Conceptual validity of a phenomenological classification of psychiatric patients (original) (raw)
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Psychological Medicine, 1994
SYNOPSIS The Grade of Membership (GoM) model is a classification procedure which allows a person to be a member of more than one diagnostic class. It simultaneously quantifies the degrees of membership in classes while generating the discrete symptom profiles or 'pure types' describing classes. The model was applied to the symptomatology, history, and follow-up of 1065 cases in the WHO International Pilot Study of Schizophrenia. The model produced an eight diagnostic class or 'pure type' solution, of which five were related to the diagnostic concepts of schizophrenia and paranoid disorder, two types were affective disorders, and one asymptomatic type. A subtype of paranoid schizophreniform disorder found primarily in developing countries was identified. There was a strong association between pure types and the original clinical and computer generated (CATEGO) diagnoses. A GoM based psychiatric classification might more clearly identify core disease processes than conventional classification models by filtering the confounding effects of individual heterogeneity from pure type definitions. TNTROniirTION 1984). The World Health Organization's International Classification of Diseases, ICD-10 The validity of a psychiatric classification is (WHO, 1992), and the American Psychiatric judged by: (a) its ability to describe clinically Association's DSM-IV (Task force on DSM-IV, elicited symptoms and patterns of disease course 1991), which is in its final revisions, represent the and outcome; (b) its correlation with criteria latest stages of this process, such as age-and sex-prevalence, heritability, The identification of psychiatric syndromes and treatment response with pathophysiological has relied on two principal approaches. The first or morphological findings and, ultimately with uses clinical insight and judgement to identify aetiology; (c) whether it meaningfully dis-'prototypes' which represent the necessary and tinguishes between diagnostic entities; and (d) sufficient attributes of the syndromes. A protowhether it leaves few cases in residual diagnostic typical case is rarely clinically encountered in its categories. pure sense but it is a 'standard' against which In the nineteenth century, clinical psychiatry patients can be evaluated and possibly grouped, identified the syndrome as the building block of The prototype can generate clinical hypotheses, nosology (Griesinger, 1861). The search for e.g. operational diagnostic criteria to be tested replicable, stable syndromes became the prin-empirically. The second uses objective, statistical cipal method in the taxonomic mapping of procedures to develop classifications. The earldisorders to symptoms (Weber & Scharfetter, iest application of a purely statistical approach to psychiatric nosology dates to the 1920s • Address for correspondence: Ms M. Anker, Epidemiological and (M°O r e > 1 9 3 0)-Attempts tO derive Statistically 3 statistical Methodology, WHO, i2ii Geneva 27, Switzerland. comprehensive classification of mental disorders 133
Heterogeneity in psychiatric diagnostic classification
Psychiatry Research, 2019
The theory and practice of psychiatric diagnosis are central yet contentious. This paper examines the heterogeneous nature of categories within the DSM-5, how this heterogeneity is expressed across diagnostic criteria, and its consequences for clinicians, clients, and the diagnostic model. Selected chapters of the DSM-5 were thematically analysed: schizophrenia spectrum and other psychotic disorders; bipolar and related disorders; depressive disorders; anxiety disorders; and trauma-and stressor-related disorders. Themes identified heterogeneity in specific diagnostic criteria, including symptom comparators, duration of difficulties, indicators of severity, and perspective used to assess difficulties. Wider variations across diagnostic categories examined symptom overlap across categories, and the role of trauma. Pragmatic criteria and difficulties that recur across multiple diagnostic categories offer flexibility for the clinician, but undermine the model of discrete categories of disorder. This nevertheless has implications for the way cause is conceptualised, such as implying that trauma affects only a limited number of diagnoses despite increasing evidence to the contrary. Individual experiences and specific causal pathways within diagnostic categories may also be obscured. A pragmatic approach to psychiatric assessment, allowing for recognition of individual experience, may therefore be a more effective way of understanding distress than maintaining commitment to a disingenuous categorical system.
Classification and psychopathology research
Journal of Abnormal Psychology, 2013
The classification of psychopathology appears to be at a crossroads, with a new version of the Diagnostic and Statistical Manual of Mental Disorders impending and one of the current aspirations of the National Institute of Mental Health being the development of new ways of classifying mental disorders. This article discusses what we currently know about psychopathology and the role that classification has played in psychopathology research. It is pointed out that a wide variety of etiological factors, both within and outside the individual, have been implicated in the etiology of psychopathology, and that there is no empirical or conceptual reason to privilege any particular level of explanation. The ways in which signs/symptoms and disorders may be related are discussed, including their implications for classification. The value of theory development and theory-driven research is emphasized, along with the potential perils of generating an ossified classification scheme that must be adhered to.
Progress in achieving quantitative classification of psychopathology
World psychiatry : official journal of the World Psychiatric Association (WPA), 2018
Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is generally more dimensional than categorical. When the discreteness versus continuity of psychopathology is treated as a research question, as opposed to being decided as a matter of tradition, the evidence clearly supports the hypothesis of continuity. In addition, a related body of literature shows how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad "spectrum level" dimensions, to specific and narrow clusters of symptoms. In this way, a quantitative approach solves the "problem of comorbidity" by explicitly modeling patterns of co-occurrence among signs and symptoms within a detailed an...
Categorical vs dimensional classifications of psychotic disorders
Comprehensive Psychiatry, 2012
Objective: Both categorical and dimensional methods appear relevant to classifying psychotic disorders; however, there is no clear consensus on the most appropriate categories and dimensions or on the best approach for constructing nosologic criteria that integrate these 2 methods. This review examines the evidence on specific dimensions and categories that would best characterize psychoses. Method: Entries in the MEDLINE database between 1980 and 2011 were searched for studies of the dimensional and/or categorical structure of psychosis. Studies were included if samples represented a spectrum of psychotic disorders and dimensions/categories were empirically derived using principal components analysis, factor analysis, or latent class analysis. Results: Most dimensional studies observed 4 or 5 dimensions within psychosis, with positive, negative, disorganization, and affective symptom domains most frequently reported. Substance abuse, anxiety, early onset/developmental, insight, cognition, hostility, and behavioral/social disturbance dimensions appeared in some studies. Categorical studies suggested 3 to 7 major classes within psychosis, including a class similar to Kraepelin's dementia praecox and one or more classes with significant mood components. Only 2 studies compared the relative fit of empirically derived dimensions and categories within the same data set, and each had significant limitations. Conclusion: There is relatively consistent evidence on appropriate categories and dimensions for characterizing psychoses. However, the lack of studies directly comparing or combining these approaches provides insufficient evidence for definitive conclusions about their relative merits and integration. The authors provide specific recommendations for designing future studies to identify valid dimensions and/or categories of the psychoses and investigate hybrid approaches to model the structure of the underlying illnesses.
Journal of Psychiatric Research, 1977
The present article examines the consistency of interpretation of phenomenological classification concepts by psychiatrists in four countries. Profiles descriptive of the eight empirically defined syndromes were provided by 31 psychiatrists in France, 18 in Italy, 26 in Mexico, and 31 in the United States. Detailed multivariate analyses were undertaken to assess variation attributable to differences between the countries. It was found that psychiatrists in the different countries interpreted the phenomenological classification concepts in highly similar manner, with less than 5 % additional variation attributed to systematic differences between the countries. The results emphasize the utility of simple syndrome description as a basis for uniform classification and communication of research results within and between countries.