This Will Make You Think About How To Diagnose Mental Health

There needs to be proper research developed in order to properly diagnose mental health.

Historically, mental health was generally less concerned with making a diagnosis, and generally more concerned with psychoanalytical approaches (Aboraya et al, 2005). From about the 1950’s onwards, psychiatric and mental health conditions were more likely to be diagnosed as entities, as a more medical model was moved towards in this area (Aboraya et al, 2005). In order to use this medical model, classification systems and diagnostic systems were needed (Aboraya et al, 2005).

Accordingly, several systems were developed. The World Health Organisation has published diagnostic criteria manuals, such as the International Classification of Diseases (ICD) (World Health Organisation, 1948). The Diagnostic and Statistical Manual (DSM) was first published by the American Psychiatric Association Committee on Nomenclature and Statistics in 1952 (American Psychiatric Publishing; 1952). Each of these has revised editions, and they map together for most conditions discussed.

For a diagnostic system to be developed and useful there must be agreement upon what are the most important parts of a disease (Aboraya et al, 2005). For instance, using schizophrenia as an example, if criteria relating to aspects such as symptoms, illness and behaviours are met, the result is a diagnosis of schizophrenia. According to the DSM-V, these include at least two of the following for at least 6 months – hallucinations, delusions, disorganised speech negative symptoms and disorganised or catatonic behaviour – with at least one active for one month, occupational or social problems and no other diagnosable reason for the problems (American Psychiatric Publishing, 2013).

Construct validity is how much a specific measure relates to other specified measures that have been deemed as consistent with a hypothesis that is hypothetically derived (Carmines et al, 1979). In mental health, researchers create a construct or hypothesis of correlating behaviours, although sometimes the construct validity is poor and circumstantial. Again using schizophrenia as an example, its construct diagnosis is based upon psychosis being present, no organic cause for the psychosis, a possible family history of schizophrenia, and a young age of onset (Aboraya et al, 2005). Therefore using these components, conditions such as schizophrenia can be standardised and placed in a framework to facilitate clinical and research components.

In creating and using diagnostic criteria based upon aspects such as construct validity, a clear framework is provided that can then be used to add scientific and research information about the condition. This can help with devising when a treatment should be initiated, as without diagnostic criteria, diagnostic thresholds could not be generated. A threshold for diagnosis of a condition can then help guide the clinical interventions and treatment options for that patient.

Diagnostic labels can divide opinions, with some feeling they are of use and others arguing against their usefulness. Some evidence suggests that they can increase stigma, in examples such as Bipolar Disorder (Paris, 2007). This leads some clinicians to be reluctant to diagnosis it, perhaps further based upon ideas that it is untreatable (Paris, 2007).

Other opinions suggest that diagnosis using diagnostic criteria can help demystify a mental health condition, and can lead to increased understanding for both the patient and those around them. They can help with comprehending the trajectory of an illness and what to expect or look out for with signs of deterioration or improvement. This in turn can help guide additional steps in treatment such as hospital admission if required.

Diagnostic criteria also fulfill important and practical administrative roles for healthcare services. They are required to help analyze and charge accordingly, ultimately helping to determine where healthcare resources are allocated within hospital and healthcare systems. They can also help quantify mental health problems to help increase political or public actions to help them.

There are obvious limitations using diagnostic systems in mental health, particularly if they are bluntly and thoughtlessly applied. These are evidenced by the fact that each additional manual is updated and amended. Yet they can be of assistance if judiciously applied. They can help provide a standardized view of a condition, guiding treatments, diagnostic thresholds, and helping to measure the impact of treatments in clinical and research scenarios.

References:

Paris, J. (2007). Why Psychiatrists are Reluctant to Diagnose: Borderline Personality Disorder. Psychiatry (Edgmont), 4(1), 35–39.

Carmines EG, Zeller RA. (1979) Reliability and Validity Assessment. London: SAGE

Diagnostic and Statistical Manual (2013) American Psychiatric Publishing https://doi.org/10.1176/appi.books.9781585624836.jb02

Helzer JE, Bucholz KK, Gossop M. A dimensional option for the diagnosis of substance dependence in DSM-V. (2008) In: Helzer JE, Kraemer HC, Krueger RF, editors. Dimensional approaches in diagnostic classification – Refining the research agenda for DSM-V. American Psychiatric Association pp. 19–34

Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Publishing; 1952

Manual of the International Classification of Diseases, Injuries and Causes of Death. Sixth Edition. (1948) Geneva: World Health Organization;

Aboraya, A., France, C., Young, J., Curci, K., & LePage, J. (2005). The Validity of Psychiatric Diagnosis Revisited: The Clinician’s Guide to Improve the Validity of Psychiatric Diagnosis. Psychiatry (Edgmont), 2(9), 48–55.

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rachel-thomas

Rachel Thomas

Dr Rachel Thomas is the British Medical Association’s 'Young Author of the Year', 2016. She has published 2 medical books, and qualified as a doctor with a B.M B.Ch from the University of Oxford. She also holds a B.Eng (Biomedical) and B.Sc (Physiology) from the University of Sydney. She currently practices in mental health, is completing a Masters in Neuroscience and Psychology of Mental Health, and is involved in the development of novel health-tech solutions. Follow her @doctor.rachel on instagram, or contact her at www.doctorrachel.org.