These are my rough notes from Dr. Kuey's very thought provoking discussion of diagnosis in which he considered categorization and dimentionality with great intellectual vigour and heart felt empathy. A truly great speaker and tremendous mind.
Lectures
Sunday, Dec. 2, 2012
First Interdisciplinary Congress “Psychiatry and Related Sciences”
Chairs; W. Gaebel (Germany) M. Mavreas (Greece)
Subthreshold states in psychiatry” a major challenge for clinical practice and classification system
L. Kuey (Turkey) MD Associate Professor of Psychiatry, Instanbul Bilgi University (WPA Secretary General)
DSMIV - there is no assumption that each category of mental disorder is ‘discrete’ and goes on to discuss ‘boundary cases’ where there will be ‘probablistic’
DSMIV says itself it should n’t be used as a ‘cook book’.
In practice though there is a tendency that these are ‘categories’ - the ‘scale of apparent mobordity (and scale of subthrehold) not consistent with the idea of ‘discrete nosological entities’.
Disorder refers to the patients experience
Diagnosis refers to the examiner’s experienc
Psychiatry has no ‘golden standard’ theerefore ‘quality of diagnosis” is important. This is important because our diagnosis are often ‘stigmatising”.
Both reliability ad validity problems exist
High rates of ‘subthreshold’ and “NOS” categories.
Problems of categorical classification systems
never ending categories
ignorance of humanistic perspective
most of treatments are not specific to diagnosis yet diagnosis is the definer of treatment in other areas of medicine
We may be at limits of what ‘Categorical” .
Therefore we are now at Categorical and Dimensional Approach
Which one is more used in daily clinical praxis?
Most clinicians use a ‘prototype’ approach whereas researchers are limitted definitely by
category
Eg. Ling Xing Gate - only dead king could pass - definition of life and death
for patient a diagnosis may not be life and death but may feel like this
Subthreshold states in psychiatry ‘are not uncommon’, significant
How do we define threshold
sympton frequency
sympton duration
etc
eg depression - if we raise threshold - underdiagnosis or misdiagnosis
if we lower - over diagnosis
eg depressive symptons and depressive disorder
Is there a risk of pathologising common/normal behavior as subthreshold?
Yes - but the clinical state or dysfunction could differentiate
may need to thresholds
one to decide ‘disease’
one for ‘health’
A threshold for each and clinical states between
Longitudinal perspective
-prodomal, illness, residual - need attention esp in bipolar and sz spectrum and addiction
“Our understanding of health and illness is ill”
“We are both healthy and ill from different perspectives”.
Sunday, December 2, 2012
Subthreshold states in Psychiatry, Athens Psychiatric Conference, Dec. 2, 2012
Labels:
Athens,
diagnosis,
DSM IV,
ICD,
Psychiatry
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