Subthreshold states in Psychiatry, Athens Psychiatric Conference, Dec. 2, 2012

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”.