

Endoscopy International Open ◽

10.1055/a-1352-3437 ◽

2021 ◽

Vol 09 (03) ◽

pp. E388-E394

Author(s):

Francesco Cocomazzi ◽

Marco Gentile ◽

Francesco Perri ◽

Antonio Merla ◽

Fabrizio Bossa ◽

...

Keyword(s):

Interobserver Agreement ◽

Classification Systems ◽

Sensitivity Analyses ◽

Size Estimation ◽

Rater Agreement ◽

Staff Members ◽

Video Clips ◽

Paris Classification ◽

Level Of Agreement

Abstract Background and study aims The Paris classification of superficial colonic lesions has been widely adopted, but a simplified description that subgroups the shape into pedunculated, sessile/flat and depressed lesions has been proposed recently. The aim of this study was to evaluate the accuracy and inter-rater agreement among 13 Western endoscopists for the two classification systems. Methods Seventy video clips of superficial colonic lesions were classified according to the two classifications, and their size estimated. The interobserver agreement for each classification was assessed using both Cohen k and AC1 statistics. Accuracy was taken as the concordance between the standard morphology definition and that made by participants. Sensitivity analyses investigated agreement between trainees (T) and staff members (SM), simple or mixed lesions, distinct lesion phenotypes, and for laterally spreading tumors (LSTs). Results Overall, the interobserver agreement for the Paris classification was substantial (κ = 0.61; AC1 = 0.66), with 79.3 % accuracy. Between SM and T, the values were superimposable. For size estimation, the agreement was 0.48 by the κ-value, and 0.50 by AC1. For single or mixed lesions, κ-values were 0.60 and 0.43, respectively; corresponding AC1 values were 0.68 and 0.57. Evaluating the several different polyp subtypes separately, agreement differed significantly when analyzed by the k-statistics (0.08–0.12) or the AC1 statistics (0.59–0.71). Analyses of LSTs provided a κ-value of 0.50 and an AC1 score of 0.62, with 77.6 % accuracy. The simplified classification outperformed the Paris classification: κ = 0.68, AC1 = 0.82, accuracy = 91.6 %. Conclusions Agreement is often measured with Cohen’s κ, but we documented higher levels of agreement when analyzed with the AC1 statistic. The level of agreement was substantial for the Paris classification, and almost perfect for the simplified system.

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Insufficient classification of anaemia in general practice: a Danish register-based observational study

Scandinavian Journal of Primary Health Care ◽

10.1080/02813432.2021.1958499 ◽

2021 ◽

pp. 1-9

Author(s):

Astrid Boennelykke ◽

Henry Jensen ◽

Lene Sofie Granfeldt Østgård ◽

Alina Zalounina Falborg ◽

Kaj Sparle Christensen ◽

...

Keyword(s):

General Practice ◽

Observational Study

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A Novel Co-Training-Based Approach for the Classification of Mental Illnesses Using Social Media Posts

IEEE Access ◽

10.1109/access.2019.2953087 ◽

2019 ◽

Vol 7 ◽

pp. 166165-166172

Author(s):

Subhan Tariq ◽

Nadeem Akhtar ◽

Humaira Afzal ◽

Shahzad Khalid ◽

Muhammad Rafiq Mufti ◽

...

Keyword(s):

Social Media ◽

Mental Illnesses

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Reliability of the classification of cartilage and labral injuries during hip arthroscopy

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnaa064 ◽

2020 ◽

Vol 7 (3) ◽

pp. 448-457

Author(s):

Stephanie W Mayer ◽

Tobias R Fauser ◽

Robert G Marx ◽

Anil S Ranawat ◽

Bryan T Kelly ◽

...

Keyword(s):

Femoral Head ◽

Transition Zone ◽

Central Compartment ◽

Classification Systems ◽

Cartilage Injury ◽

Intraobserver Agreement ◽

Acetabular Cartilage ◽

Femoral Head Cartilage ◽

Labral Tears

Abstract To determine interobserver and intraobserver reliabilities of the combination of classification systems, including the Beck and acetabular labral articular disruption (ALAD) systems for transition zone cartilage, the Outerbridge system for acetabular and femoral head cartilage, and the Beck system for labral tears. Additionally, we sought to determine interobserver and intraobserver agreements in the location of injury to labrum and cartilage. Three fellowship trained surgeons reviewed 30 standardized videos of the central compartment with one surgeon re-evaluating the videos. Labral pathology, transition zone cartilage and acetabular cartilage were classified using the Beck, Beck and ALAD systems, and Outerbridge system, respectively. The location of labral tears and transition zone cartilage injury was assessed using a clock face system, and acetabular cartilage injury using a five-zone system. Intra- and interobserver reliabilities are reported as Gwet’s agreement coefficients. Interobserver and intraobserver agreement on the location of acetabular cartilage lesions was highest in superior and anterior zones (0.814–0.914). Outerbridge interobserver and intraobserver agreement was >0.90 in most zones of the acetabular cartilage. Interobserver and intraobserver agreement on location of transition zone lesions was 0.844–0.944. The Beck and ALAD classifications showed similar interobserver and intraobserver agreement for transition zone cartilage injury. The Beck classification of labral tears was 0.745 and 0.562 for interobserver and intraobserver agreements, respectively. The Outerbridge classification had almost perfect interobserver and intraobserver agreement in classifying chondral injury of the true acetabular cartilage and femoral head. The Beck and ALAD classifications both showed moderate to substantial interobserver and intraobserver reliabilities for transition zone cartilage injury. The Beck system for classification of labral tears showed substantial agreement among observers and moderate intraobserver agreement. Interobserver agreement on location of labral tears was highest in the region where most tears occur and became lower at the anterior and posterior extents of this region. The available classification systems can be used for documentation regarding intra-articular pathology. However, continued development of a concise and highly reproducible classification system would improve communication.

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Prospects for the classification of mental disorders of children and adolescents

European Psychiatry ◽

10.1016/j.eurpsy.2008.07.003 ◽

2008 ◽

Vol 23 (7) ◽

pp. 481-485 ◽

Cited By ~ 1

Author(s):

M.H. Schmidt ◽

J. Sinzig

Keyword(s):

Mental Disorders ◽

Children And Adolescents ◽

Classification Systems ◽

General Question ◽

Specific Information ◽

Specific Symptom ◽

Trade Offs ◽

Dimensional Classification ◽

Dsm V

AbstractSuggestions for classification of mental disorders of children and adolescents in DSM-V and ICD-11 have been made, which differ strongly from the current descriptive approach of dimensional classification.These suggestions even comprise a dichotomized system for health care as well as for scientific purposes.Nevertheless it is obvious that we are far behind an “etiological” classification, so that trade-offs have necessarily to be made in DSM-V and ICD-11.Appropriate proposals concern the strict separation of disorders that are typical for children and adolescents as well as for adults.Furthermore a differentiation of diagnosis for infants, toddlers and preschool children is required in both classification systems. As far as it is relevant for treatment, combined diagnosis in DSM-V and subthreshold diagnosis as well as coding-possibilities for findings in molecular biology should be permitted.As personality disorders should only be diagnosed after the age of 16, it is recommended to dimensionally classify personality traits that are pathognomonic for specific symptom patterns and of prognostic relevance.DSM-V and ICD-11 should allow age-specific information on axis-IV. The article discusses the general question of how relational disorders respectively disturbances should be classified and include furthermore special recommendations concerning ICD and DSM categories.

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